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Achieving Universal Health Coverage



ODIRI UCHENUNU-IBEH writes on how the one percent consolidated revenue fund can strengthen the drive to achieve the much-needed universal health coverage.

It is no longer news that for Nigeria to achieve Universal Health Coverage (UHC) for all citizens, particularly the very poor and vulnerable, there is need for government at all levels, to adopt Community Participation in Health (CPH), as a vital strategy in delivering primary healthcare to its citizens.
To that effect, the Buhari led administration recently approved the one per cent consolidated revenue fund in the National Health Act (NHAct) which was meant to sustainably fund a Basic Minimum Package of Health Services (BMPHS) in PHC facilities.
According to Sections 3 and 11 of the NHAct, the PHCs shall be the foundational basis for the provision of healthcare services in Nigeria and in accordance with the act, the current administration has also, in setting out its healthcare agenda, centred it around the provision of functional PHC services in all political wards of the federation, with the ultimate objective of ensuring UHC for all Nigerians.

The Act sets out the important drivers to guide disbursement of the fund and it states that 50 per cent of the Fund shall be disbursed through the National Health Insurance Scheme (NHIS) and deployed towards the provision of the BMPHS in eligible primary or secondary health care facilities.
According to the Act, 20 per cent of the Fund shall be used to provide essential drugs, vaccines and consumables for eligible PHC facilities; 15 per cent shall be used for the provision and maintenance of facilities, equipment and transport for eligible PHC facilities; 10 per cent shall be used for the development of human resources for PHC and five per cent of the Fund shall be used for emergency medical treatment to be administered by a Committee appointed by the National Council on Health.
The disbursement of the Fund is designed to be simple and transparent. To this end, an allocation formula where all 36 States and the Federal Capital Territory (FCT) receive an equal share of the Fund (irrespective of land mass, population, and disease burden) has been adopted. Through this funding mechanism, it is expected that the majority of states (and the FCT) would be in a position to access the funds on a regular basis.
Indeed, it stipulates that each State shall make annual budgetary provisions for operational expenses in PHC to satisfy the requirement for counterpart funding outlined in Section 11 (5) of the Act.

While federal government has ensured every thing is in place to achieving UHC for all citizens, Lagos state is yet to establish key community structures such as the Local Government Health Authorities (LGHAs) in other to access the fund.
Investigation has shown that the Lagos state LGHAs were previously inaugurated during Fashola’s administration by the office of the Commissioner for Health on 4th August 2010.
The three-year tenure has lapsed almost four years ago without inauguration of new LGHAs.
Stakeholders while speaking on the importance of LGHAs, said according the the NHAct, no state can access the one percent consolidated revenue fund without the LGHAs due to the fact that 45 per cent of the fund is to be disbursed to the body for essential drugs, vaccines and consumables for eligible PHC facilities; the provision and maintenance of facilities, equipment and transport for eligible PHC facilities and for the development of Human Resources for PHC.
The LGHAs are like the implementing arms of the Primary Health Care Board (PHCB) as their functions was to coordinate all PHC activities within the Local government and ensure that there is community participation.

Its membership includes a chairman, one representative of private healthcare providers, two persons from community within the local government area, medical officer for health and representative of the traditional medicine board. Indeed, the LGHAs are one structure stakeholders have identified over the years that is so critical in ensuring that PHC is optimized.
The coordinator, Lagos State Civil Society Partnership (LACSOP), Barrister Ayo Adebusoye said “A lot is going on at the PHC level. Staff are not disciplined and the problem of accessing quality healthcare services. Even though the state government has done a lot in the revitalization of PHC, especially the flagship PHC centres, we still have the challenges of maintenance, scaling up due to limited resources. “One way we can actually increase our resource mobilization domestically is by instituting the LGHAs. They have the power to do all that. Also, we all know government cannot do it alone and Lagos state have a lot of private organizations who are ready to assist if there was structure like the LGHAs in place,” he added.
The coordinator said the NHAct 2014 stipulates that 45 per cent of the one percent consolidated revenue fund should go to the PHC facilities through the LGHAs, adding that it is about time Lagos state inaugurates that body. As to why the delay, Adebusoye said, “I think there were challenges previously because the local government chairmen were not elected and by the law, they were the ones who recommend members of the LGHAs to the commissioner, and the commissioner will then appoint. Now that we have elected local government chairmen in place, it is time for them to inaugurate the body.”

Speaking on the minimum health package, the coordinator said, basically, mother and child delivery health services are included and this is very critical because Nigeria has one of the highest maternal mortality and infant mortality in the world and rather than crowd the secondary and tertiary hospitals, the PHC can handle majority of the health challenges.
Programme Director, Access to Development Initiative, Pastor Bola Nuga said the inauguration of the LGHAs would solve the challenges in the PHCs. He said the revitalization of that body, as a key primary healthcare structure is critical to sustaining the entire healthcare delivery system.
Nuga said the body would establish clearer lines of reporting and accountability between the community structures and the government; adding that it is pertinent to, without further delay, inaugurate this statutorily established, legitimate community participation in health.
According to the programme Director, the inauguration of the LGHAs will help to effectively strengthen citizens’ voice in demanding for their health rights from the various levels of government while simultaneously assisting the government in guaranteeing the delivery of minimum health packages to its citizens.
Health finance and advocacy advisor for Mamaye, Evidence4Action, Esther Agbon, while applauding the federal government for approving the one per cent consolidated revenue fund, urged states to put structures in place so as to access the fund.

Agbon said, “We want to thank the federal government for accenting the 2018 budget which contain the one per cent consolidated revenue fund. That fund is expected to be a contributory fund to support Basic Health Care Provision Fund (BHCPF) in a bid to addressing issues of Primary Health Care in Nigeria.”
She said the NHAct 2014 stipulates that states and local government areas would be contributing 25 per cent of the project cost and so, it is important that states are ready with their projects around PHC to be able to get access to the fund.
Agbon said Lagos state is yet to inaugurate LGHAs. She said, “It won’t be a good thing for states and local government not to utilize the fund, because this is a supporting fund that is expected to facilitate and boost PHC for the citizens of Nigeria, especially the poor who ordinarily spend so much out of pocket.
While advocating that the fund should be released on time, Agbon pleaded with states government, especially Lagos state to put things in place so they can be ready to access the money.
“I am also pleading with the government to put in place strong accountability framework that would ensure that those projects are put in place. One other thing we are expected to see is a lot of transparency around the fund.

“We are calling on the government to ensure that the funds are transparently disbursed. Can we have the information on how these funds are disburse, uploaded on the Federal Ministry of Health website, so that civil society can also play their parts in Monitoring the funds?
“We expect to see that government, in the cause of developing their accountability framework, would ensure that there is meaningful participation of civil society, so that everyone is involved and as such everyone can track these resources,” she added.