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Why Nigeria must strengthen its health insurance regulations

It is now 20 years since the National Health Insurance Scheme (NHIS) was established to regulate the country’s health insurance industry.

Designed as a Public-Private Partnership, it has as the remit of providing accessible, affordable and qualitative healthcare for all Nigerians.

Health Insurance is a system of advance financing of healthcare expenditure through contributions, premiums or taxes paid into a common pool to pay for all or part of health services specified by a policy or plan. Act 35 of the 1999 Constitution established the National Health Insurance Scheme in Nigeria.

NHIS started operation under the National Health Insurance Scheme Act, Cap N42, Laws of the Federation of Nigeria, 2004 with the broad objective of providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.

The body is also set up to regulate private health Insurance operated by HMOs with 60 HMOs currently registered under the scheme.

It was created to provide a social security system that guarantees the provision of needed health services to persons on the payment of a token contribution at regular intervals.

It is primarily a risk-sharing arrangement that can improve resource mobilisation and equity in the healthcare sector.

Why set up a regulatory body?

A regulatory body for a scheme where participants pay a fixed regular amount for a pre-payment plan is essential to avoid abuse. The funds are pooled, allowing the Health Maintenance Organisations (HMOs) to pay for those needing medical attention hence checks are important to ensure the best value is derived.

A struggling 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 with other members of the African Union 18 years ago – the Abuja Declaration – to allocate at least 15 percent of its budget to improve the health sector.

Fifteen years after the inception of the scheme, the NHIS has managed to enroll about 4 percent of Nigerians, which is roughly 7.9million of the 198million population according to the latest estimate by the Nigerian Bureau of Statistics (NBS).

This compares poorly with smaller African countries that have ramped up enrolment on their national health insurance schemes leading to a sharp decrease in out-of-pocket expenditure on health. In Rwanda, out of pocket expenses as a share of health expenditure is only 18 percent and South Africa with 54million people have covered over 9.1million people.

The scheme continues to be bogged down by policy somersaults, ineffective operational guidelines, corruption, inefficiency and bureaucratic bottleneck 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, HMOs and the hospitals.

This has in turn left out many people who may require these services but lack the necessary awareness and education to get health care insurance for themselves and their families.

The Health and Managed Care Association of Nigeria (HMCAN) said in an interview that the unfavourable developments emanating from the NHIS signals a lack of political will, a need for leadership restructuring, and proper description of the responsibilities of all stakeholders and the regulator.

The sustainability and viability of a country’s economic and social growth depend largely on a vibrant healthcare sector hence the need for federal and state governments to make health insurance compulsory and affordable to the citizenry. This can be achieved by improved funding of the sector and subsidizing the premiums paid by the citizens.

Other steps that can be taken to further strengthen the scheme includes more supervision and sanctioning of erring HMOs and hospitals, increased accountability and advocacy to convince Nigerians that the health insurance scheme can work.



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