National health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform; it is enforced by law, and may be administered by the public sector, the private sector, or a combination of both. The National Health Insurance Scheme (NHIS) though conceived in 1962, was launched in 2005 to address a number of problems plaguing the health system and to improve service access and coverage in Nigeria.
Nigeria, with a population of about 160 million has only about 7.5 million enrolees nine years after the NHIS was established. According to the Executive Secretary of the scheme, Femi Thomas, who made the revelation during a mid-term management retreat held in Ado-Ekiti, recently, the 36 per cent increase in enrolee uptake data base from 5.5 million was achieved within the last nine months.
According to him, the growth is a boost to the various efforts of NHIS to attain the Presidential mandate of providing health insurance coverage to over 40 per cent of the Nigerian population by the end of 2015. He further stated that between 2011 and 2013, only about 600,000 lives were added to the Scheme’s data base, while this year alone the number has grown by about two million.
While we commend the Executive secretary and his team for the quantum leap in the database within one year, the fact remains that the number of enrolees is still too small compared to the target population. At this level, it will be impossible to achieve the Presidential mandate.
We observe that despite the lofty objectives of the NHIS, it was only executed forty three years after it was conceived because of lack of political will to actualize the dream by successive governments. Participation in the scheme is optional except for workers in the private and public sectors who are expected to contribute 5 per cent of their basic salary to the scheme while their employers pay 10 per cent for each worker.
In Nigeria, the provision of quality, accessible and affordable healthcare remains an important issue and there is no denying the fact that Nigeria’s healthcare index is very poor, hence the country has one of the highest maternal morbidity and infant mortality rates in the world. Statistics show that public health expenditures in Nigeria accounts for only 20 to 30 per cent of total health expenditures. Private expenditures account for the remaining 70 to 80 per cent of the expenditures and the dominant private expenditure is out of pocket spending.
According to experts, a health insurance scheme should provide quality, equitable, accessible, affordable, and efficient care; it should assure a significant reduction in out of pocket expenditure and it should provide universal coverage. It should also provide a comprehensive good quality and cost effective health services to entitled and insured persons and their dependents in the formal sector, self-employed, rural communities, the poor and the vulnerable groups.
But out of pocket expenditure still accounts for 70 per cent of health care financing in Nigeria, thus making health care services economically inaccessible especially to the populations in greatest need. In addition, considering that about 60 per cent of Nigerians live below the poverty line, and are therefore not in a position to afford the high cost of health care, it means that millions are left without any form of coverage thereby leading to the downward spiral of Nigeria’s key health indicators. According to UNICEF, this is not the case in Ghana where the NHIS has succeeded in extending health insurance coverage to 45 per cent of the Ghanaian population a level of coverage unprecedented in the region.
Thus, if the Presidential mandate is to be achieved, government needs to cover people who are unable to pay premiums.
