Femi Thomas, executive secretary of National Health Insurance Scheme (NHIS), in this interview with DANIEL OBI, Brand Editor, gives insight into the partnership with MTN, and ways the new partnership will afford Nigerians quality health care services. Excerpts:
In 2012, the United Nations (UN) adopted a resolution emphasising health as a valuable element of sustainable development. What is the relationship between that and the National Health Insurance Scheme (NHIS)?
The history of national health insurance dates back to 1999 when an Act was signed into law, it was a decree and it later became Act 35 of 1999 and that actually came before this concept of Universal Health Care (UHC). NHIS Act was actually the beginning of what is now seen as UHC. UHC emphasizes three elements: removing financial barriers, removing physical barriers and ensuring quality of service. This is actually a way of looking at the totality of health in Nigeria or the world over. Where NHIS is asked to remove the financial barrier, there are other segments of the health industry that are now to remove the physical barriers and to ensure quality. That is the responsibility of both sides. The demand side and supply side.
Where does the insurance beat come in?
Health insurance is to ensure the removal of financial barriers; that means, people can have unfettered access to good health care without doing what is known as out-of-pocket expenses. But more recently, a committee of Ministers of Health in Africa met in Angola and there they decided that UHC must be attained in Africa by the year 2025 but in Nigeria, we are saying we should be able to achieve that by the year 2020.
How has the financing been so far?
The journey has not been very smooth. Presently, the level of coverage is very low. We still operate at single digit although government has expended close much on this sector in the last 15 years. The impact has not been very commensurate with what the government has put in. That is the whole essence of what we are doing, we are trying to get innovative ways of moving out of that situation because the neighbouring countries are not waiting for us anymore. Ghana has coverage of as high as 60% now, Rwanda has coverage of over 97% while Nigeria is still very low but I believe that the story will change in the next few months.
Apart from the innovation, what is NHIS doing in terms of educating the populace; is education an aspect of the scheme?
Education goes with advocacy; it goes with publicising our activities, programmes and policies. Recently, a presidential summit on Universal Health Coverage was held and we did high level advocacy to the governors, members of the House of Assembly, the Senators, the Reps, the Presidency and everybody in the country and the International Development partners that was one level. At another level, we move out from our offices to meet the relevant stakeholders, the state governors, commissioners for health, and commissioners of education in the states. So also, at the zonal levels, we have zonal officers who move out to relate with government officials, relate with people in organised private sectors, talking about SMEs. We relate at that level. At state level, our people actually go out to meet with people in the industry and various facilities telling them about health insurance, we also do community-based health insurance, we go into communities, especially communities that are hard to reach to launch community-based health insurance and also to educate them about health insurance. We are going to do that in four local government areas per state, this year.
Do you think that its link with insurance scheme will have any adverse effect on it, because of the general apathy to insurance in the country?
Well, I think it is not only in Nigeria, it is so all over the world; it is only about enforcement. It is only when you enforce it that you see people doing the right thing. Hardly will you see people who will love to pay for something they do not need immediately. Health insurance is one of such products; where you are being asked to pay for something you will only need later.
What is the scope of coverage, considering our target audience especially the under-privileged who are mainly rural dwellers?
Let me say with all sincerity that 80 percent of the diseases can be taken care of at primary level. When we target the primary level, we are targeting 80 percent of the diseases in the body. Beyond that, we do referral system where cases that cannot be handled at primary level are referred to secondary and tertiary level and there is what we call ‘fee-for-service’ that we pay through the HMOs quarterly for that kind of service. Presently, we have full coverage at primary level, some coverage at secondary level and some at tertiary level. Particularly this year, being a centenary year, we have a special programme for this year where we are tackling 100 major cases that are cardiac-related, major orthopaedic operations, major renal operations including transplant; the diseases mentioned will all be treated in its hundreds to align with the centenary. All those things are going on right now and it is our intention to complete all, this year.
What is the basis of the tripartite arrangement among MTN, NHIS and Salt & Einstein that we have in place now?
We have a situation where Salt and Einstein is linking up with the big player, MTN, for us to partner and have access to their database to be able to reach out to those who will be covered under the scheme. It is a fantastic offering and we are really very ready to go along that line because we expect that this partnership will add some millions to our enrolment bank. That is something that will be very substantial at this time.
And beyond that, we have also given ourselves target: to achieve this goal by 2020. We are targeting 40 percent coverage by the end of next year. It is expected that this partnership with MTN will accelerate and help us to go beyond that. So the possibilities of failure are very slim considering our partnership with the big player MTN and its over 58 million subscribers.
In recent times, a lot of Nigerians have been noted to invest heavily in medical tourism. Is there any way this partnership is going to have an impact on that trend?
There is collateral advantage that goes with health insurance. Even though the primary aim is to target primary ailments like I mentioned earlier. You will get to know that because of the level of awareness people will stay within the country to take care of themselves because there are people who fly out for ordinary headache. If all these things can be taken care of locally, you will see that even the cost of manpower will reduce, the cost of equipment will reduce, the cost of consumables will reduce and then the consumption patterns for medical items will change. You will now see a situation where pharmaceutical industry will be able to produce more because of increase in demand. More and quality equipment will also fly in because of increase in demand; it will also get to a point where equipment will be assembled in Nigeria. These are collateral interests that go with it.
What is the relationship with HMOs and what role do they play in the loop, relative to your mandate?
Well, when it comes to health insurance in Nigeria, we have the NHIS as the health regulators relating directly with the HMOs and the HMOs relating with the facilities, and to close the loop, NHIS also relates with the facilities especially getting feedback.
Is accreditation part of the mandate?
Yes, it is part of the mandate. We do accreditation and re-accreditation.
Why the preference of MTN to push this scheme?
The truth is that MTN is a major player in the telecommunications industry in Nigeria. We all know that MTN has a database of over 55 million subscribers. We want to leverage on that platform to reach out to Nigerians and enroll them for the health insurance scheme.
What should Nigerians look forward to from this partnership with MTN?
Improved NHIS; new NHIS; improved healthy living, and improved health indices over time.
By this time next year, what level of penetration should we be expecting?
We have the directive of the President to hit 30 percent by the end of next year but with this new partnership with MTN, I believe we will hit 40 percent. We have two major projects now. Public school enrolment which will take us to 17 percent by December, and by next year we will be targeting the pregnant women nationwide and children under 5 years. That will take us to 42 percent.
