Last month in New York Dr Tedros Adhanom Ghebreyesus, the first African Director-General of the World Health Organization, addressed 70,000 global citizens in Central Park. His question to the crowd was the same one that had been asked to world leaders all week at the 72nd General Assembly: “Do you believe in universal health coverage?”
Dr Tedros has consistently insisted that UHC not only improves health, but also reduces poverty, creates jobs, drives economic growth, promotes gender equality and protects populations against epidemics.
As Founder-President of the Wellbeing Foundation Africa, I have dedicated the past 13 years to the rights of the voiceless and unmet needs, in effect health security, equity and justice for all, especially expectant mothers, in Nigeria and around the world. I was therefore delighted to see the issue of attaining UHC come to the fore this year at the General Assembly thanks to high-level exponents.
There can be no doubting the urgency of the health situation in Africa, which faces the triple burden of weak health systems and bothcommunicable and non-communicable diseases in a population estimated to reach 2.5 billion by 2050. Every year, roughly 100 million people globally are pushed into poverty due to colossal health costs, while only 1 in 5 have social security protection that will cover lost wages in the event of illness.
The situation in Nigeria reflects that of many developing countries. With an estimated population of 191 million, less than 5% of its population is covered by the National Health Insurance Scheme (NHIS), with out-of-pocket expenditure as a percentage of private expenditure on health above 90%.
The nation is victim to a lethal killer that the Nigerian Government must swiftly act on: its fragile healthcare system. Currently, the system struggles to live up to even the most basic public health responsibilities such as immunisation coverage and access to family planning.
The impact of inadequate care is huge. According to Nigeria's Institute for Health Metrics and Evaluation in 2015 alone, malaria killed 192,284 people in Nigeria, diarrheal diseases killed 143,880 people and neonatal and maternal disorders killed the 212,557 women and children during pregnancy and childbirth.
These figures amount to a crisis as dire and as urgent as the violent conflict that pervades Nigeria’s northeast. Yet for every 1 Naira spent on health, 2.5 Naira is spent on defence. It is time the Government’s response to healthcare deficits be as swift and aggressive as the response to national security threats.
There is however reason for optimism as we emerge from the UN General Assembly. According to the WHO’s figures, 85% of the costs of meeting the SDG health targets can be met with domestic resources – an investment which would prevent 97 million premature deaths between now and 2030. Indeed, the National Assembly of Nigeria has wisely vowed to effect a pro-health legislative agenda that engages budgetary appropriations and acts as the driver for development. In July, Nigeria's Senate President launched the Legislative Network for Universal Health Coverage to address “the issue of financing in healthcare in a sustainable manner to reach all Nigerians.” This network will enhance the knowledge base and understanding of strategies in the legislature, geared towards achieving the goal of Universal Health Coverage.
At the 72nd United Nations General Assembly, I convened with high-level players on the political, development and policy front, where we discussed the implementation of innovative country and regional initiatives on policy and governance, working towards strengthening primary healthcare systems and the development of health security in Nigeria.
My call is now for action and investment – we must act to ensure that every person, rich or poor, living in cities or rural areas, has access to quality healthcare. What’s more, return on investment is high. Any innovator, partner, donor, or expert that seeks to make tangible positive change around the world cannot ignore Nigeria and its burgeoning population, and I would urge them to prioritse Nigeria for that reason.
Dr Tedros was absolutely correct in his assessment last week that universal health coverage is a political choice and a smart imperative. The vision and courage required has already been demonstrated by some, and the result will be a safer and healthier world. Political leaders in Africa and around the world must agree that the path of inaction is one that cannot be taken.