BeyHealth Quarterly Journal (BHQJ) BHQJ 2018: 001:1 (May 2018) - Page 20

Feature Article Funding Healthcare Services in Nigeria – A conundrum of demand, policy and supply! Leke Oshunniyi MBBS Dr Leke Oshunniyi is CEO/MD, AIICO Multishield Healthcare Ltd. and Director, Royal Cross Medical Centre, Ikoyi, Lagos. “ Doctor, I happy say na you I meet, I largely by government. Private healthcare don dey pray say make I meet the delivery was at best rudimentary. The triad of a doctor wey get bear-bear for population explosion, massive urban migration hospital today”, said the smiling lady sitting and dwindling oil revenue meant an increasing opposite me, in impeccable pidgin English. I recourse to private care, as government recognised her from more than a decade in the hospitals became “mere consulting clinics” and past. She was the wife of one of the members public of staff of a long defunct government dilapidated. The outcome is that in 2014, parastatal, “Retainership private expenditure on health as a share of total Agreement” with the private hospital in Lagos, health expenditure in Nigeria was almost 75%. which had a healthcare infrastructure became Nigeria, in which I am a partner. To ask each of the 3 tiers of government to “Na dis pikin O!”, she continued, pointing to the reverse this trend is unrealistic, not only teenage boy beside her. “Na here we born am. because of competing obligations but also Na him dey sick. As I dey here my broda, chichi because in an absolute sense, the funds are no dey my han. Even sef, na you go give us simply not available. For many decades, the danfo moni to go house.” Federal Government of Nigeria spent oil The foregoing translates roughly to mean the revenue to fund the budget and neglected tax lady was happy (don’t tell my partners, but she revenue in the process. When in the recent probably considered me to be kindhearted) to past, the precipitous drop in oil prices triggered see the bearded doctor (I have worn a beard a recession and near collapse of the economy, for almost 40 years) but didn’t have any money the focus shifted to taxation as a more to care for her ailing child who had been born dependable source of revenue. in my hospital. She expected me to provide “ In a cash- backed market economy, supply responds with provision, and competition and regulation smooth-out the rough edges. 20 both free treatment and transport fare back home, with a little “extra”. I complied with her request. ...a nation of tax evaders Unfortunately, statistics reveal that Nigeria appears to be a nation of tax evaders or to put The Problem it more politely, tax compliance in Nigeria is So, here was I in a private hospital, compelled poor. According to the Joint Tax Board, there to administer both care and charity on the very are ten million people (precisely 10,006,304) tenuous basis of a lapsed business relationship. registered for personal income tax purposes in Amusing as the incident may have been, it was all the states of the federation including the evidently indicative of the creeping malady FCT. Out of these, about 4.6 million or 40% are afflicting the Nigerian healthcare delivery registered with the Lagos State Internal system. Some of my colleagues in the teaching Revenue Service (LIRS) indicating an average hospitals had admitted going to work without of 153,000 or 1.5% per state for others. any money whatsoever on their persons, to Compared to the labour workforce estimated avoid funding care delivery to patients out of at 77 million at the end of 2015 according to sympathy. Clearly, the contagion had now the National Bureau of Statistics (NBS), the reached the private sector. I knew then, that we number of people in the tax net is only 13%. were in the middle of a countrywide healthcare Total tax collection in Nigeria for the year 2017 delivery emergency. by Federal and State agencies is still being collated but is projected to be approximately The Reality Healthcare is never N6 Trillion or about $20 Billion. This is an free. Someone or abysmal figure when compared with the $60 something always has to pay. In the times of Billion collected by our continental neighbour, plenty in Nigeria, Western-style healthcare South Africa, which has a smaller GDP and delivery in urban public hospitals was funded about one-third of our population. In other | MAY 2018 | Issue 1