In Nigeria, the pursuit of universal health coverage has reached a critical juncture, with the National Primary Health Care Development Agency (NPHCDA) unveiling a 10-year roadmap to tackle the issue of out-of-pocket expenses. The country's healthcare system, especially its primary care facilities, faces significant challenges in providing accessible and affordable care to its citizens, particularly those with limited financial means.
One of the key issues is the hidden or unprepared costs that patients encounter, which can deter them from seeking the care they need. While Primary Healthcare Centres (PHCs) are designed to offer essential services at an affordable rate, the reality often differs. Patients still face out-of-pocket expenses, and for those managing chronic conditions or requiring frequent visits, these costs can quickly become a burden.
The Looming Challenge of Health Financing
A major concern highlighted in a recent interview with Dr Kelechi Ohiri, Director General of Nigeria's Health Insurance Authority (NHIA), is the high proportion of out-of-pocket payments by poor Nigerians. With a significant percentage of the population living below the poverty line, this issue is particularly pressing. The World Bank's Nigeria Poverty and Equity Brief further emphasizes the urgency, revealing a stark reality of poverty in rural areas.
The Impact of Out-of-Pocket Expenses
Out-of-pocket expenses extend beyond direct medical costs. Indirect costs, such as transportation and lost income, can deter patients from seeking care, especially those living far from PHCs or working in informal sectors without paid leave. Caregivers, often women, face additional challenges due to childcare responsibilities, sometimes resorting to unregulated medical stores or traditional remedies, which can lead to misdiagnosis and severe complications.
Referrals and Unexpected Costs
Referrals from PHCs to higher-level facilities can result in unexpected transportation and treatment costs, often without ambulance support. This not only adds to the financial burden but also discourages patients from seeking further care, especially if their health issues remain unresolved.
Managing Costs and Improving Access
Value-based healthcare approaches can help manage costs. Health insurance, when understood and utilized effectively, can reduce out-of-pocket spending. PHCs offering subsidized services and medications, along with community medical outreaches, provide much-needed support for patients. Emphasizing preventive care and prescribing generic medications are additional strategies to reduce costs without compromising patient care.
The Role of Community Engagement
Community engagement initiatives, such as those implemented by BudgIT, have proven successful in building trust and improving the continuity of care. By incorporating patient feedback into facility and town hall meetings, these initiatives have increased service utilization and participation in health-related activities at PHCs. This highlights the importance of a strong relationship between healthcare providers and the communities they serve.
Policy Frameworks and Government Support
Policy frameworks play a crucial role in improving access and affordability. Increased government funding for PHCs can enhance service quality and expand the range of services offered. Expanding insurance coverage for low-income earners and local production of essential drugs can further reduce financial barriers and protect patients from economic shocks.
Conclusion
The challenges faced by Nigeria's healthcare system, particularly in terms of out-of-pocket expenses, are complex and multifaceted. However, with a combination of value-based healthcare approaches, community engagement, and supportive policy frameworks, there is hope for a more resilient and affordable healthcare system for all. As Dr Biobele Davidson, Head of the Strengthening Health Systems Unit at BudgIT Foundation, puts it, "Through community-led initiatives, we can advocate for stronger PHC financing and accountability, ensuring that healthcare becomes more accessible and affordable for every Nigerian."
