Deaths spread over failed health coverage

Fifty-year-old Mama Shuaibu held an infant firmly as she awaited her turn to participate in the free medical outreach offered by a foundation to residents of Wukara Community of the Federal Capital Territory (FCT) of Nigeria. She approached the health care team together with her 31- year-old son, Shuaibu Maiangwa. The three were screened and given drugs.

“This woman is my mother and she is holding my baby. My wife died six days ago; three days after giving birth to the baby,”Shuaibu, a farmer, told Daily Trust.

He said his 20-year-old wife began to bleed immediately after she gave birth till she died three days later.

Asked why he did not take her to the hospital, he said, “We don’t have any health facility in this community, and I didn’t have money to transport her down to the Kuje General Hospital; which is far from our community.”

Shuaibu said he tried borrowing money from friends but could not get anyone to assist him, and added that he was finding it difficult to buy milk for the baby.

He, therefore, called on the Federal Government of Nigeria to establish a health post in his community to enable residents to access health care; especially at night.

His mother, Mama Shuaibu , who looked thin and ill herself, said she seized the opportunity of the free outreach to  get herself and the baby treated because they could not afford to go to the hospital whenever they fell ill.

Charity ran out of the female ward of the National Hospital, Abuja, where her elder sister was hospitalised and required dialysis, begging for money from whoever she came across.

She cried, “Please help me.  “I don’t want my sister to die. She has become unconscious now.”

Twenty eight-year-old Charity who works as a secretary in a private firm, said she had spent all her savings on her sister’s illness and that they could now barely feed. She said her sister was supposed to undergo dialysis three days earlier but that she (Charity) was only able to raise the complete amount required as she was short of N3,000.

Charity said she shared a strong bond with her sister and resorted to begging people on the streets, and lamented that it was “something I never imagined I would do, but I closed my eyes to shame so that my sister can survive this illness.”

However, Charity was all smiles as she accompanied the nursing assistants in wheeling her sister to the dialysis section of the hospital after getting the N3,000 to balance up the shortfall.

Charity’s problem is not over as her sister requires three dialysis sessions per week and she does not know where she will get the money for the next session.

Two orphans, Adaeze and Chiemela, said, “We lost our parents early” and “Chiemala got married to a soldier who was posted to fight the insurgency in Borno State,” Adaeze told this reporter at a hospital.

Adaeze said, “For over two years now, Chiemala hasn’t heard from him. We think he is dead. I am the one taking care of her and her five-year-old son.”

She said they were in the hospital but that she had not been able to pay for many tests and drugs for Chiemela because of lack of money, but added that their only hope was to travel to Lagos to meet a popular pastor for healing.

After some days, they left the hospital for Lagos; a state in Nigeria. Three months later, Adaeze called the reporter and told her that her sister had died and that she was soliciting for money to transport her remains to their village for burial.

She said when they got to Lagos, things did not turn out the way she envisaged; as they could not see the “Man of God” till her sister died. In fact, she said when they got to the church, they were asked to rent a room; preparatory to their seeing the pastor, but that they could not afford it and had to sleep in an uncompleted building near the church till her sister died.

Nosa told Daily Trust that he lost his friend, Samuel, because the later could not afford to buy malaria drugs prescribed for him.

He said Samuel, a security guard, felt feverish towards the end of 2018 and went to a hospital and that after paying for tests, anti-malaria drugs were prescribed for him but he could not afford them.

Nosa said Samuel’s neighbours told him there was no need to spend large sums of money when he could simply buy herbal medicine, popularly called agbo, at a far cheaper price. So he bought agbo of N50 and took it for three days.

However, a week later, he started having stomach cramps, chest pain and felt as if something was stuck in his throat. He was rushed to hospital as his case worsened and was diagnosed with kidney failure. He died a few hours after his first dialysis.

Access to quality and essential healthcare services is a fundamental human right. However, for many individuals and communities in Nigeria, it remains a luxury; and comes with untold hardship and sometimes death.

Over 70 per cent of Nigerians pay their health bills from their little income thereby making it difficult for many to access healthcare. This unfortunate situation is driving millions of Nigerians to premature deaths.

According to the World Health Organisation (WHO), Universal Health Coverage (UHC) means that all people and communities can use preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.

