Archive for June, 2012

Universal (UHC) requires that all people get the health services they need without the risk of severe financial problems linked to paying for them. At the same time, the health services people receive need to be of good quality. There are a list of 10 key facts about Universal Health Coverage according to the Wold Health Organization, and they are listed below:

1. Universal coverage ensures that all people can use health services without financial hardship

Member States of the Wold Health Organization have set themselves the target of developing their health financing systems to ensure universal coverage. Universal coverage means that all people can use health services, while being protected against financial hardship associated with paying for them.

2. All people should have access to the health services they need

There are wide variations in coverage of essential health services both between and within countries. For example, in some countries less than 20% of births are attended by a skilled health worker, compared with almost 100% in other countries.

3. Out-of-pocket payments push over a 100 million people into poverty every year

Every year 100 million people are pushed into poverty because they have to pay for health services directly. To reduce these financial risks, countries such as Thailand are moving away from a system funded largely by out-of-pocket payments to one funded by prepaid funds – a mix of taxes and insurance contributions.

4. The most effective way to provide universal coverage is to share the costs across the population

In this way, people make compulsory contributions – through taxation and/or insurance – to a pool of funds. They can then draw on these funds in case of illness, regardless of how much they have contributed. In Kyrgyzstan, for example, the pooling of general revenues with insurance payroll taxes has helped improve access to health care.

5. All countries are continually seeking more funds for health care

Even richer countries struggle to keep up with the rising costs of technological advances and the increasing health demands of their populations. Low-income countries often have insufficient resources to ensure access to even a very basic set of health services.

6. In 2010, 79 countries devoted less than 10% of government expenditure to health

Governments need to give higher priority to health in their budgets as domestic financial support is crucial for sustaining universal coverage in the long term. If African Union countries increased government expenditure on health to 15% as promised in the Abuja Declaration in 2001, they could together raise an extra US$ 29 billion per year for health.

7. Countries are finding innovative ways to raise revenue for health

All countries can improve their tax collection mechanisms. They can also consider introducing levies or taxes earmarked for health, such as “sin” taxes on the sale of tobacco and alcohol. As an example, Ghana funded its national health insurance partly by increasing value-added tax by 2.5%.

8. Only eight of the world’s 49 poorest countries have any chance of financing a set of basic services with their own domestic resources by 2015

Increased external support is vital. Global solidarity is needed to support the poorest countries. If high-income countries were to immediately keep their international commitments for official development assistance, the estimated shortfall in funds to reach the health-related Millennium Development Goals would be virtually eliminated.

9. Globally, 20–40% of resources spent on health are wasted

Common causes of inefficiencies include demotivated health workers, duplication of services, and inappropriate or overuse of medicines and technologies. In 2008 for example, France saved almost US$2 billion by use of generic medicines wherever possible.

10. All countries can do more in order to move towards universal coverage

The Wold Health Organization has developed an action plan to support countries in developing good health financing strategies. Engaging all stakeholders and improving the health system as a whole are also essential to move towards universal coverage.

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In light of the Supreme Court ruling yesterday, to uphold the Affordable Care Act of the United States, popularly called Obamacare, social media exploded, with lots of views and perspectives on what Obamacare actually means to people.

Nigerian twitter came alive with different perspectives, and of course some extreme reactions wondering why Nigerians should even care or become so engrossed in discussing the pros and cons or any implications of Obamacare.

Computers on, research modes activated and let us see, how Obamacare concerns us and could affect our lives over the coming decade!

Over the last years, the International Health Community and all global health enthusiasts have been ceaselessly working on Universal Health Coverage (UHC). UHC requires that all people get the health services they need without the risk of severe financial problems linked to paying for them. At the same time, the health services people receive need to be of good quality.

UHC with needed health services maintains and improves health. Good health allows children to learn and adults to earn. It helps people escape from poverty and provides the basis for long-term economic development. At the same time, financial risk protection in health prevents people from being pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their own futures and often those of their children. UHC is therefore a critical component of sustainable development.

