William Beveridge was a British economist and social reformer considered to be one of the grandfathers of the welfare state.
Unlike his socialist contemporaries, Beveridge was an economist who believed in the labour market as an instrument of poverty alleviation and economic prosperity. So, he wanted a healthier workforce.
Today, Beveridge is best known for his report that laid the foundational ideas for the UK's National Health Service (NHS). In the Beveridge report, he laid out policies to tackle what he termed the five “Giant Evils” in society: squalor, ignorance, want, idleness, and disease. In his view, the most important was disease, which he argued amplified the other four. An effective state puts health first, was his conclusion.
The Beveridge report was initially intended as a list of minor ideas the government could quickly implement. But Beveridge believed something more radical was required, and the report became the most widely-read government report ever written. Ordinary citizens demanded it so extensively that it sold out in many bookstores.
The formula worked. A healthier labour force led to greater economic productivity which allowed the British workforce to take advantage of globalisation and the early days of the computer revolution.
Closer to home
Nigeria faces similar problems to post-war Britain: huge debts, rising unemployment, and massive poverty. According to the World Bank, there are only seven other countries where citizens have gotten poorer in the last twenty years at the same rate as Nigeria.
The world is also on the cusp of another revolution; the fourth industrial revolution; a technology-driven revolution that will profoundly alter the way we live, work, and relate to one another. It will be characterised by the exciting fusion of technologies that blur the lines between the physical, digital, and biological spheres.
And just like the UK in 1942, we will need a healthy workforce to take advantage of the opportunity. We need to look at healthcare as an investment in our future.
Five pillars of healthcare
Nigeria’s policy-makers should focus on five aspects. In my book, ‘Fixing Healthcare in Nigeria’, I call them the five pillars of healthcare policy: maternal and child health, centralising tertiary care to improve quality and reduce cost, expanding primary care, sustainable healthcare financing, and task-shifting skills from doctors to other healthcare professionals.
In 2000, the World Organisation ranked Nigeria's healthcare as one of the worst five in the world. More recently, the Lancet ranked Nigeria 142 out of 195 countries in its Healthcare Access and Quality Index.
Our maternal and infant mortality indices are also among the worst in the world, and any proper healthcare policy ought to focus on the indicators.
Furthermore, reform should focus on the centralisation of large hospital facilities to enable us to benefit from the economies of scale that come with being able to perform high numbers of specialist procedures at a lower unit cost.
As quoted from the Ned Tijdschr Geneeskd: substantial evidence indicates that the outcome of critically ill children treated in tertiary pediatric intensive care units (PICUs) is superior to that of those treated in other settings.
Primary care is the mainstay and the lifeblood of any healthcare system and will form the bedrock of any serious healthcare reform in Nigeria. The healthcare budget in the United States is almost $1 trillion. It is an expensive healthcare system that focuses on expensive hospital-based care. This cost constraint imposed on the treatment of preventable diseases can be alleviated by long-term social improvements that focus on prevention rather than treatment.
Investing in Nigeria's health
Our national debt and budgeting constraints can be restructured to dedicate more resources to healthcare while we embrace task-shifting, moving roles normally performed by doctors to other healthcare professionals, reducing cost and perhaps even increasing quality.
Historically, policy-makers in Nigeria have seen healthcare as a cost rather than an investment. This is evident from the amount of money allocated to healthcare in the budget. According to the World Bank, Nigeria spends less than 1% of its GDP of healthcare. The United States and Switzerland spent 17% and 12% respectively in 2017.
Part of this is political will. Investments in physical infrastructure like roads are easier to see, commission, and photograph, whereas the dividends from investments in human capital are less visible immediately. But like Beveridge, we need to take a long-term view and see healthcare as an investment.
This is a view shared by Bill Gates, who pointed out Nigeria’s lack of investment in human capital during his visit in 2018. The Gates Foundation can point to Rwanda as an example. When the government prioritised building its healthcare system, GDP grew from $754 million in 1994 to $8.4 billion in 2016.
Ultimately, a healthy population is more economically productive. In 1979, Theodore W. Schultz, Nobel Laureate for Economics, showed how population quality is the ‘decisive factor’ of production. He emphasised the merits of investing in health while identifying the main channels through which health could boost economic productivity and growth. Health affects economic growth by enhancing worker productivity, increasing savings over the individual’s life-cycle, boosting education and encouraging foreign direct investment. Each additional year of increase in life expectancy increases economic output by 4%, even after controlling for work experience and education (Bloom et al., 2004).
If the UK had ignored the recommendations of the Beveridge report and refused to undertake on radical healthcare reforms like the creation of the NHS, it is almost certain that they would not have had the significant economic growth experienced over the past 100 years. Nigeria must take the opportunity to position itself for growth, by pursuing similarly aggressive healthcare reforms.
The Gates Foundation estimates that each $1 invested in healthcare reaps $20 worth of benefits. A better investment would be hard to find.
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