The situation in Nigeria is such that some people cannot afford drugs for mild ailments, and for some, diagnosis of diabetes, cancer, renal, cardiovascular and other major ailments, equals a death sentence.

As such, it is common for people to resort to “prayer” when they are diagnosed with an ailment they soon expend the little money they have for treatment,  especially for ailments that require long term management.

Prayer in this sense means going to meet clerics in churches, mosques, shrines and prayer houses to receive “divine” healing.

Some people approach media houses, social media canvassers, and Non-Governmental Organisations (NGOs) to publish their plight and solicit for help. Some others, based on the advice of relatives and friends, return to their villages for traditional treatment; even for surgical cases, because the relatives and friends believe the ailment “is not a hospital disease that can be handled by modern medicine.”

While others still, especially in the rural areas, approach patent medicine vendors to “mix” drugs for them for serious cases such as stroke, diabetes and high blood pressure.

A mix of up to five different pain relievers may cost up to N1,000, which far exceeds what health facilities will charge for similar drugs. In fact, the health facilities will diagnose before prescribing drugs.

It is common to see people with medical reports moving round markets, shops and banks soliciting for money to access treatment .Some of them hold up their clothes to show people tumours and wounds to ensure no one doubts the veracity of their claims. Frail patients who should be resting at the hospital or at home are often seen fainting from the fatigue of walking all day seeking for help.

Funding for the health sector in Nigeria has been very low and has ranged from between two to seven per cent in the last 10 years instead of at least 15 per cent of the national budget as agreed in the Abuja Declaration.

Till date, less than 12 per cent of Nigerians are covered by the National Health Insurance Scheme (NHIS), 13 years after it was established by the Federal Government. Only few states have keyed into the “state version” of the scheme.

There is poor primary healthcare service delivery in Nigeria and many communities lack health facilities and where they are found, lack standard infrastructure, equipment and personnel.

The Country Director of ONE, an international advocacy organisation, Serah Makka-Ugbabe, said Nigerians paid 70 per cent of their healthcare bills out of their pockets.

Makka-Ugbabe said, “The cost of taking care of our health is too high. It is higher than other countries in the world. In fact, Nigeria contributes less to our health per person than South Sudan. Universal Health Coverage (UHC) means that I and you can walk into a health care centre and the bill for our health care is affordable. That means we don’t have to choose between getting treatment for malaria and eating; it means it should be affordable and accessible. UHC means there are actually functional primary healthcare centres with doctors, nurses and commodities inside of them, and that we can get care.”

Media houses are daily inundated with mails, letters and visits by people soliciting for funds for treatment of illnesses. However, only few are lucky to receive the funds, and in time, and many die before help reaches them, as the funds come in trickles or none at all come.

Jemila who recently lost an aunt to leukaemia, said, “My aunt really suffered before she died because we couldn’t afford the money to take her to India for treatment. We sold lands and even her property”

Someone advised Jemila’s family to approach a private television station that features sick people soliciting for funds on weekly basis. The family went but the station told them that the list of people awaiting airing was very long and that it might not get to their turn till the next seven months.

Six-year-old Musa also suffered the same fate with Jemila’s aunt. He was diagnosed of cancer of the eye which required about N10,000,000 for surgery. His family approached some NGOs and media houses, but help did not come his way before he died.

Juliet Usman, a cousin of one Engr. Michael Gomina, approached this reporter to publish her appeal for funds to help the engineer undergo a kidney transplant at the St. Nicholas Hospital, Lagos, which would cost about N8million.

The reporter interviewed Engr. Gomina and his wife at his house. However, unfortunately, he died in the afternoon the following day before the appeal and story were published.

Engr. Gomina is one of many people who had approached media houses but died before any assistance came their way even after long periods of publication and waiting.

Some people are detained in hospitals because they cannot pay their bills. Fifteen-year-old Abdulmutalib Tijani was knocked down by a hit-and-run driver. He remained in the hospital for three weeks after he was discharged because his mother could not afford the N300,000 balance they were supposed to pay the hospital.

Abdulmutalib’s mother, Mariam, said, “I took N50,000 to the social welfare unit of the hospital but they told me that I had to try harder as it was too small out of the money we owed to let us go home.”

Mother and son said it became increasingly difficult for them to feed while at the hospital.

Paul Chuks Nwachukwu, 30,  a 200-level student of the University of Abuja, was detained at the same hospital for four months after he was discharged because he could not pay the balance of N667,000 out of the N1,671,000  bill incurred during his admission, his sister, Blessing, told Daily Trust.

