The biggest challenge facing Nigeria’s health insurance scheme borders on what the new executive secretary needs to do differently in order to sustainably expand the Scheme. ANTHONIA OBOKOH highlights four issues that Mohammed Sambo has to address.
Advances in Nigeria’s health insurance scheme (NHIS) and practice would have led to greater health benefits, wellbeing, longevity and universal health coverage for every Nigerian. But, not everyone has been able to take advantage of the scheme.
Health insurance in Nigeria has had many challenges compared to its peers in Africa including Rwanda and South Africa. Nigeria still struggles to meet the commitment it signed-up to with other members of African Union 18 years ago – the Abuja Declaration – to allocate at least 15 percent of its budget to improve the health sector.
Almost sixteen years after the inception of the scheme, at present, less than 1 percent of Nigerians are covered under the NHIS, even this number is only a conservative estimate, and the true figure is still unknown.
The scheme has been continuously bogged down by policy somersaults, ineffective operational guidelines, corruption, inefficiency and bureaucratic bottlenecks in the registration process. Regrettably, the quality of care received under the scheme is questionable with accusing fingers pointed at major stakeholders including the NHIS, Health Management Organisations (HMOs) and the hospitals.
Also the gaps in standards of care and shortage in enrolees coverage persists, and for many they have worsened without access and affordability leading to a large number in the populations paying out of pocket for healthcare.
Meanwhile, Nigeria suffers from high rates of infectious diseases increasingly and have to cope with growing rates of chronic diseases with no mature health care systems finding it harder to deliver effective, timely care in malaria, mental health, cancers for example which makes conditions worse.
The demand for health insurance care as we currently understand it continues to grow. The NHIS had in 2013, proceeded to implement a set of recommendations which were to see compulsory health insurance coming into effect, and this included; the need for state governments to set up the State Supported Health Insurance Schemes (SSHIS) through a National Council of Health memo approved in March 2014 by the federal government.
As at today, states that have passed laws establishing SSHIS are Lagos, Abia, Kwara, Delta, Ekiti, Kano and Bauchi. Ogun, Enugu, Anambra , Ebonyi among others are reported to be at advanced stages with enabling laws in the process of being passed.
Jide Idris, former Lagos State’s Commissioner for Health, said to achieve Universal Health Coverage in Nigeria, we must improve the quality of our healthcare services.
“Mandating health insurance in the various states of Nigeria will enhance accessibility of people to healthcare as it would also become more affordable than having to pay out of pocket,” he said.
To address these gaps, the new executive secretary will need to deliver the NHIS in a fundamentally different way tackling these issues.
Four Issues to Address
Four big issues need to be addressed by the new NHIS executive secretary in order to build on the success of this scheme and make progress in addressing gaps.
First, there must be wider recognition that mandatory health insurance is essential. Expand its coverage of the health insurance plans both in formal and the informal sector and scope of coverage to cover more services. Many places—including in rural regions in states — still simply lack awareness of the benefits of health insurance plans. However, environmental, biological and social conditions are creating new sources of gaps in achieving the Universal Health Coverage.
Second, health is on the concurrent list, there is a minister at the federal level, commissioner at the state level; there is a supervisory health at the local level. Health policymakers must recognise that quality care depends on more than bringing people to a clinic or hospital when they are ill. To keep costs down and to meet demand, care needs to be delivered independent of location, even “practically,” and often determined by consumers themselves.
Third, reviewing of the NHIS Act had become necessary in view of the poor coverage and so far the national Assembly has not passed the new NHIS Act. The three ties of government should review the NHIS Act with a view to addressing various aspects of the Act that were obstacles to attaining UHC in the country. The new Act must make NHIS compulsory for us to move forward.
Finally, improving the health of citizens and the country’s UHC is increasingly about addressing the social determinants of care, and not simply medical interventions. This in turn demands the participation of government, HMOs, industry and civil society, not just health care providers. And also partnership with others is essential. NHIS and HMOs organisations, alone, cannot solve these problems of the scheme; it takes at the very least, a system.
Addressing Nigeria’s health insurance gaps is a function that can unite citizens and governments, industry watcher say Nigeria can set in quality at the core of universal health coverage, through improving the National Health Insurance coverage, implementation of national policy and having an ideal clinic with good infrastructure spaces, needed equipment, information and communication technology, adequate staff numbers, adequate medicines and supplies, good administrative processes, guidelines, and collaboration support to ensure the provision of quality health services to the public.
Also, these industry experts have raised concerns stating that this singular act is majorly responsible for the systematic slowdown of expansion of health insurance in Nigeria.