“Universal health coverage and health security are two sides of the same coin” is a popular quote by the director-general of the World Health Organisation (WHO) Tedros Abedgedom Ghebreyhesus. It has extensively been used by advocates of both Universal Health Coverage (UHC) and health security. But what does this really mean? It means that efforts to ensure people have access to quality healthcare without facing financial hardships eventually protects the public from public health threats posed by infectious diseases.
According to the WHO, Universal Health Coverage means that all individuals and communities receive adequate health services without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. Health security refers to all the efforts made by government and its public health institutions, in this case, the Nigeria Centre for Disease Control (NCDC) to mitigate adverse public health incidents.
At the first-ever UN high-level meeting on UHC in September 2019, member states reaffirmed their commitment to achieving UHC by 2030 and asserted the right of people to enjoy the highest attainable standard of physical and mental health as an integral part of the Sustainable Development Goals (SDGs).
Clearly, the world was taking positive steps to deliver health for all by 2030 before Covid-19 fundamentally disrupted health systems, societies and economies. To get back on track, world leaders need to take this opportunity to reset the foundations of health systems and strengthen the capacities of all countries to prevent and respond to health emergencies. Covid-19 has shown that we must act now.
At over 70 percent, out of pocket expenditure for healthcare in Nigeria is extremely high. This is mostly motivated by poverty as people, reluctant to visit hospitals when they are ill because they could not afford to, would rather use cheaper alternatives like self-medication. This becomes a missed opportunity to quickly detect infectious diseases that can potentially become outbreaks. Therefore, efforts geared towards getting more people to frequently access healthcare in hospitals are good for health security.
If people have health insurance coverage, which is a strategy to achieve UHC, their health seeking behaviour is more likely to improve. This is because, when they are ill, the priority is seeking quality healthcare and not worrying about paying out of pocket. When citizens are not reluctant to seek care because they know they won’t be thrown into financial hardships, then it’s easier for health workers to detect and halt potential disease outbreaks.
Effectively responding to public health emergencies requires funds. Advocacy efforts like the prevent epidemics project being implemented by Nigeria Health Watch and other partners continue to push for sustained funding to improve Nigeria’s health security.
All attention is on government budgets to provide funds needed to drive the nation’s health security efforts, but the necessary funds can also come from other sources. With health insurance made compulsory by the new National Health Insurance Authority (NHIA) Act, more premiums will be paid for more Nigerians to be covered. These funds can be invested into strengthening the health system to be more resilient and to deliver quality healthcare. The funds can also go into human resources, research and development, information management systems, etc.
These investments help strengthen health security in many ways. When a patient’s quality care expectations are met, more trust in the system is built so they keep returning. Also, constant contact with health workers makes it easier to identify, report, and respond to potential outbreaks. But picking up potential sources of outbreaks requires high index of suspicion which are skills picked up with constant training of health workers. With the push for integrated health insurance schemes by states, it will be imperative to harmonise health records thereby making it easier to track patient history and movement and initiate contact tracing in the case of outbreaks.
Investments aimed at achieving UHC such as the full implementation of the NHIA act will stimulate access to all-inclusive healthcare services which include the “full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across life course.”
This is because when UHC enables access to quality care for all, the focus of care is not only on providing treatments when people fall ill. Attention is also given to health promotion activities aimed at preventing both communicable and non-communicable diseases before they happen. As a result, population health is improved.
Historically, governments rarely invest as much as they should in healthcare. Reasons for this usually include limited resources and other competing priorities. However, they must realise that a healthy workforce guarantees a productive workforce. This in turn, guarantees a prosperous economy.
So, government must set their priorities straight and be more open to strategically collaborate with the private sector to plug funding gaps. An organisation like PharmAccess Nigeria is already helping state governments across the country setup frameworks for health insurance and deliver quality healthcare to citizens. Such efforts should be scaled to other states and the national level.
Finance is the middle ground between health security and UHC. It’s time to invest more to ensure Nigerians have universal health coverage and benefit from the added benefit of being protected from emerging and reemerging health security threats.
Alagboso is a programme manager at Nigeria Health Watch.