Blessing, who is the first child and bread winner of the family, said they would have been able to pay the bill if they had not lost their father in an accident four years ago and that their mother was old.

As a result of taking care of Paul, Blessing said she could not concentrate fully on the business she was doing.

She added that Paul missed his last semester examination as a result of his detention in the hospital.

There are many others detained in hospitals across the country; sometimes for years, because they do not have money to pay their bills.

Social welfare departments of hospitals are also overwhelmed with requests to write off or reduce bills incurred by patients.

A spokesman of a hospital said the hospital would go bankrupt if they listened to half of the patients.

Asked the way his hospital helped indigent patients, Dr. Olatise Olalekan, a consultant nephrologist and Chief Medical Director of Zenith Medical and Kidney Centre, Abuja, said his hospital sometimes subsidized treatment for patients and also wrote medical reports for them take to individuals and organizations.

During a visit to Roguwa Community of Uke Kingdom in Nasarawa State, the residents said they had been suffering hardship accessing healthcare.

The community, which is about 64 kilometres from Abuja, has a dilapidated primary healthcare centre manned by a community health worker.

A resident of Roguwa, Alhaji Rabo Sarkin Noma, 38, said many residents of the community could not afford to pay for diagnosis and treatment of diseases like bilharzia, stomach ache in children, typhoid and malaria that affected them regularly.

Alhaji Noma said he lost his wife during childbirth because of lack of good health facilities in the community.

He said patients paid an average of N4,500 for the treatment of malaria, while pregnant women paid N1,500 for ante-natal services and N4,000 to N5,000 for delivery, adding that “these fees are not affordable for many residents.”

He said between January and July, 2018, the community lost about 30 women due to pregnancy-related complications and over 10 men and several children.

What is the state of Universal Health Coverage (UHC) in Nigeria today?

Professor Eyitayo Lambo, Nigeria’s Minister of Health from 2003 to 2007, said one of the indicators of UHC is that a country’s Total Health Expenditure (THE) must be at least between four to five per cent of its Gross Domestic Product (GDP), with public spending being at least three per cent of the four to five per cent.

Prof. Lambo, who is also a health economist and health system expert, said, “While Nigeria’s THE as a percentage of GDP has consistently been between four and five per cent, the public spending component has been below one per cent; which is grossly inadequate.”

He said another indicator was that Out of Pocket Expenses (OOPE) should not be more than 30 to 40 per cent of the THE, and that for Nigeria, OOPE had constituted between 62 and 72 per cent over the years.

“Also, at least 90 per cent of THE should be through pre-payment and risk-pooling schemes. The highest coverage level with pre-payment and risk-pooling schemes that Nigeria has ever achieved is seven percent,” Prof. Lambo said.

The fourth indicator is that close to 100 per cent of the poor and vulnerable must be covered by social assistance and safety-net programmes. While Nigeria‘s achievement is not exactly known, a generous guess will be less than 25 per cent.

Another indicator is that at least 80 per cent of the poorest 40 per cent of the population should have effective coverage with quality health services.

Prof. Lambo said Nigeria’s current performance with this indicator was certainly very low in view of the longstanding and widespread problem of low quality of health services.

He said, “Lastly, on the Abuja target of spending at least 15 per cent of Total Government Expenditure (TGE) on health by all levels of government, the best performance that we have ever achieved was less than nine per cent. It is as low as less than five per cent currently. From these scores, it is clear that Nigeria is yet to seriously start the journey towards Universal Health Coverage (UHC),” Prof. Lambo said.

Health insurance in Nigeria

Effort to establish a health insurance scheme was made by Nigeria’s first Health Minister, Dr. Moses Majekodunmi, in 1962, but the bill did not pull through.

Admiral Patrick Koshoni and Prof. Olikoye Ransome-Kuti (Minister of Health from 1985 to 1992) made renewed effort in 1984 and a template was developed.

In 1999, the then Head of State, Gen. Abdulsalami Abubakar, enacted the National Health Insurance Scheme (NHIS) Decree.

Prof. Eyitayo said the NHIS Act of 1999 had some deficiencies and it included making health insurance voluntary instead of mandatory and that it provided the legislative framework for establishing and implementing HIS in Nigeria.

