Towards Achieving Universal Health Coverage: Delta State Contributory Healthcare Insurance Scheme, National Health Act and Other Matters


Evaborhene, Aghogho Nelson highlights efforts of the Delta state Government to achieve Universal Health Coverage for its citizens using contributory health insurance

Access to quality healthcare is one of the most important factors that determine how an individual perceive his/her quality of life. In most countries, alongside the economy, it is a major political issue and debate. Health is directly or indirectly related to other sectors such as food security, household income generation, nutrition, employment status and other social security services. This makes health an essential sector in any progressive society. Martin Luther King Jr once said, “of all forms of inequalities, injustice in healthcare is the most shocking and inhumane”.

Even though Nigeria is striving to achieve global health standards which are measurable by the attainment of some of the 17 sustainable development goals, the Nigeria health system is still lopsided due to certain constraints which will be addressed in another article. Health remains an integral part of man’s existence even amid global crisis, natural or manmade. The economic crisis rocking the nation today continues to deteriorate the structure and functions of the already frail health system.

Despite the above, Delta State Government under his Excellency Dr. Ifeanyi Arthur Okowa, is making laudable strides in efforts towards provision of accessible, affordable and quality healthcare to its citizens. This is evident with the creation of the state contributory healthcare insurance scheme, which is the first of its kind by any state in the federation. The bill which was passed by the state assembly in the first quarter of 2016, is a giant step towards health system strengthening.

The design of the program is such that indigenes of Delta state or people residing in the state can make monthly or yearly contributions for their health care, thereby having access to a defined package of quality healthcare services whenever they need it.

The program is regulated by the state’s contributory healthcare insurance commission which recently won an award by the Nigeria healthcare excellence awards held in Lagos State. The scheme creates a financial pool which spreads financial risk to ensure sustainability. It is supported by the federal government through the National Health Insurance Scheme (NHIS), with contributions also from non-governmental organizations, donor agencies and well-meaning individuals within and outside the state.

Since its inception on 1st January 2017, over 60,000 people have registered and had direct access to primary health care across the state with special provisions for vulnerable people (women, newborn, elderly and people with disabilities).

The socioeconomic benefits are enormous as individuals and families will have more disposable income through a reduction in catastrophic health expenditures as existing literature currently estimate out-of- pocket spending as the major source of health care financing in Nigeria.

The right to health supersedes other rights. Thus, providing affordable, accessible and quality healthcare should be a cardinal policy and program of any government because nation-building efforts cannot succeed or be sustained unless adequate attention is paid to population health.

A national health insurance scheme for all can guarantee the attainment of universal health care coverage for all Nigerians as contemplated by the National Health Act, 2014. In the absence of such a scheme, the dream of economic growth and prosperity for all Nigerians will remain elusive. The act provides for the first time an all-encompassing legal framework for delivery of affordable, accessible and quality healthcare for all Nigerians. This can be accomplished in synergy with an efficient health financing system.

The national health act strategically defines the comprehensive vision of the health care system that creates value for both patients and healthcare providers and the process required to achieve it. The act was signed by ex-president Goodluck Jonathan in 2014. Prior to that historic moment, stakeholders in Nigeria and diaspora have been lamenting the absence of any legislation guiding the operation of the national health system. It also Addresses the availability, distribution, capacity development and management of human resources. The act prioritizes patients by emphasizing confidentiality, providing a mechanism for addressing complaints while stipulating the right and responsibilities of health personnel. It further strengthens health information and research systems, which collectively encourage institutionalization of evidence-based decision making while promoting development through research. It is no doubt one singular instrument to unlock the economy and the greatest transformation of the health sector. It guarantees the RIGHT OF THE PATIENT AT ALL TIME to take complete charge and provides access to health care even during emergencies.

Arguably, the impact of the nation’s economic crisis has affected health care delivery. Nevertheless, other states in the federation need to follow the footsteps of Delta state or even surpass it, if SDG’s must be close to achievement in Nigeria.

This is calling on the federal government for the full and speedy implementation of the National Health Act, for the attainment of universal healthcare for all Nigerians in other to live a mentally, socially and economically productive lives.

For the citizens to create wealth, they must be in good health, hence strengthening the health system should be given due attention from all tiers of government and policy makers. The central focus of a healthcare delivery process must be centered on continuously increasing value for patients, with value defined as “health outcomes achieved per naira spent”.

The time to act is now!!!


Evaborhene, Aghogho Nelson is a medical practitioner with interest in healthcare financing and systems, an advocate for universal health for all, writes from Warri, Nigeria.


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