Nigeria’s inability to make efficient its health insurance scheme and expand it particularly to the informal sector is affecting the country’s health indices and will continue to keep it far away from attaining Universal Health Coverage (UHC).
Experts are worried that after 59 years of independence, Nigeria still ranks low among the World Health Organisation (WHO) member nations – yet, the National Health Insurance Scheme (NHIS) on which has been heaped the burden of enhancing access to quality and affordable health care for all Nigerians covers just less than 10 percent of Nigerians after 14 years of its establishment.
The NHIS scheme which only came into force in 2005 had a major target of providing universal coverage for all Nigerians by 2015, but it has not been able to ensure citizens have access to health care services as many die daily of curable ailments, aside from huge medical costs and losses to medical tourism. Over 90 percent of Nigerians are not in the insurance scheme, according to available figures.
Runcie Chidebe, executive director of a cancer fighting organisation, Project PINK BLUE, regretted that the greater percentage of Nigerians are the informal sector operators who also are major drivers of the economy but, unfortunately, have not been incorporated into the health insurance scheme.
“Nigeria cannot have a healthy economy if the major contributors are not healthy,” Chidebe told BusinessDay.
Quoting the International Monetary Fund (IMF) report in 2017, he said the Nigerian informal sector accounted for 65 percent of Nigeria’s GDP but is still neglected in the scheme.
He regretted that Universal Health Coverage cannot has remained a hard nut because the Nigerian government has failed to make health insurance a priority.
“It is a shame that we live in a country where vehicle insurance is mandatory, but health insurance is not. What is our priority – to protect the vehicles or people driving the vehicles?” he queried.
“We have over three agencies checking vehicles worthiness. But we have only one agency checking for the health insurance of Nigerians. The truth is the Nigerian government, both federal and state, does not see healthcare as a priority. Until, we make health of Nigerians a priority, Universal Health Coverage will continue to be on the pages of newspapers,” he added.
Chidebe is of the opinion that the NHIS can cover more Nigerians if it deploys community insurance and invests in creating awareness and educating Nigerians to know the benefits of health insurance.
John Onyeokoro, a consultant to the National Assembly Committee on Health, is of the opinion that government has not done enough yet.
He said the best way to reach the informal sector which accounts for over 90 percent is through various associations and groups like the NLC, traders’ association, okada riders association, etc, advising NHIS to come up with incentives to ensure compliance.
Onyeokoro added that to ensure continuity, NHIS must compel service providers to deliver quality services, saying the only way people will be stay on the scheme is if the service provided is of good quality.
“The HMOs often delay payment to service providers and the doctors end up treating the patients on credit. Because of this delay, they tend to discriminate,” he said.
He advised the NHIS to pay service providers directly if “the HMOs will complicate the mandate of the NHIS which is to ensure available and affordable health care delivery to all Nigerians”.
But an NHIS official who spoke to BusinessDay explained the difficulty in expanding the scheme and bringing the informal sector onboard. He said the insurance scheme, as it is today, basically is designed to cater for the formal sector, government workers, and that bringing the informal sector has proved impossible.
According to the official, who is a reliable authority in the scheme, NHIS has over the years designed several projects to accommodate the informal sector which constitutes a larger percentage of the Nigerian populace but has failed.
He explained that the NHIS operates like any insurance and requires some upfront regular remittances, but tracking the revenue of the informal sector is difficult which has made their incorporation into the scheme almost impossible.
The official, who pleaded anonymity, added that the scheme has developed several programmes for every segment of the society including the retirees, the petty traders, artisans, people living with disability, prisoners, farmers and the likes with no success recorded.
He explained that the counterpart fund for capitation which is about to be reviewed to 15 percent and would require that the employer pays 10 percent while the employee pays 5 percent is very easy to track because salaries are being paid from the office of the Accountant General, hence government can easily remove the percentage even before salary is paid and brought to NHIS.
“But how can you track the revenue of the informal sector? Do you know how much the okada man outside earns daily or the petty trader?” the official queried.
“So, it’s difficult to bring the informal sector together to get the part payment, but in civil service it is very easy because there is a legal backing,” he said.
The official pointed out that the belief system of most Nigerians is also not encouraging the growth of the scheme as most Nigerians still don’t believe in orthodox medicine but rely only on herbal.
He informed that the NHIS is, however, working to reform the scheme and weed out some fraudulent Health Management Organisations (HMOs) who do not remit capitation fees to the service providers. He confirmed that four have already been de-listed and assured that the hospitals which discriminate against NHIS patients will also be de-listed in the process.
He said NHIS management has already asked the service providers to compile the list of all HMOs that owe them with evidence and NHIS will compel payment.
“Capitation is a game of numbers. The more people use a hospital, the more monthly capitation they get. So, if nobody uses the service, the money becomes the hospital’s; so they are fraudulently trying to maximise profit, that is why we advise people to use the service because we have observed that it is underutilised,” the official said.
The official further disclosed that the review of the scheme’s operational guidelines would also involve cutting down the present 15 percent contribution by employees of government and private sector participants.
After the review, government is likely to pay 3.5 percent while the civil servant will pay 1.5 percent from the consolidated salary, he said, adding that the scheme will expand to accommodate more ailments that were hitherto not covered by the scheme.
But despite efforts which NHIS claims it has put into the process, experts fault the inability of the government to bring the informal sector into the health insurance scheme.
Experts call for an overhaul of the scheme as many individuals have no faith in the scheme while even consumers complain that many diseases are not covered and they are given substandard drugs and that that treatment from accredited hospitals is often shabby and questionable.
GODSGIFT ONYEDINEFU, Abuja