He said, “There was, however, slow or non-implementation of the act  until during President Olusegun Obasanjo’s second tenure when the Formal Sector Programme (FSP) of the NHIS was launched on June 6, 2005, to cover federal civil servants.

“However, the current status of this last effort is not known. So, for almost 20 years after the defective 1999 NHIS Act was enacted, it is yet to be amended despite the fact that “its limitations had been recognised even from the beginning; such limitations have contributed greatly to the slow and poor implementation of health insurance in Nigeria; and that no country has been able to achieve UHC with voluntary health insurance scheme is common knowledge.”

NHIS still in crises

The National Health Insurance Scheme (NHIS) has been enmeshed in crises under the leadership of Prof. Usman Yusuf, the executive secretary of the scheme, in the last two years thereby affecting health insurance for Nigerians.

Prof. Yusuf is presently on suspension. There have been allegations and counter allegations of mismanagement, gross misconduct and corruption between Yusuf and the Federal Ministry of Health, the governing board of the agency, as well as staff of the scheme.

The crises led to the suspension of Yusuf in October, 2018, and the presidency directed a probe of the agency. The report was submitted by the committee set up for the probe but the findings are yet to be made public.

Prof. Yusuf, however, told Daily Trust during an interview that the scheme had essentially been covering only Federal Government employees and did not cover states or local government areas.

He said, “That is why we encourage state governments to enact laws to create their own state health insurance schemes. But after creating the law, state governments need to sit down and decide how to fund the agencies to provide health insurance for their people.

“NHIS is there to help them as technical partners. We do not have the financial resources to help any state or local government; that is not our mandate. Our mandate is to use the contribution of Federal Government workers to provide healthcare for them.”

He also said diseases like kidney failure, HIV, cancer and other major and terminal illnesses were not covered in the scheme but that they could be discussed.

“The federal or state governments need to discuss how to take care of those people left behind, such as the poor, the vulnerable, the Internally Displaced Persons (IDPs), the aged, prisoners, pregnant women and children under five, among others,” he said.

Challenges of health insurance in Nigeria and the way foreword

A public health physician and health economist, Dr. Uche Ewelike, has said the Nigerian Universal Health Coverage (NUHC) drive faced numerous challenges, ranging from poor coverage, supply inadequacies, weak fiscal space and legislative bottlenecks, to lack of needed political will.

Dr. Ewelike said this resulted to many households financing their healthcare needs through the regressive out-of-pocket payment system.

“Regrettably, the below 20 to 30 per cent WHO-acceptable benchmark for out-of-pocket payment for nations has not been met by Nigeria. The 2016 National Health Accounts of Nigeria estimated that over 70 per cent of healthcare expenditure is done through this catastrophic and inequitable means. What this simply means is that households are shouldering the burden of healthcare cost in Nigeria as against the Universal Health Coverage (UHC) principle that lays emphasis on public spending. Considering the strong correlation between health and economic development, this abnormal health system behaviour must be corrected if we must achieve the health related SDGs in Nigeria,” Dr. Ewelike said.

He said despite these challenges, the sincere commitment of government to release the N55bn for Basic Health Care Provision Fund (BHCPF) which was a product of the National Health Act of 2014 in the 2018 appropriation year was apt and commendable.

“The gateways to the implementation of these earmarked funds which are the NHIS, the National Primary Health Care Development Agency (NPHCDA) and the Federal Ministry of Health are encouraged to work assiduously and demonstrate efficiency in the utilisation of these funds. Health system actors, policy makers and other stakeholders should also begin to work across states and at the federal level on other sustainable domestic resource mobilisation strategies. At this juncture, we should not rely only on the 15 per cent budgetary allocation to health as stated in the 2001 Abuja Declaration by African heads of state, but also ensure these estimates are released to finance health,” he advised.

He added that the road to UHC was tedious but attainable and that “therefore all hands must be on deck to ensure it becomes a reality within the shortest possible time. The needed political will to achieving UHC has always been the magic and we must sincerely and urgently provide this at all levels. No nation achieves greatness with an unhealthy population. This is a call to duty and we must rise to this call to build a just, equitable and egalitarian society as enshrined in the 1999 Constitution of the Federal Republic of Nigeria.”

