Investment fund for Health: An approach to attaining Universal Coverage in Nigeria, By Dr. Noimot Balogun

Health has been agreed at the United Nations General Assembly to be a “precondition for and an outcome and indicator of the social, economic and environmental dimensions of sustainable development”.
According to WHO, Universal Health Coverage means that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”. Unfortunately, approximately 75% of Nigerians have to pay out of pocket in order to access healthcare, with less than 5% of its population having any form of health insurance. These figures should be viewed in the context of a country whose minimum wage is approximately 30,000 Naira. With this context in mind, it is evident that the average Nigerian with no health insurance is at a very high risk of being impoverished due to health expenses. Imagine the effect of this gap on the pregnant woman and her unborn child.
In 2020, Nigeria had the second-highest maternal deaths globally and the fourth country with the highest neonatal deaths in 2021. These depressing indices caused by financial incapability, other health burdens such as infectious diseases and non-communicable diseases, and poor maternal health advocacy continuously put thousands of pregnant women in low-income communities at risk of death or life-threatening complications. This crisis also affects the economy as negative birthing outcomes could lead to reduced human capital, increased absenteeism from work, and increased financial burden on the government and taxpayers. Therefore, achieving Universal Health Coverage in Nigeria is a multifaceted need that requires solutions from collaborative interactions of Government, donor organizations, private stakeholders and the populace.
Without a doubt, significant efforts have been put into achieving UHC in Nigeria, however, the results of these efforts are still not satisfactory. It is therefore imperative to begin to look at other innovative opportunities to improve sustainability for health. One such opportunity is creating an investment fund for health with a view towards building social capital where all actors benefit. One of the oldest forms of funding for healthcare apart from Government funding is donor aid from international organizations; some of these aids are however time-bound; hence the issue of sustainability. Local mobilization of funding is therefore more veritable to harness potential resources from local actors. A key element to achieving this funding is the effective collaboration between the public and private stakeholders of healthcare. Using the maternal and child health index as a case study, one factor that contributes to maternal mortality is the low use of skilled birth attendants at delivery. This has been shown to be partly due to the affordability of the cost of care amongst other factors.  With an investment fund, healthcare services such as antenatal care and delivery can be further subsidized to improve access to these services and subsequently reduce maternal mortality. Aside from improving access to care, an investment fund can also improve the quality of care received at public facilities through the provision of modern facilities such as incubators, radiant warmers, oxygen dispensers, and inverters. Also, in the area of drug delivery in maternal and child health, having a pool of funds that caters to the supply of essential medicines and routine antenatal care drugs, and even kits such as diapers, and baby clothing will further reduce the cost of care and improve quality of healthcare delivery.
Another very important sector which will expedite the achievement of UHC in Nigeria is the technology industry. By funding the digitization of healthcare, we stand a chance to promote health across wider regions and areas. For example, the provision of simple digital tools to carry out point-of-care diagnosis in rural areas as well as training of health staff in such facilities has the potential to reduce the distance travelled by these individuals to get quality care and encourage the use of health facilities for health needs. Also, the use of simple mobile technology to disseminate health promotion messages in local languages can encourage the average Nigerian to make better health choices and improve their health outcomes.
Inadequate data storage and management also have negative impacts on the quality of care Nigerians receive. This is because with poor data, healthcare will not be appropriately budgeted for, hence, leaving Nigerians to deal with the effects of having limited health resources. However, digitization of healthcare will address the key areas of healthcare delivery which include health information management and data storage, maintenance of servers, and provision of digital apparatus among others. Although these projects require funding and human resources, an investment fund developed through a public-private partnership increases the chances of taking up these challenges in Nigeria. This is the idea behind MRH Collective’s MamaBase Digital Registry, an innovative registry to take unique identification of all pregnant women in Lagos State; and a systematic tracking of the identified mothers such that the women present for antenatal visits, complete all tests and vaccinations, receive and use all drugs, and then deliver with a skilled birth attendant at the time of delivery. A health investment fund creates a pool for funding cutting-edge research and maternal follow up which are tailored to the peculiar needs of Nigerian women while accounting for the peculiarities of the Nigerian health sector. This not only gives room to create local solutions for Nigerians but also empowers the average Nigerian health provider to give adequate healthcare delivery using evidence-based research which strives towards global standards
 It is also important to strengthen the social capital for health by deliberately creating conversations for partnerships for health. Partnerships are innovative paths towards improving universal health coverage through Primary Healthcare. Through partnerships, everyone wins; Government is able to achieve its dividends for Democracy; Private partners are positioned as socially responsible corporate citizens with a sense of social good; the public benefits as the lives of primary caregivers at homes and families are protected for now and the future.
*Dr. Noimot Balogun writes from Maternal and Reproductive Health Research Collective, (MRH Collective

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