The journey to universal health coverage in Nigeria has been a long one with twists and turns.
The first enactment towards a universal health coverage scheme in Nigeria was in 1988 when the then Minister for Health, Olukoye Ransome-Kuti inaugurated a committee that recommended a template for adoption. By the 1990s, medical professionals began to leverage this proposition to provide health solutions to Nigerians as Health Maintenance Organizations (HMOs). The first organization to do so is Total Health Trust Ltd. (THT), established in 1997 and began operations in 1998.
Building on this, Act 35 of the 1999 Constitution by the Federal Government of Nigeria established the National Health Insurance Scheme (NHIS). This was signed into law in May 1999 but became operational in 2005 after a review by the National Assembly in 2004. By this act, the NHIS became the umbrella body for all HMO operations and other health insurance initiatives in Nigeria
Today, there are about 60 HMOs in the country. HMOs are either publicly or privately incorporated entities registered by the NHIS to manage the provision of healthcare services through health care facilities accredited by the scheme.
Now over 20 years since the scheme kicked off, we examine how much progress the stakeholders in this industry have achieved through this service vehicle to improve nagging health care challenges in the country.
Total Health Trust (THT) is a leading HMO in Nigeria and is a member of the Liberty Group, which operates in 27 countries. As a very active player in the health insurance industry, the Chief Executive Officer, Kieran Godden shares their success story with our team in this interview.
Excerpts:
What are your high and low points since commencing operation in Nigeria?
The growth of our organization has been a remarkable one accentuated by various independent awards of recognition. The organization started 23 years ago as an idea and has grown to provide healthcare insurance services to about 500 employer groups as well as facilitate care for over 200,000 individuals.
You don’t grow unless you are providing the right kind of support and services to the people. I think that is a significant measure of success. As I reflect on how we started, I think a high point for us has to be the establishment of the health insurance industry. Before 1997, there was nothing like health insurance as a sub-sector, nor was there any national health insurance scheme. THT was instrumental to the progress in the industry that makes HMO solutions work in Nigeria today. The founders are proud of their contribution to helping health insurance grow as big as it has become over the last 20 years.
Are your products and services not available for the vulnerable especially those at the grassroots?
I mentioned that we had over 200,000 individuals that we manage. A portion of these are members of the public who are either on the Lagos State Health Scheme or the National Health Insurance Scheme (NHIS). We channel our efforts for the most vulnerable part of the population through these schemes. In this way, we are able to make a meaningful difference as the public sector schemes have the scale that enables this. If we were to act alone, we would be unable to have the reach that we currently do.
Read also: COVID-19: Stakeholders call for investment in Nigeria’s health sector
Nigeria has a population of over 200 million. Is that not a large market size enough to include every Nigerian in the available HMOs?
Nigeria indeed has a huge population. However, other variables influence the ability to sell HMO solutions to the market. In Nigeria today, many people do not necessarily buy into the idea of insurance as a concept. This unfortunate reality is due to the activities of bad actors in the past who have given insurance a poor image. These are significant issues affecting the adoption of insurance solutions, specifically health insurance. To the average Nigerian, the interest is there, but the will may not be. Some people have had instances where they subscribed to an insurance solution, and when they come to make their claims, the companies start with excuses why they can’t pay, simply because monies have been squandered and are then not available to settle the claims.
As a responsible organization, we understand these shortcomings and continue to do all we can to help people understand insurance and the value it adds to life. We believe that the more people are insured, the more they are empowered to pursue other tasks knowing that they have reliable cover for their health needs whenever it arises.
A fund was set aside as part of FG’s efforts at aiding a robust health sector. How much have you been able to access and in what aspect has THT benefitted from these funds?
The intervention fund of the Federal Government of Nigeria aimed at improving access to healthcare for the average citizen in the country. This was to be achieved by building clinics in underserved communities and funding health coverage for the vulnerable part of the population in the states.
In response to this, several states have rolled out health coverage schemes. These schemes helped the vulnerable people access these funds by registering them with primary healthcare centres in their localities. The schemes also work with other health facilities and partners to provide the care under a sustainable arrangement.
Like every HMO, we do not provide care but finance care. As such, HMOs do not have any direct access to the funds. The benefit to us from this intervention would be the increase in health provision in the country which becomes a win-win situation for both the government and HMO businesses. We believe that the more healthcare penetration the country records, the better for every citizen.