The three identified impediments to UHC are (i) the availability of resources to any government, (ii) over-reliance on direct payment for health services and (iii) inefficient and inequitable use of resources. The path to universal coverage, then, is relatively simple – at least on paper. Countries must raise sufficient funds, reduce the reliance on direct payments to finance services, and improve efficiency and equity

The 2010 World Health Report, produced by the World Health Organization (WHO) focuses on transforming the evidence, gathered from studies in a diversity of settings, into a menu of options for raising sufficient resources and removing financial barriers to access, especially for the poor. Moving towards universal coverage is the emphasis of this report, a goal currently at the center of debates about health service provision. Promoting and protecting health is indeed essential to human welfare and sustained economic and social development. This was recognized more than 30 years ago by the Alma-Ata Declaration signatories, who noted “Health for All would contribute both to a better quality of life and also to global peace and security”. Health financing is therefore an important part of broader efforts to ensure social protection in health.

The International Health Community unequivocally agrees that continued reliance on direct payments, including user fees, is by far the greatest obstacle to progress in universal health coverage. According to the WHO, abundant evidence shows that raising funds through required prepayment is the most efficient and equitable base for increasing population coverage. In effect, such mechanisms mean that the rich subsidize the poor, and the healthy subsidize the sick. Documented experience shows this approach works best when prepayment comes from a large number of people, with subsequent pooling of funds to cover everyone’s health-care costs.

The obligation to pay directly for services at the moment of need – whether that payment is made on a formal or informal (under the table) basis – prevents millions of people receiving health care when they need it. For those who do seek treatment, it can result in severe financial hardship, even impoverishment. The World Health Assembly resolution 58.33 from 2005 says, “everyone should be able to access health services and not be subject to financial hardship in doing so”. On both counts, the world is still a long way from universal coverage. In some countries, up to 11% of the population suffers severe financial hardship each year, and up to 5% is forced into poverty due to direct payment healthcare costs. Globally, about 150 million people suffer financial catastrophe annually while 100 million are pushed below the poverty line.

The only way to reduce reliance on direct payments is for governments to encourage the risk pooling, prepayment approach, the path chosen by most of the countries that have come closest to universal coverage. When a population has access to prepayment and pooling mechanisms, the goal of universal health coverage becomes more realistic.

To remove financial risk and barriers to access, the WHO maintains that country experience reveals three broad lessons to be considered when formulating policies. First, in every country a proportion of the population is too poor to contribute via income taxes or insurance premiums. They will need to be subsidized from pooled funds, generally government revenues. Second, contributions need to be compulsory, otherwise the rich and healthy will opt out and there will be insufficient funding to cover the needs of the poor and sick. While voluntary insurance schemes can raise some funds in the absence of widespread prepayment and pooling, and also help to familiarize people with the benefits of insurance, they have a limited ability to cover a range of services for those too poor to pay premiums. Third, pools that protect the health needs of a small number of people are not viable in the long run. A few episodes of expensive illness will wipe them out.

Let us now consider ten of the most important benefits, captured in the Affordable Care Act (Obamacare):

  1. Prohibit pre-existing condition exclusions for children in all new plans.
  2. Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool.
  3. Prohibit dropping people from coverage when they get sick in all individual plans
  4. Lower seniors’ prescription-drug prices
  5. Offer tax credits to small businesses to purchase coverage
  6. Eliminate lifetime limits and restrictive annual limits on benefits in all plans
  7. Require plans to cover an enrollee’s dependent children until age 26
  8. Require new plans to cover preventive services and immunizations without cost-sharing
  9. Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions
  10. Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.

The fear of many, and mostly the members of the Middle to Upper class, stem from the expected increase in cost of maintaining their health insurance. This is a typically self-centered reaction of the rich, in my opinion. And with the typical verve and audience they command, all attention is now focused on how Obamacare will potentially increase the cost of healthcare for the middle to upper class. No one seems to have his or her eyes on the real price. A huge barrier on access to care is being removed. More people will have access to insurance or health pre-payments and fewer families will be driven into impoverishment for paying for healthcare. More people will take up a proactive approach to care, by putting aside a dollar today, rather than waiting to borrow exponentially a hundred times more, when they get sick. Your insurance plan is now required to spend at least 80 percent of the premium costs you pay for health insurance premiums on health care or improving the quality of care. If an insurance company spends less than this amount, it must provide a rebate or additional services. The resource pool for providing care, at high quality to all Americans just got bigger.

