Why we must tax Nigerians for Healthcare Delivery -Adewole
If Nigerians want to enjoy robust and affordable healthcare in the nearest possible future, then they must be ready to pay tax as well as encourage private investment in Key medical projects.
Health Minister, Professor Isaac Adewole who spoke with Healthstyleplus Online in an interview, dismissed the hitherto belief that Nigerians’ health indices would thrive only if more people enrolled on the National Health Insurance Scheme (NHIS).
Presently, it is estimated that only one percent of about 180m Nigerians are on health insurance since 2005 when the NHIS formerly kicked off.
“If we expect some magic with the present NHIS to deliver the type of quality healthcare we crave for our people, it cannot happen”, said Adewole.
The Minister though agreed that health insurance cover is a good way to access basic healthcare by a large population however said, “it an imperfect way of funding healthcare in any situation”.
According to him, “The surest way to fund healthcare is through a direct public funding mechanism which is taxation and budgetary allocation; these are the only certain ways” he posited.
He however observed, “In many countries these are the two ways, mixed. In Nigeria, the reality (for us), is through direct taxation but many do not pay tax and don’t want to pay”, the Minister lamented.
” I have said it repeatedly that what we need to effectively grow our healthcare system is, for more private investors to endow health projects while we (the citizens), must be ready to pay more tax”, said Adewole .
To Adewole, “for us as a nation, it has been proven over the years that government alone cannot fund healthcare delivery, it is just not possible especially for the magnitude of care we require for our people.
“In UK, tax funds the heath sector. Here, we have one of the lowest taxes in the world after those countries that don’t even pay tax at all, like the oil rich countries. We are not a tax-paying people and that is why we have not been able to meet up with our social needs” said Adewole
“I have visited places in the UK and elsewhere and found a lot of private investments and endowment in medical facilities and our people often travel to such facilities to access treatment unknown that it is not the government of UK that provide those state of the art facilities.
“You find individuals endowing into healthcare for the benefit of the population and such individuals enjoy tax holidays from government. Their contributions augment government spending and public tax system”, Adewole pointed out.
He added: “Wherein all we need to do too is to give more incentives to our private investors to replicate such endowments here for our people “, argues Adewole.
On the plan of government towards improving healthcare of Nigerians in 2018, Adewole told Healthstyleplus Online, ” For instance, we would like to have more private investors to complement government in critical areas like child routine immunization, supply chains, medical infrastructure such as we currently have in some tertiary hospitals and Accountability mechanism among others”.
The Minister told our Correspondent, “In 2018, we expect to see more Nigerian private investors keying into our dreams to complement government spending in critical areas; we are already reaching out to some private and corporate bodies through notable giants and industrialists and already, some are signing agreements and we shall unveil them soon”, he revealed.
He described the challenges in the sector as enormous and real saying, “We are more than before convinced why we need to give health the priority it deserves.
“We are determined to ensure we drive more resources to health, we need to make sure the various actors (in the sector) work together, we need to minimise strikes and you see, they (ie the challenges) are many and we need to address all of them”, assured Adewole.
The Minister was emphatic that aside Alhaji Aliko Dangote and a few others who have been investing in some areas of health, “In 2018, we are opening opportunities for more entrepreneurs to come into health investment to boost the sector.
“We need to encourage the Nigerian citizens to be fair and we also need Nigerian citizens to invest in health. There are very few Dangotes in Nigeria and we need them.
“I would love to see Nigerian entrepreneurs invest in our health sector, endowing in the sector. Many of them have done in other areas like education, sports and son but we want them to invest in health, to do more”The minister pleaded.
The Minister also disclosed that Nigerians may have to wake up to the reality that they would need to pay more tax to augment government spending on healthcare.
He noted that the establishment of the Nigerian Sovereign Investment Authority is to ensure co-investment in centres of Excellence in FCT as well as the six geo-political zones of the country and this would have to involve some form of taxation soon to be worked out.
Prof. Adewole described the 2018 budget allocation to health ministry as, ” just a drop in the ocean needs of the sector”.
He however pointed out, “healthcare needs other critical sectors to grow and impact on lives.
“It needs Education, Nutrition and employment and when all of these areas equally receive adequate attention, the health needs of the populace would have been greatly impacted “, said the minister.
On the promised revamping of 10,000 Primary Healthcare Centres (PHC) across the country, he noted, “there are about 30,000 PHCs with just bout 20% functioning.
“We believe cross the country we can make about 10,000 of them work and we would be fairly okay.
“We are so fortunate to have some implementing partners working with us, like World Bank which has refurbished 1400, DFID through maternal, newborn and child health (MNCH) did 950, the EU signed an agreement with us to do 74 PHCs in three states and that is apart from what each states are doing.
“Kaduna has done 254, Bauchi and Ogun have done some too and so it is all over.
“The National Primary Healthcare Development Agency is going round the country to take stock to know where we are. The 10,000 target is the minimum because by the end of the day, we will have more than that. We are encouraging the states and the World Health Organisation (WHO) has taken it on as an issue saying, for us to achieve universal health coverage, UHC, we should use PHCs as the platform because that is healthcare closet to the people. In the ministry, we made provision for 110 to receive direct support”, Adewole noted.
In 2018, the sum of N21bn has been earmarked for Primary Healthcare Centres for provision of basic consumables. It got a little increase of N2bn from N19bn allocated in 2017 and the additional N3. 5bn recently earmarked for the outbreak of measles in parts of the country.
In 2016 capital budget for health was N28bn, 2017, it was N55bn and in 2018, it is N71. 1bn
Recurrent budget in 2017 received N252bn as against N250bn in 2016.