23 years after the launch of the National Health Insurance Scheme by the federal government, available statistics indicate that less than 10 per cent of the Nigerian population have registered for the scheme. Ebere Nwoji in this report looks at possible causes of this.
When the former President Olusegun Obasanjo in the year 2000 muted the idea of introducing the National Health Insurance Scheme (NHIS), the target was the formal sector, mainly the federal government workers benefiting maximally from it.
Indeed, the initial plan was that the government and the workers will in part benefit. However, 23 years down the line, the coverage of NHIS is still very poor as official statistics show that the penetration figure is still less than 10 per cent.
Against this backdrop, the government later introduced the State Social Contributory Health Insurance Scheme and the target was to increase the coverage of the health insurance scheme.
But this could not perfectly achieve the purpose, as the coverage of the health insurance scheme is still much below expectation with the result that to date, the government is still looking for ways of improving the scheme.
Meanwhile, managers of the National Health Insurance scheme said that despite the government efforts, more than 190 million Nigerians are still paying out of pocket to access medical services, which health experts said is forcing individuals, businesses, and households to incur enormous usually unplanned health expenditures.
Against this backdrop, private business organisations, mainly insurance firms started floating their own Health Management Organisations (HMOs) to cover the gap by bringing private individuals and those working for non-governmental organisations under health insurance cover.
For instance, Leadway Assurance launched its health management organisation tagged, Leadway Health Limited.
At the unveiling ceremony, Leadway Assurance said it has unveiled a range of healthcare service offerings targeted at improving and fostering access to quality health and wellbeing solutions for Nigerians.
The Chief Executive Officer of the organisation, Dr Tokunbo Alli stated that the introduction of Leadway Health would serve as a disruption and an exceptional redefinition of the delivery of reliable and affordable health care to the public.
Alli said with the introduction of Leadway Health Limited, a range of solutions in the firm’s kitty would help bridge the gap in providing quality, accessible, and affordable health services to Nigerians.
“We are confident in a healthcare system that genuinely cares for your health, your wealth and more. With nationwide coverage and seamless healthcare service on the go backed by a high-tech Artificial Intelligence (AI) application, quality customer service delivery that enables convenient access and smooth 24/7 support from a team of experienced and thoroughbred professionals, there is no doubt that our customers are assured of disruptive healthcare services and an exceptional delivery experience” he stated.
Alli further said that Leadway is in partnership with a leading pioneer of one of the most comprehensive West African Third-Party Administration and registered health maintenance organisations under the National Health Insurance Scheme (NHIS).
He expressed the belief that with this partnership, the new firm with over 1,500 health providers and a diverse range of bespoke corporate, retail and international products will be able to extend health insurance penetration to millions of Nigerians and Africa at large.
“We, therefore, enjoin individuals, families, business owners and corporates alike to come on board and experience healthcare delivery tailor-made to suit their specific needs”, he added.
AXA Mansard also unveiled its own health management organisation likewise Royal Exchange Assurance among others.
These are targeted at private-sector employers and employees to deepen health insurance penetration in Nigeria.
But despite these efforts, millions of Nigerians are still out of coverage of health insurance schemes.
The reason for this is not far fetched. For an average Nigerian, anything that bears the name “insurance” is like a gamble and any money committed to it in their view, has equal chances of serving the purpose for which it was paid.
Bearing this erroneous impression in mind, the greater number of Nigerians to date jettison insurance and its related products and schemes.
NHIS
This is the main reason the National Health insurance scheme has suffered significant setbacks in terms of patronage. The NHIS, though bears the name insurance, is not managed by conventional insurers. A recent investigation by THISDAY on why many Nigerians have not keyed into the scheme showed that many Nigerians are ignorant of the benefits inherent in insurance.
The National Health Insurance scheme also called statutory health insurance is health insurance that insures a national population for the costs of health care.
It is usually instituted as a program of healthcare reform enforced by law. It may be administered by the public sector, the private sector, or a combination of both.
Funding for the scheme differs from one country to another.
Health Insurance in Nigeria
Here in Nigeria, the scheme functions as a social health security system in which the health care of employees in the formal sector is paid for from funds created by pooling the contributions of employees and employers. The formal sector in this regard consists of the public sector, organised private sector, armed forces, police and allied services, students of tertiary institutions and voluntary contributors. Healthcare providers under the Scheme provide the benefits package to the contributors such as outpatient care including necessary consumables.
The scheme from inception was aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.
The scheme established under Act 35 of 1999 is totally committed to securing universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians, especially for those participating in the various programmes/products of the Scheme.
