by Evo Olori Esievoadje.
After my Part 1 examinations, I was faced with the dilemma of getting a suitable topic for my Part 2 dissertation in both Colleges. Prior to this, I was preoccupied with passing Part 1, as were most of my contemporaries. Who cared about getting a research topic when I hadn’t passed the dreaded MCQs, MEQs, Essays and Clinical exams of Part 1? With all I had heard about the challenges and difficulties in post-graduate medical examinations, passing in one sitting was the only goal!
Then I finally passed! And it seemed like everywhere you turned, Consultants were asking for your proposal! Haba! Allow somebody rest! The frantic search started for a topic. Nobody was giving you topics to choose from. I longed for Part 1 with all the readily available materials to just read. The topics I came up with were rejected! Months passed with no reprieve.
Then I attended the Research Methodology Course of the National Postgraduate Medical College of Nigeria at Ijanikin. I went to the library there and was surrounded by an array of beautiful case books and dissertations (libraries have always been one of my favorite places). So many ideas popped up as I looked through them and made notes. I left Ijanikin feeling invigorated and ready to slay any dragon Part 2 threw at me.
I had chosen Universal Health Coverage as my main theme. It was appropriate as I was working in the National Health Insurance Scheme (NHIS) clinic at my health facility and saw the advantages of health insurance. When I had to attend to patients without health insurance, the difference was glaring.
Universal Health Coverage is defined as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring the use of these services does not expose the user to financial hardship (World Health Organization).
Searching for literature on universal health coverage in Nigeria pointed out the wide gaps in knowledge that needed to be filled. These gaps made me push harder as I realized that only about 4% of the population in Nigeria had health insurance. The numbers were so dismal!
It is obvious a lot of work needs to be done in this field. On the surface, it seems like the answer to the health disparities in Nigeria. But how could it be adapted to the Nigerian situation? The National Health Insurance Scheme was only for federal civil servants. Private companies like banks used private health insurance companies for their workers. Some states have developed their version of the scheme for their civil servants. Even though the initial plan for the National Health Insurance Scheme included tertiary students, prisoners, community schemes, this has not been implemented. What scheme would enroll the children, artisans, traders and unemployed adults?
And even when these are all enrolled? Would health insurance be the panacea to all the maladies in our health system? Would it improve health promotion practices? Would acutely – ill patients present early enough at health facilities and not self-medicate? Would having health insurance improve adherence to medications for patients with chronic diseases? Or would they prefer to patronize other sources of healthcare in order to avoid the long wait times at the government hospitals where they are mostly registered? Would it improve patient satisfaction in hospitals? Would it improve the standards of the government and private hospitals? How would abuse of the scheme be prevented? Abuse by the users, the health facilities and the health management organizations. The questions are myriad.
More research is needed on universal health coverage in Nigeria and Africa. The call for universal health coverage needs to be backed up by scientific data showing its advantages. Its downsides need to be documented and not just remain anecdotal. It is an interesting aspect of Medicine that sucks you in and makes you want to ensure every Nigerian gets access to it. Hopefully, that would happen soon.
Dr. Evo Olori Esievoadje is a Senior Registrar in the Department of Family Medicine, Federal Medical Centre, Asaba, Delta State and an active member of Research Collaboration Network (RCN)