While increased efficiency and transparency within the health sector can make us maximise what we have at the moment
The Nigerian health sector is underfunded. While this is no
new development, the COVID-19 pandemic brought this to the fore once again. In
a previous article, I observed that the allocation to the health sector in the
past five years had averaged less than five per cent of total budgetary
allocation in flagrant disobedience to the 2001 Abuja declaration made on our
soil. While increased efficiency and transparency within the health sector can
make us maximise what we have at the moment, we will not experience much
progress until the issue of perpetual underfunding is dealt with.
As a speaker at the "Funding the COVID-19 Response in Nigeria" webinar organised by Nigeria Health Watch, Dr Ola Brown ended on a dominant note by stating that: "To solve the issue of underfunding, we need to find a way to implement compulsory taxation to create a prepayment pool for healthcare in the country". She then went on to give the instance of how "telecommunications tax" can serve as a plug to make more funds available for health.
This idea resonates with the proposal in her book:
"Fixing healthcare in Nigeria" where she noted that the country could
raise an additional $1bn annually by introducing a levy of 1,000 to 2,000 on
each telephone subscriber. Dr Ola isn't a solo voice in advocating for
telecommunications tax for the health sector. In 2015, a group of leading
health policy researchers from University of Nigeria recommended the
introduction of solidarity levies on mobile phone call tariffs
(telecommunications tax) as an innovative means of solving the challenge of
underfunding in the Nigerian health sector. Similarly, in 2018, a group of
Civil Society organizations advocated for the introduction of mobile phone
(telecommunications) tax to fund the country's healthcare system.
The telecommunications tax is a form of indirect tax in
which citizens prepay for healthcare by proxy through telecommunications
company. There is no better time than now for the government to tap into this
opportunity for financing the country's health sector.
One of the sectors that have continued to grow in Nigeria
despite the ongoing pandemic is the telecommunications sector. Between January
and June 2020, telecommunications operators earned $5.15bn (N1.97trn) in
revenue which represents an increase of $149m (N57bn) compared to the earnings
within the same time frame last year. On average, each subscriber spends $4.51
on airtime purchases every month. A tax of 10 Kobo on every naira of airtime
purchased would have yielded an additional $515m (N197bn) for the nation's
health sector in the first half of 2020, an amount that represents 46 per cent
of the total budgetary allocation to health for the year 2020. Why should we
continue to allow this golden opportunity slide?
It's been established that focused investment in healthcare
boosts national and personal income. However, with a per capita health
expenditure of $73.9 (N28,600), the country should expect minimum returns on
her citizen's health which will impact the nation's productivity and GDP. In
light of this, it is essential to explore available alternatives to improve the
nation's health spending. A special telephone tax for the health sector set
between (1kobo - 10kobo) for every naira of airtime purchased will contribute a
lot to the pool of funds available for healthcare in Nigeria, this fund if
utilized judiciously and efficiently will have a tremendous positive impact on
the nation's health fortunes.
To make the best of this fund, it will be essential for the
government to create a package of highly cost-effective interventions that will
guarantee that all Nigerians get quality health care at the primary health care
level. This intervention might be an extension of the current Basic Minimum
Package of Health Services, covering more population groups or a more
comprehensive package covering maternal and child health, non-communicable
diseases, Malaria, Tuberculosis (TB), Human Immunodeficiency Virus (HIV),
mental health and common oral health conditions.
A portion of the fund should also be dedicated to revamping
the infrastructural and human resource capacities of the Primary Health Care
system to reposition them to provide quality health care for all Nigerians.
Before the rollout of this scheme, adequate sensitization of Nigerians about
the scheme should be carried out to get citizens buy-in and awareness,
necessary monitoring and evaluation indicators put in place and mechanisms to
ensure transparency in the allocation and management of funds put into place.
If implemented, Nigeria will join ranks with Gabon, which
already funds healthcare for the poorest members of her society through a
mandatory health insurance levy [redevance obligatoire à l’assurance maladie
(ROAM), supported by 10 per cent of telecommunications revenue. The rollout of
a telecommunication tax for the health sector, if implemented in good faith,
will improve the fortunes of Nigeria's health sector and represent a massive
stride towards universal health coverage in Africa's most populous nation.
Toluwani Oluwatola is a dentist in Osun State, Nigeria, interested in public health systems especially health financing block. He’s enthusiastic about the transformation of the health financing landscape of Sub-Saharan Africa.
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