In a recent analysis by The Economist, 35 years from now (2050), Nigeria will be the world’s third largest nation, after India and China. The reason for this projection is obvious – we have a young and growing population. More than 70 per cent of Nigerians are less than 45 years old and are either young parents, soon-to-be parents or children who would be parents in less than 18 years’ time.
The British weekly’s prediction was made considering several factors, which include our present socio-economic state, population growth rate and life expectancy. The prediction shows that despite the relatively higher maternal mortality rates and other poor health care indices in Nigeria, we are still expected as a nation to grow tremendously, population-wise. The quality of that growth, however, is a function of the socio-economic realities that we will be facing in the years to come and the quality of ideas championed by leaders in the health care sector.
Nigeria’s socio-economic growth inevitably depends on the productivity of its citizenry; in other words, the relative aggregate productivity of the population which is a factor of the level of education, quality of life, level of health care and access to local, regional and international markets. The recent upheaval in the crude oil market, which is a major backbone of the nation’s economy is proof that achieving socio-economic development is not a given; strategic thrusts must be made and sustained for us to arrive at our desired destination.
We are in dire need of big, revolutionary ideas as a nation. For a population growing so fast, only such ideas would do. For example, it is common knowledge that every developed nation operates, at least, one form of health care financing structure that provides a relatively cheaper and comprehensive health care package with a very wide coverage, in some cases, for 100 per cent of the population. The NHS in the United Kingdom is one such of such health financing structures – a big and noble idea to say the least. One remarkable thing about the programme is that the cost of care in nations with such structures is relatively cheaper than elsewhere. In other words, the cost of getting health care in Nigeria is far more expensive than is obtainable in Britain, regardless of who is paying for it.
One big idea we are proposing is an ambitious quest for 100 per cent national health insurance coverage in 2019 and this would be more auspicious if our politicians were having the same vision. Working with a current population of over 173 million individuals and an average basic annual health insurance package of 30,000 naira for a family of five, we estimate that with a budget of slightly more than a trillion naira, we would have achieved universal coverage.
Seen in the light of our current GDP and government budget, the expenditure would represent less than 2 per cent of our Gross Domestic Product (GDP) and about 20 per cent of our current fiscal national budget. Compared with the NHS, which represents more than 6 per cent of the GDP of the United Kingdom, ours is still not overly ambitious but rather a step in the right direction.
In view of this aspiration, it is clear that the one per cent consolidated revenue allocation to primary health care provision in the new National Health Act, though not representing the totality of government expenditure on health care (which currently is at 6 per cent of the budget) is still a far cry from what we need if a winning strategy is the goal.
Though the above does not represent the complexity of the proposed level of intervention and the structure of its implementation, it essentially presents a goal we deem achievable. Also, we do not expect that the government would fund the entire project, but rather that participation in such a programme be made mandatory for all employed persons and for unemployed persons to be placed on a special platform (fully government-funded) from which they could migrate to the employed platform and vice versa. At the end, considering the level of unemployment in Nigeria at the moment, government expenditure would be about 15 per cent, in line with the Abuja declaration by African Heads of States in 2001.
While one trillion naira may seem to be a lot of money, it is, in reality, a manageable sum, when compared to the present size of the Nigerian health care and pharmaceutical market combined (worth 3.4 trillion naira, according to BMI, 2014) or that of other competing nations. This, indeed, is the time to start thinking big in the light of our certain future.