Health service delivery in Nigeria has endured one of its biggest squeezes due to the silence over unresolved allegations of corruption in the sector.
As the crisis rocking the National Health Insurance Scheme (NHIS) lingers, many Nigerians have been struggling to access healthcare services. NHIS was set up to, among other things monitor the Health Management Organisations (HMOs) in the discharge of their functions in the envisaged new health delivery structure. But with its current state, it has been unable to carry out this role.
However, it is hoped that the submission on Monday 24th December of the investigate report from the Presidential Independent Fact-Finding Panel on NHIS Executive Secretary will help resuscitate the health insurance scheme before it collapses.
“It is our belief and aspiration that our recommendations will reposition the scheme and proffer solutions to the challenges that have hindered the scheme in achieving its laudable objectives,’’ the Chairman of the Panel, Bukar Hassan, said while submitting the report to the Secretary to the Government of the Federation.
The biggest fallout of the crisis has been that the hospitals, which actually provide the services, are now in the red. BusinessDay investigations revealed that because of the crisis, the HMOs have not been making payments to the hospitals or healthcare providers for services rendered many months ago. The hospitals in turn have been complaining about the delays, which, according to them has slowed down healthcare services provision to affected patients.
“The crisis at the NHIS is affecting the whole healthcare insurance business,” Umar Sanda, president of Healthcare Provider’s Association of Nigerian (HCPAN), said in a telephone interview. “There is lack of payment disbursements from the HMOs and payment has been delayed,” he explained, adding: “The enthusiasm to do the work has reduced.”
A medical practitioner based in Lagos, who pleaded anonymity, lamented that the crisis at NHIS could truncate the health insurance scheme in the country.
“The bills are piling up and they have not been paying, if this crisis is not properly managed effectively, the beneficiaries from the HMOs may not receive treatment and will be expected to pay out of their pockets,” he said.
These trends in the sector are already scaring away some clients, a development that calls for a speedy response to restore sanity in the industry. “The last time I used the services of HMO was in 2014, the service was supposed to cover myself and my wife but when my wife goes to the hospital from time to time they usually ask her or me to contact the HMO” said Adedeji Muftai, a civil servant.
“When we even reach the HMO, it takes a long time for them to resolve the challenge. Even at that they might not give you any drugs, they will tell you that the drugs are not available or that it will be available next week before you can get them” Muftai explained.
The on-going crisis may also have contributed to the slow pace in health insurance coverage in the country, according to health analysts. As at now, the NHIS has managed to enrol just about 4 per cent of Nigerians, which is roughly 7.9 million of the 198 million populations, according to the latest estimate by the Nigerian Bureau of Statistics (NBS).
Sanda, for instance, believes that the current events in the industry pose a threat to Nigeria’s aim of attaining complete health coverage. “The whole health sector is still at a standstill as regards insurance and it puts the country more at losing its strength in the target of the universal health coverage,” he said.
Some of the subscribers to the health insurance scheme, including Muftai, already feel that it is not working for them. “Assuming someone is dying, will the family wait for one week before the person can get drugs?” he asked. “At the end of the day you find out that what you do is to pay for the service out of your own pocket. We pay for our drug, so the HMO is not working for me.”
Solutions to the challenges
Baring whatever recommendations the investigative panel may have come up with, industry watchers say Nigeria can introduce quality at the core of universal health coverage, through a number of measures. These include increasing the National Health Insurance coverage, implementation all the national policies that have to do with the health sector, improving health infrastructure, and good administrative processes.
Sanda also believes that part of the solution to the problems in the sector lies with a review of the NHIS Act, especially with regards to the slow progress in expanding care provision under the Scheme “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 new Act must make NHIS compulsory for us to move forward.”
He argues that healthcare services have been dull because the state governments that are supposed to key into NHIS have failed to respond, which has affected healthcare provisions generally, according to him.
ANTHONIA OBOKOH
