New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Flinders University, Bedford Park, South Australia, Australia.
Int J Soc Determinants Health Health Serv. 2023 Oct;53(4):434-443. doi: 10.1177/27551938231173611. Epub 2023 May 15.
A good health financing system is crucial for the effective performance of a country's health system. Many health systems around the world, especially in lower- and middle-income countries such as Nigeria, grapple with perennial challenges such as chronic underfunding, wastefulness, and lack of accountability rendering these systems inefficient. Nigeria's health system faces additional extraneous challenges such as a huge and rapidly growing population, a stagnant economy, and worsening insecurity of lives and property. Furthermore, recent disease outbreaks such as the Ebola epidemic and the COVID-19 pandemic and an evolving disease demography evidenced by an increasing prevalence of chronic, noncommunicable diseases asphyxiate an already floundering health system. To address these challenges and to bolster its efforts in attaining universal health coverage (UHC) and meeting the targets of the Sustainable Development Goals, the Nigerian government launched a new health policy in 2017. A review of the health financing section of this policy shows a focus on improving funding for health care by all levels of government and guaranteeing affordable and equitable access to health services by all Nigerians, albeit with insufficient clarity on how these will be achieved. A more critical review of the country's health financing system also reveals deep-seated systemic issues. Its out-of-pocket payments for funding health care are among the highest in the world, with abysmally low government contributions to health. Successive governments seem to lack the political will to address these shortfalls. Critical gaps exist in the country's health laws, making it difficult to implement the strategies proposed in the new policy. Nigeria must strengthen its health laws to, among other things, mandate health insurance and provide adequate funding for the health system by the government. It should also formulate a dedicated, more precise health financing policy with specific, measurable aims targeting identified problems to enable it to attain universal health coverage.
一个良好的健康融资体系对于一个国家的卫生系统的有效运作至关重要。全球许多卫生系统，特别是在尼日利亚等中低收入国家，都面临着长期存在的挑战，如慢性资金不足、浪费和缺乏问责制，这使得这些系统效率低下。尼日利亚的卫生系统还面临着其他额外的挑战，如庞大且快速增长的人口、停滞不前的经济以及生命和财产安全状况不断恶化。此外，最近的疾病爆发，如埃博拉疫情和 COVID-19 大流行，以及慢性非传染性疾病日益流行所证明的疾病人口结构演变，使本已陷入困境的卫生系统更加艰难。为了应对这些挑战，并加强其实现全民健康覆盖（UHC）和实现可持续发展目标的努力，尼日利亚政府于 2017 年推出了一项新的卫生政策。对该政策中健康融资部分的审查表明，政府各级都注重增加医疗保健资金，并保证所有尼日利亚人都能负担得起和公平地获得医疗服务，尽管对如何实现这些目标的说明不够明确。对该国卫生融资系统更具批判性的审查还揭示了深层次的系统性问题。其用于资助医疗保健的自付费用在全球处于最高水平，而政府对卫生的贡献极低。历届政府似乎缺乏解决这些不足的政治意愿。该国卫生法律存在严重漏洞，难以实施新政策中提出的战略。尼日利亚必须加强其卫生法律，除其他外，通过政府强制实施医疗保险，并为卫生系统提供充足的资金。它还应制定一项专门的、更精确的卫生融资政策，其中包含针对已确定问题的具体、可衡量的目标，以使该国实现全民健康覆盖。
