In Nigeria, 75% of all health expenditure is out-of-pocket payments, and for almost two decades, the Nigerian health insurance scheme offered basic health services to less than five percent of the population. 1
For women dealing with a breast cancer diagnosis, this means that care and its associated costs are often borne by the patients, their families and the wider community. This lack of a cancer reimbursement system and its impact on women’s health cannot be overstated as Nigeria has the highest breast cancer mortality rate of all nations. 2
The Roche Nigeria team believed that Roche’s extensive global reach could play a part in improving these devastating statistics. To begin with, the thought of reimbursing for cancer care seemed next to impossible, but after several attempts coupled with leadership changes at the government agency, Roche Nigeria succeeded in engaging and signing a Memorandum of Understanding with the National Health Insurance Authority (NHIA).
Then we set out to make our case for change, which we knew lay in building on previous experience, data, and insights.
Experience: In the not-so-distant past, Thailand had a health system similar to Nigeria's, and universal health coverage has now become common. Having built a partnership with the NHIA, we leveraged our global reach to set up an experience exchange programme with Thailand’s National Health Security Office through the Mahidol University, to demonstrate in practice how cancer coverage can be incorporated into a health system. The NHIA in Nigeria was able to draw insights from Thailand's experience undergoing this transformation to avoid similar pitfalls and emulate areas of success. The partnership between the national health bodies of Nigeria and Thailand is ongoing to this day. Witnessing a real-world example of the programme helped instil confidence in the path forward, enabling the Nigerian NHIA to envision a similar future for themselves in universal healthcare.
Data: In partnership with the NHIA, we also gathered robust data to allow them to comfortably weigh their options and make informed decisions. This involved comprehensive policy and health system analysis, to identify the capacity and needs of the clinical landscape and set priorities for establishing a lasting reimbursement scheme.
Insights: Lastly, we provided a platform for healthcare practitioners to express the gravity of the need for cancer coverage and advocate for a transformation of the existing healthcare reimbursement system. The opportunity to hear from doctors made the issue more tangible, allowing people to share their stories and connect on an emotional level.
By approaching the goal of universal cancer coverage from multiple robust angles with the NHIA, we were able to achieve a remarkable paradigm shift in Nigerian healthcare.
When, in 2022, it became law that health insurance is mandatory for all Nigerians and legal residents in the country, the NHIA-Roche partnership became a springboard to accelerate enrolment. In the pilot phase of the project, seven clinical Centres of Excellence were established across Nigeria. So far, 147 cancer patients have received treatment and the team is working to scale the project to 11 more centres. This action will take much needed care closer to Nigerians as the centres aim to expand treatment offerings to include preventative screening services as well.
The year 2024 has presented yet another opportunity in the form of the Africa Breast Cancer Ambition (ABCA) to spread our activation messaging even further. ABCA is a large-scale initiative, which aims to improve survival rates and accelerate treatment for women with breast cancer throughout Africa by engaging key stakeholders including government officials for truly sustainable change.
We know that vast improvements in women’s and entire populations’ health alike often depend on national-level reforms. The success of funding cancer care in Nigeria demonstrates our commitment to improving health systems and is a case we are determined to emulate. By leveraging previous initiatives, connecting the right people, and setting up subsequent successes in turn, we have the opportunity to shift perspectives and move the needle.
References
World Bank. Out-of-pocket expenditure (% of current health expenditure) – Nigeria [Internet; updated 2023 Apr 7; cited 2024 May]. Available from:
Omolara A. Fatiregun et al., Breast Cancer Research to Support Evidence-Based Medicine in Nigeria: A Review of the Literature. JCO Glob Oncol 7, 384-390(2021).
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