Unfortunately 23 years down the line, available records said that less than 5.3 million Nigerians have keyed into the scheme out of over 160 million population of the country. These are mainly public sector workers.
This is so despite the fact that today, many pregnant women die during childbirth in their bid to patronise quacks and traditional mid wives even in urban areas of the country like Lagos. It is so pathetic to know although many children die of diseases like measles, chickenpox malaria due to a lack of quality medical services, a report of a recent poll conducted by a foreign nongovernmental organisation {NGO], ‘Save The Children’ said that only about 21 per cent of Nigerians have access to the health insurance scheme. The report also said one in five children in Nigeria dies before their fifth birthday. And that nearly two million children have lost one or both parents to an AIDS-related disease.
Benefits
But guidelines on the NHIS listed benefits in the scheme as prescription of drugs, pharmaceutical care and diagnostic tests as contained in the National Essential Drugs List and Diagnostic Test for the workers and their families,
Provision of maternity care for up to four live births for every insured contributor/couple in the Formal Sector Programme; provision of preventive care, including immunisation, as it applies in the National Programme on Immunisation, health education, family planning, antenatal and postnatal care among others.
These benefits go to participants in the scheme on payment of a token but despite this many Nigerians are still alienated from the scheme. They rather patronise quacks and roadside drug vendors and native medicine men and women.
But the scheme managers had before now promised that by December 2015, they would ensure that all Nigerians registered.
NHIS and MDG
It is now 2022 and the extent to which the set goals have been achieved remains a question. Meanwhile, there were reports that the NHIS with funds from the Millennium Development Goals (MDGs) office has put up to 600,000 pregnant women and children under five in six states on health insurance as well as started in six other states with funds from the Debt Relief Gain (DRG).
It was reported that the pilot project, which enlisted over 300,000 vulnerable women and children, took place in Gombe for the North East, Sokoto for North West, Niger (North Central), and Oyo (South West), Bayelsa (South-South), and Imo (South East).
The effort of the scheme managers in this regard was confirmed by an insurance expert and Managing Director of Risk Guard Africa, Mr Yemi Soladoye.
Soladoye who is an expert in the development of grassroots and retail insurance in Nigeria said though the figure of Nigerians who have keyed into the scheme may seem low, the scheme managers are not performing badly.
According to him, his thorough study of the plans and activities of the scheme managers shows that they know and understand where they are going and what they are doing. He said they have a good structure on the ground.
Expectations from Managers
He however said what the scheme managers need to do to ensure that many more Nigerians key into the scheme is to push for the review and amendment of the act that set up the scheme which he said was weak in content and could not compel Nigerians to key into the scheme.
According to him, the use of the word “may” in place of shall or must in the act establishing the scheme has created a loophole for Nigerian employers and the employees to escape from keying into the scheme.
He also advised the managers to seek collaboration with the National Insurance Commission and insurance companies in order to use the branch network and marketing system of insurers to market the scheme to Nigerians.
Giving reasons for the non-patronage of the scheme by many Nigerians, former Executive Secretary, NHIS, Dr. Dogo Mohammed, explains, “The first challenge is the Act, which has a lot of inadequacies and until the right amendments are done, we will not be able to have a very strong legal document to operate.”
The NHIS: 8
According to him, “The Act establishing the NHIS makes social insurance optional. From experience, quite a number of potential participants are not participating. Because it is not mandatory you find out that despite our advocacy to states and local government areas (LGAs), they are not doing anything about joining the scheme. And the only way we can make it mandatory is to amend the Act, “he stated.
The Act and Membership
“Since 2006, attempts have been made to get this Act changed. The name of NHIS will change because we have realised that the Act gave the scheme a very difficult name to operate. The Act as it does not cover private insurance, the vulnerable group (women and children) but only the formal sector, public servants.
“If we want the NHIS to regulate all the various fields either in the social health insurance, or the private or vulnerable groups, it cannot just be a scheme, it has to be an agency that is going to look like an authority that can monitor various schemes in the country that are to be established, “he stated.
The NHIS boss said the second major challenge towards making the scheme universal is the three tiers of governance in the country.
Eligible members of the scheme include employees of the public and organised private sector employing 10 or more persons shall participate in the Programme
Contributions into the scheme are earnings-related. The employer pays 10% while the employee pays 5%, representing 15% of the employee’s basic salary. However, the employer may decide to pay the entire contribution. In accordance with the existing contractual agreement between employers and employees, especially in the organized private sector, an employer may undertake extra contributions for additional cover to the benefits package.