Obamacare is therefore the first of hopefully many new, high-profile policy decisions that aggressively work towards achieving health for all. Many low- and middle-income countries have shown over the past decade that moving closer to universal coverage is not the prerogative of high-income countries. Brazil, Mexico, Chile, China, Rwanda and Thailand have all taken giant policy steps in addressing the three main impediments to UHC. Gabon, Cambodia, Lebanon and Ghana have all taken steps to address at least one of the key impediments. A high-profile entrant like the US, draws a lot of international attention to UHC, and will serve as lobby loci, to encourage other countries to seriously reconsider their health policies and begin to strive towards UHC.

 

Where does Nigeria come in?

The Nigerian National Health Bill. Debated by National Assembly (NASS) for over seven years, during which the Nigerian Medical Association (NMA) estimated that 7 million children and 385,000 mothers died, while the bill was debated by NASS. Passed and adopted by NASS in May 2011. Still not signed into law by the President, 13 months later.

Constitutionally, NASS are empowered to push the bill into law, in the face of Presidential delay of signing the bill after a certain number of months. However, the Executive arm of government can veto this move. Some conundrum. I stand corrected on this issue of legislative procedure.

In 2008, Prof. Adenike Grange, in describing the issue of a National health policy, said:

“….the absence of a National Health Act to back up the National Health Policy has been a fundamental weakness which needed to be tackled frontally. This weakness means that there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions”

The National Health bill in summary:

  • Seeks to define, streamline and provide a framework for standard and regulation of health services in the country
  • Spells out rights and duties of healthcare providers, health workers, health agencies and users
  • Serves as a guide in the development, promotion and formulation of national and health policies amongst others.
  • Promises to provide all Nigerians with a basic minimum package of health services.
  • Pledges to develop a national health policy that includes 60 billion naira (about US$380 million) devoted to primary health care each year, provision of essential drugs, and comprehensive vaccination programs for pregnant women and children younger than 5 years of age

So, the National Health Bill, is our own equivalent of Policy that can bring us progress as a country, towards Universal Health Coverage, by tackling at least two of the three impediments to health for all, among the other highlighted benefits.

As Obamacare is upheld as law, there can never be a better time to reconvene and lobby for our National Health Bill to be signed into law. This high profile global health success must be milked by all of us, to see that an oversight legislature exists, to improve access to healthcare within this country.

Let us all celebrate this global health success, with the American people and the most vulnerable members of their society. Let us also use it as a stepping stone, to drive efforts to improve our own health through appropriate policy making and implementation!

 

The saying “You don’t know what you have till is gone”, is unequivocal in its description of the general attitude of people towards their health. The common man walks the streets, able to excel in his day-to-day activities, earning a living, networking with family, friends and colleagues alike, and yet, pays no heed to one simple reality: None of these would be possible, without optimal health!

This individual care-free attitude towards health and health care issues, stays manifest, in every aspect of our private lives and becomes even more deleterious, when individuals transition into public service. Consider this critically, and in line with the typical reactionary attitude to most issues, and indeed we can envision dire consequences.

When you take a look at most private lives, many large-scale private sector employers, do not offer healthcare benefits as part of their employment packages; many individuals do not have health insurance or health targeted savings of any kind; and even many more do not consider the health implications of their social habits. These are just a few examples, of private reactions to health and health care.

In the public sector, most environmental negotiations, do not consider the health implications of a lack of adequate mitigation of and adaptation to climate change; most leaders do not consider the health implications of going to war; very few countries have health budgets that are more than 10% of the total national budget; most countries do not have legislature that mandates inter-sectorial collaboration to improve health & wellbeing. Again, these are just a few examples.

Many of us got on board to read this, as yet another opportunity to point fingers at the failings of the government, on the issue of health and health care. We can lay it on governance and the public sector, all we like. They do have their many failings, most evident in the failure to sign the National health bill into law in Nigeria and to begin implementation.