We partner with the Lagos State Government in administering healthcare insurance solutions on the state’s scheme. As partners, we assist to facilitate the care, vet claims, and manage payment authentications. We provide a service to the community this way, for which we are reimbursed. We have invested a significant amount of our own financial and human resources in this initiative, our small contribution to ensure that is has the best chance of success.
How has your firm delivered first-rate health plan and other services ahead of others in the industry?
As a business, we understand that even basic operations need to be done accurately to make solutions work. 98% of our claims are settled promptly and directly to the medical provider – not everyone gets this right. In Nigeria and across Sub-Saharan Africa, we have enabled access for our members to over 7000 hospitals as part of our network. This gives us significant leverage when addressing healthcare needs both locally and internationally. With an equally strong finance base and experienced staff, we have some of the best plan options for everyone.
In addition, we have pivoted our wellness solutions from physical activity to an equally engaging digital provision. As strong advocates for preventive healthcare, we have a team of doctors and nurses dedicated to catering to the needs of our members via a unique in-house solution powered by social media. Over the last year, we engaged over 6000 members on our scheme in virtual education, ranging from physical health issues to mental health management which is becoming a bigger issue globally.
Working from home has had unexpected negative consequences as well as benefits. People have been isolated and alone as they no longer have much contact with their colleagues. In addition, our homes were never geared up as work environments. People may also be spending far more time in the company of their family, which ironically may escalate work stress. Our role is to assist people with strategies to deal with the uncertainty and anxiety.
We believe that there are developing health issues such as hypertension, heart attacks, and cancer which are outcomes of the pandemic outbreak – these have been exacerbated by lifestyle changes. As a forward-thinking organization, we see the need to help people understand these issues and have adequate health coverage for them. We believe it’s not just enough to have hope against hope, but to have the information you need to make better decisions every day – especially health-wise. That is why we have provided cover for COVID testing and treatment from the start and continue to explore ways to ensure we are there for our members’ health needs.
Amongst other things, we also have digital solutions (such as telemedicine) designed to make healthcare provision more accessible anywhere, anytime. Beyond the leverage of digital and tech to provide healthcare solutions, we focus on developing our plans to provide proper comprehensive medical cover that assures our members that if something serious happens, we are there for them.
Nigeria as a country and Africa more broadly need to revive health care delivery and the health sector generally. The pandemic has cast the spotlight on our health infrastructure, and people have begun to realize the value of access to proper health care and proper health cover.
Could you tell us some of the services that you offer at THT?
We have a robust bouquet of healthcare plans. It includes our Liberty Health cover, Managed Care capitation plans, government-sponsored health insurance scheme, and third-party administrative services.
Our Liberty Health cover is a fee-for-service model designed for corporates and multinationals. This cover has a range of products from Nigeria only cover, to Africa-wide, to full global solutions. Generally, all the health plans mentioned above include day-to-day (outpatient), hospital (inpatient), and major disease benefits, as well as international emergency medical evacuation in the top plans.
Our Managed Care Capitation cover is a service model designed for SMEs and organizations operating with budget constraints. This type of cover also has a range of options with different benefits and pricing levels. This cover provides primary health care at all levels and certain forms of secondary or tertiary care.
We offer government-sponsored health insurance under the National Health Insurance Scheme (NHIS) pan-Nigeria and the Lagos State Health Scheme in Lagos. We partner with a wide range of providers such as primary care clinics, hospitals, specialists, and providers of ancillary services (e.g. X-ray centres, laboratories, etc.) to bring affordable healthcare to every Nigerian.
Our Third-party Administrative (TPA) Services cater for clients who require expertise in the management of their healthcare needs, such as outsourcing of their health care benefits to THT)
In terms of revamping health care sector in Nigeria, you mentioned infrastructures. What are the other areas we should be looking at?
Infrastructure provision is one thing; the supply of medical personnel is another.
There is a disturbing emigration of medical personnel from Nigeria, majorly driven by weakening power of the Naira and the increased demand for medical personnel in the western world. This is an unfortunate reality we have, but we must move beyond this as a nation and indeed as a continent. What we must do is begin looking inwards to address the reasons for these migrations. We have the brains and the people but not the platform.
We must start following through on reforms and agendas to keep our doctors and support them to build a healthier Nigeria. Every stakeholder in the public and private sectors must see our reality as it is and begin to commit to ensuring a gradual re-awakening. There is a lot of potential in what we can do with a functioning and attractive health sector. However, we must begin the rebuilding process by will and commitment.
