Self-reliance and Resolve in Abia: Southeastern Nigeria Takes Historic Strides toward Universal Health Coverage
This September, in a historic move, the Abia State legislature took up—for the first time—the issue of universal health coverage (UHC), inviting in outside experts and resolving to act.
As in the rest of Nigeria, Abia State’s primary healthcare system is in dire need of repair. Poorly resourced facilities and high healthcare costs make accessing even basic care an insurmountable challenge for most of the state’s citizens. Ndifreke Mbaba, an Abia-based capacity development advisor with the U.S. Agency for International Development (USAID)-funded Health Policy Plus (HP+) project explains it this way: “Primary healthcare facilities are in a sorry state. The structures themselves are old with leaky roofs, washed-off paint. We also have issues of inadequate human resources for health.”
And healthcare remains expensive. Mbaba continues. “If you seek [healthcare], you have to have money in your pocket and that has [caused] a whole lot of people to not go to the health centers when they are sick, especially in the rural areas.”
The state of Nigeria’s primary healthcare system has stymied progress nationwide. Dr. Emmanuel Meribole, director of planning, research, and statistics for the country’s Federal Ministry of Health observes, “In 2008 [maternal mortality] was 545 per 100,000 live births. In 2013, it was 576 per 100,000 live births. We were increasing instead of going down. The same thing with the contraceptive prevalence rate, just marginal improvement. If we don't do things differently, we might, instead of improving, keep on going backward.”
Over the past year, USAID through HP+ has been providing support to a handful of Nigerian states including Abia, to meet eligibility requirements for two major, national health reforms—Primary Health Care Under One Roof (PHCUOR) and the Basic Health Care Provision Fund (BHCPF). PHCUOR seeks to improve the coverage and quality of primary healthcare, while the BHCPF aims to remove financial barriers, especially among the poor.
“We targeted the services that are in relation to primary healthcare: maternal issues, child health issues, issues of family planning, issues of nutrition of course, issues of treatment for malaria and basic things like screening for high blood pressure and diabetes.”
As part of a country-wide effort to roll-out these reforms, HP+ brokered a collaboration between three national agencies to develop a joint training for implementation of both the primary health and insurance fund initiatives and has been helping to cascade the training from national to facility levels. So far, thousands have been trained, including nearly 1,200 in Abia State.
HP+ has also supported Abia to meet the primary healthcare and insurance eligibility requirements, helping to strengthen the state’s social health insurance and primary healthcare development agencies—the two bodies responsible for implementing the reforms at the state level. Project staff also assisted the state to develop key legislative regulations and operational guidelines; establish a multisectoral, working group to help further drive health financing reforms; and track gaps in financial and human resources and identify opportunities to bridge those gaps.
Amid backdrop of the health reforms, the Abia State House of Assembly called for the special session on universal health coverage—the first of its kind. Dr. Suneeta Sharma, Palladium’s vice president for health and HP+ project director addressed the State House as part of the special session. In an impassioned speech, Dr. Sharma urged assembly members to prioritize support of the state’s social health insurance scheme and release needed funds. “The role of government in driving public policy in order to catalyze positive change in the social health sector is indispensable,” she said. “While donor support plays a supportive role in strengthening the health system, evidence shows that it is public financing mechanisms that drive improvements in health performance.”
Following Dr. Sharma’s address, assembly members took swift action, committing to take legislative measures, launch the state’s social health insurance scheme, and collaborate with development partners and donors. All three actions—codified in a communiqué—are focused on making progress toward UHC, improving healthcare delivery, and ensuring that Abians have equal access to high-quality, essential, and affordable health services like maternal and child health, family planning, and care for preventable diseases. The following day, Abia officially launched and began enrollment in its state social health insurance scheme, opening up the promise of improved and affordable healthcare.
At the close of the special session, Speaker of the House of Assembly Right Honorable Chinedum Orji said, “We will give legislative backing to universal health coverage [and] carry out oversight functions…ensuring that our primary health centers are upgraded for services.”
Chairman of the House Committee on Public Private Partnership, Hon. Onyekwere Michael Ukoha, commented that the move would also improve the state’s economy by ensuring a healthy workforce. Expressing his happiness that the State Assembly was taking up the issue of healthcare and highlighting the importance of equity in health, he said, “Rural people, women, children will [now] have access to health.”