The reality however, remains that those in leadership, have simply taken the lack of health literacy in their private lives, into public office. A change of leadership will most likely continue in the same trend. Even if the baton is handed to us today, our level of health literacy in our private life, will simply be translated into our dedication to health and healthcare improvement!

Health literacy is not just about one’s reading, writing, speaking and listening skills. It is especially about understanding particular health concepts and knowing what to do in particular circumstances. For example, if you are a parent and your young child is running a fever of 37.5°C, what should you do? Some know the answer to this question but, for individuals with poor health literacy, minor healthcare woes like this can be a tremendous challenge. Even more such examples exist for public health concepts.

It is no longer debatable, that corporate governance and organizational development can only be achieved through an enhanced and purpose driven youth participation in governmental business. However, for young people to take part in a demand for better consideration of health from the government, we, must come to terms with our need for optimal health and improved healthcare. We must also come to terms with the exact role of the individual and the role of the government, in improving health standards.

The biggest challenge then, is in engineering a paradigm shift among young people, and endowing us with a more health seeking behavior. This will in turn drive us to seek exact knowledge on basic health concepts. High levels of health literacy among young people, empowers us to engage our leaders and make proper demands for healthcare reform. It also ensures that this next generation of leaders, are better equipped to set up frameworks that improve health and healthcare.

According to the WHO, at the just concluded Rio+20 conference, “Health is not everything, but without health, the struggle for a better life is much, much harder”. If young people do not see how and vehemently agree that health is at the center of it all, then how can we expect the government to care? The government may not care, but it has a lot to do with the fact that we do not care!

We as young people need to take a moment. We need to take our health more seriously. We need to long for higher levels of health literacy. We need to realize that the government is not always to blame! The onus is and should be on all of us!

There’s the section for comments. Let’s hear what you think! 🙂

Young Nigerians have visions and aspirations that may seem unattainable, yet they make an essential contribution to today’s societies and the future that awaits coming generations. In all parts of the world, young people live in countries at various stages of development and within differing socio-economic situations, where they generally aspire to live full lives as members of the societies to which they belong. Today’s young people are also considerably more educated and much more aware of global opportunities than was the case a decade or so ago, giving them high expectations of a better life. Gainful employment, is regarded as a major access point towards this better life.

The large youth population in Nigeria can be seen as an asset for development if appropriate human capital investment measures are taken. Decisions therefore, to invest in Nigeria youth should be among other things, based on the type of skills that young people are attaining in preparation for the labor market. Better prepared young people mean better fits for the job market, and in turn both the person and the country at large, benefit.

The Government has used the National Youth Service Corps (NYSC) to provide young people with skills and instill in them a sense of service to the nation. Established in 1973 to engage Nigerian youths in the development process and foster integration among the estimated 250 ethnic groups in the country through the cross posting of university and polytechnic graduates for national service away from their home States and regions. The program is compulsory for all citizens aged 30 and under on completion of their first degree. Recruitment usually takes place three times a year, and Corps participants (popularly called “corpers”) earn a monthly allowance slightly above the national minimum wage while in the program.

Internationally, NYSC is considered as one of the best practices in strengthening youth education (formal and informal), to harness the employment benefits of globalization. This, according to the African Youth Report (AYR) of 2011, is based on the fact that NYSC is an effort to increase skilled young labor force, in the short term and help the ploy to diversify national economy in the long term. NYSC, is thus regarded as a pillar towards providing apprenticeship that integrates theoretical learning with working experience. A similar system (providing apprenticeship that integrates theoretical learning with working experience) is lauded to have contributed to the economic success of the East Asian countries, according to the Economic Report on Africa 2012 and the AYR 2011. Quite clearly, the International Community sees NYSC as a national strategy to harness resources and include young people in ways, which create specific production capacities that are globally competitive.

The description of NYSC in a number of international reports, sounds really amazing, until you ask the chap in khakis and white shirt coming home from Community Development Service (CDS) or the kid who just got posted to Borno state, in light of today’s Boko Haram menace.

There is a huge disconnect between what the NYSC is supposed to be, what it is and what it could be in terms of economic and well being benefits for a country.

