Achieving Universal Health Coverage through demographic dividends

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In the demographic transition model, Nigeria is a pre-demographic dividend country due to certain factors ranging from high fertility levels which is above four births per woman and declining mortality rates all posing risks for population age structure.

According to data from the National Population Commission, Nigeria’s population was estimated to be more than 206 million in 2020, compared to more than 201 million in 2019 and 196 million in 2018.

Population growth was also estimated to be about 2.6 per cent in 2020.

Also, the Nigeria Demographic and Health Survey (NDHS 2018) said that the total fertility rate was 5.3 births per woman.

However, the Federal Government had at various instances set up policies and plans to ensure that Nigeria attained demographic transition and in turn reap its dividends.

One of such initiatives was the inauguration of the Family Planning 2030 (FP2030) commitment to increase domestic funding and sustainable financing through earmarking one per cent of the country’s health budget at federal and state levels and perhaps also at local government level.

The allocation to Family Planning, aimed at reducing the mother and child death rate in the country by 2030, is also expected to ensure availability of FP commodities.

Also, at a panel session titled “Nigeria’s Demographic Transition: Addressing The Urgency of Now” during the 63rd Regular National Council on Health (NCH) held in Abuja in December 2022, experts said achieving demographic dividends depends on fast tracking demographic transition.

They also said that incomplete demographic transition, which is transition from high death and birth rates to low birth and death rates, would hinder growth prospects, as population growth intensifies the demand for social services and hinders the capacity of the economy to generate jobs.

It also hinders the ability to Universal Health Coverage (UHC) for all.

Dr Mustapha Lecky, former Executive Secretary, National Health Insurance Authority (NHIA), said Nigeria’s inauguration of the revised National Policy on Population for Sustainable Development, was to raise awareness and call attention to issues of population management.

He, however, said that the current state of Nigeria’s demographic transition portends grave dangers for the country to reap demographic dividends and will also impede the capacity of the national health system to deliver on UHC.

He added that “a connection is being made between where we are now and the performance on the delivery of UHC, which is the ultimate goal of the health system, as well as the Sustainable Development Goals (SDGs).

“The demographic transition model itself has been here for over five decades and the model is the basis for two main demographic population trends, namely the issues of birth rate and death rate.

“It suggests that the country’s total population growth rate cycles through stages and the country develops economically.

“This theory has continuously been seen as framework to benchmark the delivery of demographic dividend, so, in other words, you cannot have demographic dividend outside the application of this theory.”

Dr Ejike Oji, the Chairman, Technical Management Committee, Association for the Advancement of Family Planning (AAFP),  said “Nigeria is presently experiencing a demographic crisis.

According to him, there is a youthful bulge, a situation where 72 per cent of the nation’s population is under the age of 30, saying, however that it is not supposed to be a disadvantage if the youths are productive.

He also expressed concern over insecurity in parts of the country and the relocation of many Nigerians to other countries to seek greener pastures.

He said “people talk about demographic dividend but you can’t talk about dividend when you have not transited and the problem is our fertility rate.

“The key thing is if we do not reduce our fertility rate to four, we cannot transit because for you to transit you must transit fertility rate to four, we are at 5.3 now.”

On her part, Ulla Mueller, the Country Representative of United Nations Population Fund (UNFPA), said the requisite commitment at all levels of government is essential to attaining demographic transition and reaping its dividends.

She, therefore, stressed the need for increased investment in education and family planning at a sufficient level to achieve demographic dividend.

She added that “for me, the answer is quite clear actually. We need every state to have a budget line for several clinics commodities and to deliver on that into the family planning, monitoring task and at federal level.

“We also need a budget line and you need the money to be released not to remain in your budget line.”

The Minister of Health, Dr Osagie Ehanire, said transitions and attainment of UHC are the mandates of the Ministry of Health and to extend access to basic healthcare to citizens ideally at least for up to 95 per cent.”

He said “so, this conversation on demographic transition at this time makes sense, and a reflection of the health sector’s commitment.

“Now, it is a clear thing that the population of every nation is an asset but it is an asset if it has that significant proportion of trained workforce of highly skilled workforce relative to the population of the country that is dependent. Those who are trained and skilled to do something versus those who are dependent.”

He, however, said that to harness the best of all of these, education and training are at the heart of the conversation.

He added that “education and training are what all countries put emphasis on, and they designed programs for education in a way that allows them to attend to the needs of the people.

“You will notice that developed countries are very deliberate in the way they designed their education systems and many undeveloped countries who actually don’t have a design just allow all players to come into the education field and do what they like.

“So, education is critical and particularly at the very early stage where you do nation building, you are molding your citizens, building citizenship.

“But all of these are also not possible without health. We say that health is wealth because we are talking about human capital development. Education and health are key factors in human capital development.

“This is because it is only a healthy population that can be educated. In order to acquire the skills, you need the minimum level of capacity to be able to contribute to active and productive workforce”, Ehanire said.

Dr Salma Anas-Kolo, the Director, Family Health, Federal Ministry of Health, at the time, said that the urgency of addressing the current population growth trajectory in the country is real, as the unchanging fertility rate requires concerted efforts across key sectors and key intervention areas to fast track demographic transition.

In a call to action, she said there was need to improve access to safe and affordable free family planning commodities and services for sexually active people and not only women, but also men wherever they are.

She also said there should be improved access to quality primary healthcare services, including antenatal and postnatal care, immunization and nutritional services to increase child survival and life expectancy.

Anas-Kolo also advocated for compulsory secondary school education for girls to discourage early marriage and childbirth.

She said “there should be productive labour force opportunities to boost women’s empowerment at all levels.

“The Federal Government is working to ensure improved health coverage, consisting of basic minimum package of care that can improve outcomes.

“While the Federal Government takes the lead in policy formulation and design, a lot needs to happen at the sub national level and state governments are expected to domesticate policies and commit to implementation.

“We need to work together to have genuine and sincere goals that are transparent and accountable.”

As for the National Demographic Development Plan and the recently revised National Population Policy for sustainable development, she said it should be implemented under the combination of the relevant arms of government.

She also said that the private sector have key roles to play, both in service condition and creation of employment opportunities, especially for women.

She, however, added that “government needs to create an enabling environment for the private sector to thrive. Development partners and donor communities should continue to support government at all levels to achieve results in a sustainable manner.

“We call on them to align with the Federal Government’s vision, the sub national level and official partners so that collectively, we can achieve the results.

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