A former Nigeria’s Minister of Health, Prof. Eyitayo Lambo, said some of the grey areas in the implementation of health insurance in Nigeria included how to cover the people outside the formal sector, as well as the poor, the vulnerable, retirees, and the elderly; how to ensure effective regulation of the operators in the health insurance market, and how to generate adequate and sustainable funding to ensure that all Nigerians were covered by pre-payment and risk-pooling schemes.

Prof. Lambo said the way forward was to make UHC a national agenda and a political goal.

“The most important way forward is to develop and sustain political leadership and commitment to UHC which is virtually non-existent currently. This will require decision leaders to use their power, influence and personal involvement to ensure that UHC receives the visibility, leadership, resources and political support that are required to undertake all necessary steps to achieve it.

“The political leadership and commitment would need to be expressed or demonstrated by making UHC a political goal and putting it on the nation’s agenda.

“It involves making UHC explicit in party policies, manifestos and regarding it as a political campaign issue. It also includes ensuring that the leadership and the commitment to UHC from the office of the president at the federal level and the office of the governor at the state level.

“Others include formulating a clear vision for UHC, developing and implementing all necessary policies, plans, laws and regulations to attain the vision. It also requires allocating adequate and sustainable domestic resources to health by all levels of government, mobilising domestic and external resources and using such resources efficiently, equitably and effectively.”

The health economist said it could also be demonstrated by according first priority to covering the poor and vulnerable groups with public funds, setting up a multi-sectoral organ to coordinate the effort of all stakeholders involved in the production of health, not health services; setting up a political monitoring process to track the use of allocated resources and concrete progress made, as well as working closely with Civil Society Organisations (CSOs) to sustain political support.

“Other measures to take as a way forward are strengthening the national health system with emphasis on revitalising the primary healthcare system to make it effective and efficient, having adequate and appropriately distributed health infrastructure and staffing, removal of financial barriers through the acceleration of the implementation of pre-payment and risk-pooling schemes and provision and financing of essential health services package,”

Also, a global health expert, Dr. Muhammad Ali Pate, said primary healthcare was the foundation for achieving universal access to healthcare, adding that the primary healthcare system must be people-centred.

Dr. Pate, who is a professor at Duke University’s Global Health Institute, United States of America, and a former Minister of Health, said it should be designed for the people, taking into account their voices and what their needs were and ensuring that they had a say in holding people accountable at the front lines.

“Universal Health Coverage will not happen by just rhetoric. We have to invest in it. Now that we have the basic health services funds, if they are released and used, it will take much more than that, but it will be making a contribution in Nigeria’s progress to UHC,” he added.

Sarah of One Campaign said, “We need to work on our health insurance. The National Health Insurance Scheme (NHIS) is still covering single digit Nigerians. There are only five per cent of Nigerians accessing health insurance; that means 95 per cent of us are paying out-of-pocket.”

Sarah said the National Health Act (NHA) established an organisational and management structure for the health system in Nigeria, including funding.

Specifically, the act created the Basic Health Care Provision Fund (BHCPF) and stipulated that funding of the Basic Health Care Provision Fund is to be derived from contributions that include an annual statutory transfer from the Federal Government of Nigeria of not less than one per cent of its Consolidated Revenue Fund (CRF).

She said, “Full funding of the Basic Health Care Provision Fund will provide a Basic Minimum Package of Health Services (BMPHS) to citizens, in eligible primary or secondary healthcare facilities through the NHIS.

“Unfortunately, the National Health Act has never been fully implemented since its passage (from the 2015 Budget to date), especially the budgetary provision of the Federal Government’s per cent of its revenue, resulting in the denial of these services to millions of Nigerians and the perpetuation of the country’s poor health outcome, including millions of preventable deaths annually.

“We also need to strengthen our primary healthcare system; it is the first place that determines the strength of our nation’s hospitals and clinics.”

Many people were delighted with the appropriation of N55.15bn Basic Health Care Provision Fund (BHCPF) in the 2018 budget. However, it has not been released till date.

The Chairman of the Board of Trustees (BoT) of Community Health and Research Initiative (CHR), Dr. Aminu Magashi Garba, said it was important for the money to be released, and also called on state and local governments to play their roles in providing healthcare services.

The National Advocates for Health (NAH), a group chaired by Prof. Dapo Ladipo, called on President Muhammad Buhari to increase the health budget and also capture the Basic Health Care Provision Fund (BHCPF) in the statutory transfer schedule.