Many in the upper echelons, insist that NYSC provides mentoring, provides a possibility of employment in an institution right after service, helps under-developed sectors across the country and increases cultural awareness, among other socioeconomic developments. A number of young people who have served, are serving and have intentions of serving have a completely different perspective.

The average young graduate, who opts to serve, does so either because (s)he is not sure of getting a good job soon or because he does not want to be held back from a job opportunity or government appointment in the future because (s)he has no service completion certificate. This stems largely from the imbibed perspective of the average person, on what NYSC really is.

A large number of people, across this country, old and young alike see NYSC as a tool of increasing cultural awareness, a source of cheap labor for government and private institutions, a source of government exploitation to staff choice sectors at minimal cost, easy employment if you can not find a better job or just another form of totemism. You can spot a number of the touted socioeconomic benefits of NYSC within these views, except that it is all shrouded in gloom and decay.

The key questions then are, can NYSC really be a tool of socioeconomic development? Can NYSC be devoid of exploitation and made to concretely benefit young people? My answer is, a conditional yes!

After examining the dynamics of NYSC and considering the integral services that it should provide our young people and our country, there are a few aspects that must be overhauled.

National Service must be re-oriented to focus on functioning as a half way house for young people. It must focus on supplementing for vocational skills that are not acquired during the formal education process. It must also be allowed to cater to those young people, who do not or are not capable of pursuing tertiary education and still need to be made viable for the job market. Considering that 16% of the Forbes 400 most influential Americans, do not have a college degree, our post-secondary school young people, need as much an enabling environment, as the next person. The aims here, being to indeed create specific production capacities within majority of our young people, which make them globally competitive in all fields.

In emphasizing the need for skills acquisition, NYSC should be designed to allow corpers work in two different institutions, in two different capacities, done over two six-month postings. This diversifies the scope of experience and responsibility taken on throughout the service year.

Some of our graduates, feel mentored enough to step into the job market. These few, consider a service year, as a hindrance to their abilities to take on the world. It would feel unfair to mandate them to serve, at meager salaries and with barely any promise of retention, under the shrouds of patriotism. An opt-out scheme for National Service maintains the mandate, while allowing you the option of deciding against serving. This differs from an opt-in scheme, where no one is asked to serve and you will have to make a request, before taking up service. An opt-out must indeed be the next direction for NYSC.

The need for cultural awareness seems to have taken over the service scheme, and needs to be reconsidered. The added expenses of relocation, pegged to NYSC postings, render the monthly stipend redundant, as settling into a new state, generally costs more than the total annual stipend from the service year. If the new emphasis is on skills acquisition for young people, then the postings need not be an issue. Alas, there have been some improvements in the posting system and in time, we will see where this gets us.

In line with the much-needed paradigm shift about the role of NYSC, private institutions, who take up corpers, must be seen to contribute to the corpers development. An evaluation of the skills acquired by a corper are most relevant, be it in the form of surveys, oral evaluation, skills fairs or dissertations on an issue. A mentoring program cannot be deemed successful, if there is no form of monitoring and evaluation. As well, exploitation of cheap labor must be minimized, by mandating private institutions to keep a percentage of the corpers they take on every year (For example, retention of 5% or at least one person, where 5% is less than one, of all corpers taken during one year). It will be a huge strain on these companies, but it will also limit companies from taking on a lot of corpers, every year at minimum wage, and not employ permanent staff, which cost more.

Lastly, NYSC cannot be run to develop weaker sectors across the nation. Mandating all corpers to teach, as seen in Rivers State for example, boosts the education sector with staff, whilst ensuring that the students are being taught by “quacks” who often dislike the job, do not know enough and do not give enough. This in turn, collapses the quality of education and ruins the sector, which we are supposedly developing. Postings to sectors must as such, be based on qualification and knowledge of the auspices of that sector.

The most important thing to point out here, is that NYSC can be reformed, to focus on providing benefits for young people, increasing their vocational skills and in turn chances of employment, with all attendant socioeconomic implications. A scheme for young people must have young people as the winners and the scheme at the present, is not maximizing its potential to achieve this.