Mandatory health coverage grows in popularity as economy bites

…Weak enforcement remains a challenge

Mandatory health coverage in Nigeria is witnessing a growth in popularity as economic hardship lures more people towards cost-effective healthcare plans.

Nigerians looking to reduce their out-of-pocket health expenditure are gradually subscribing to government-run health insurance plans such as the Eko Social Health Alliance initiative.

Emmanuella Zamba, permanent secretary of the Lagos State Health Management Agency, told BusinessDay that there has been an uptick in public interest since the National Health Insurance Act 2022 made health insurance compulsory and placed states in the lead role for implementation.

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Over 923,000 residents have enrolled under the scheme, which pegs enrollment at N8,500 per individual and N40,000 for a family of four children under 23 years old.

“We have seen a lot of improvement but we still have a long way to go. We are rolling out initiatives to encourage people to enroll and I’m convinced that it will get better as we progress,” Zamba said.

Overall, Nigeria still has less than three percent of its population covered under healthcare insurance.

Some stakeholders believe there are hurdles including the weak enforcement of the Act that could hinder its ability to achieve universal coverage in Nigeria.

Despite initial expectations of a significant increase in insurance participation, private health insurers are particularly concerned over the lack of enforcement and understanding of insurance principles among Nigeria’s larger populace.

They are also worried that excluding private insurance from basic health services may limit resources for expanding coverage, especially at a time of high national need.

Eddie Efekoha, group CEO of Consolidated Hallmark Holdings Plc, said the enforcement of the Act is critical for successful policy implementation.

Drawing parallels with the Pension Act, he stressed the importance of compelling compliance through enforcement mechanisms, warning that the Act could become just another dormant policy stalled by ineffective implementation.

“It’s a stepping stone that we have a policy that says everyone should have a health plan. But a lot of the population does not yet see value in it. What made the Pension Act successful today is that you can’t apply for any government contract without attaching evidence that you have paid your pension. So to that extent, people are compelled. That is the enforcement. So this plan for the health sector needs enforcement,” Efekoha said during the third edition of the annual stakeholders’ engagement convened by Hallmark Health Services.

The forum explored integrating customer-centric technology for enhanced access and affordability as an approach to transforming healthcare delivery in Nigeria.

Modupeola Ogundimu, director of the National Health Insurance Authority, Lagos Zone and one of the speakers, emphasised that a robust technological solution, coupled with strong policies, collaboration, and an enabling environment are key ingredients for achieving a successful and sustainable healthcare system in Nigeria.

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According to her, such solutions should be cost-effective, user-friendly across devices, and adaptable for all stakeholders.

She said it should utilise application programming interfaces for easy integration and enable functionalities like claims management, fraud detection, benefits verification, and user enrollment.

It should support hosting a national Electronic Medical Records system, she added.

In terms of collaboration, Ogundimu said the government, regulatory agencies, healthcare institutions, and all stakeholders must work together.

She explained that this aligns with the renewed hope agenda of the current administration, which prioritises affordable and accessible healthcare.

She also stated that formulating policies is not enough. The government and regulatory agencies must ensure these policies are implementable and followed through.

“An enabling environment with proper resources for technology is essential. Addressing power issues and other infrastructural limitations is crucial for a fully automated healthcare system,” Ogundimu said.

Speaking on Lagos State’s efforts to achieve universal health coverage by increasing health insurance enrollment, Tosin Awosika, coordinator of regulation at the Lagos State Health Management Agency (LASHMA), said the state still faces low enrollment.

Currently, less than 3 percent of Lagos State’s over 20 million residents have health insurance, resulting in low enrollment results and insufficient revenue to sustain the healthcare system, he said.

However, there is an upcoming executive order that will require residents to show proof of health insurance for certain social services, Awosika said.

The government is also taking several steps to address these challenges, including allocating funds to cover premiums for vulnerable residents.

It is upgrading and building healthcare facilities to improve access to care while decentralising healthcare administration through the creation of six healthcare districts.

Emphasising the importance of collaboration with all stakeholders, he said partnerships with health maintenance organisations are crucial.

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He also noted that a tripartite committee and a technical working group have been established to integrate the private sector and develop a successful implementation plan.

Technology will be used to manage the healthcare system for a large population as LASHMA seeks discussions on improving efficiency and cost-effectiveness.