“The 2018 approved budget is about N9.12tn, out of that, N356bn is earmarked for health, which represents 3.9 per cent. When compared to the 2017 health budget, which was an aggregate sum of N308.464bn, being 4.15 per cent of the 2017 approved budget; the Federal Government’s commitment to the 2001 Abuja Declaration of allocating at least 15 per cent of total national budget to health is declining rather than improving.

“The 2018 approved budget has earmarked in the health capital expenditure the sum of  N55.15bn  to the Basic Health Care Provision Fund (BHCPF), while this is commendable , however, we notice that it is not captured as a statutory transfer as provided by Section 11 of the National Health Act, 2014,” NAH said.

A coalition of CSOs and other professional associations in the Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) said the government’s funding of the second National Strategic Health Development Plan (NSHDP II) and ensuring accountability in its implementation among others, would help the country achieve Universal Health Coverage (UHC).

The Second National Strategic Health Development Plan (NSHDP II) is a five-year roadmap for policy implementation on improved health and well-being of Nigerians. It also prioritises health promotion and intervention.

Speaking on behalf of the coalition, Barr. Ayo Adebusoye, said, “Universal Health Coverage (UHC) means that all Nigerians get quality healthcare services where and when needed without suffering financial hardship. The coalition believes that if these barriers are removed by fully funding, implementing and ensuring accountability of the National Strategic Health Development Plan II (NSHDP II), every Nigerian will have access to affordable and quality healthcare.”

The coalition said the country had been unable to ensure that every citizen had access to healthcare despite the development of structures like the first National Strategic Development Plan (NSHDP-I) and the National Health Insurance Scheme (NHIS).

The coalition said some other barriers to Universal Health Coverage (UHC) in Nigeria included low political will to adequately fund healthcare, poor governance, mismanagement of resources and lack of coordination among federal, state and local governments.

The civil society organisations also called on the Federal Government to release the Basic Healthcare Provision Fund in the 2018 Health Budget without delay.

They also called on government to explore innovative ways of funding the health system in order to achieve UHC such as the introduction of mobile phone tax that would involve charging one kobo per second on every outgoing mobile phone call in Nigeria.

The Minister of State for Health, Dr. Osagie Ehanire, said government recognised the importance of UHC in the National Health System, and as part of the social protection architecture to ensure that Nigerian citizens get quality health service, when and where they needed it, without suffering financial hardship.

Dr. Enahire said, “To this end, the government is working to provide physical access to healthcare with the revitalisation of one functional primary healthcare centre in every political ward to serve citizens, even when they do not immediately have money to pay. This helps to preserve our human capital and contributes to productivity and socio-economic development, while supporting equity, especially among rural dwellers and the urban poor, leaving no one behind. School children, the elderly and child-bearing women will thus also enjoy healthcare access without risk of financial ruin to their families.

He said since the universal healthcare strategy and approach to better healthcare varies from country to country, “Nigeria has studied other countries’ models. Lessons learned towards the goal of Universal Health Coverage for Nigerians yielded the National Health Act (NHAct) with guidelines for the Basic Health Care Provision Fund (BHCPF), National Health Care Financing Policy and Strategy, Primary Health Care Under One Roof (PHCUOR), National Health Policy, National Strategic Health Development Plan II (NSHDP II), among others,” he said.

He said the operationalisation of the act as a step towards UHC was expected to support physical and financial access to healthcare by aiding revamping of neighborhood primary healthcare centres and solving human resources for health challenges, for a basic healthcare package that included free ante-natal and post-natal care, free immunisation service and free treatment of children under the age of five.

He said government also recognised primary healthcare centres as the platform for UHC, and was pursuing the rehabilitation of almost 10,000 primary healthcare centres in Nigeria between now and the end of 2019, the operational design of which would be the Ward Health System (WHS), he added.

The minister said his ministry, through the NHIS, had the mandate to achieve UHC by 2025 and demonstrated leadership by committing to institute mandatory contributory health insurance scheme for all persons who earned an income; whether formal or informal, and a fund to cover the vulnerable states committed to this, and were at various stages of implementation.

It is hoped that the country will leave up to its promises and commitment to ensure Nigerians access healthcare without suffering financial hardship just as Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation (WHO) said, “Universal Health Coverage (UHC) is not just an option. It is the only way to realise health for all.”