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A private sector driven investment climate and mandatory health insurance appears to be the solution to Nigeria’s debilitating health sector as government shows itself incapable of providing an environment for quality healthcare delivery in the country.
Currently, a little over eight million Nigerians are covered by any form of health insurance, representing less than five percent of the country’s over 190 million population.
However, majority of Nigerians cannot afford the out of pocket payments at hospitals, making it imperative that the entire country, or at least a substantial part is covered.
BusinessDay findings have shown that the National Health Insurance Scheme has since 2014, barely captured 4 million Nigerians (working in the civil service), with private sector insurers having about 4.5 million enrolees.
Industry sources however opine that, when health insurance is made compulsory, market driven, and properly regulated, the resulting competitiveness will be the making of a new health sector in Nigeria.
“The idea of universal health coverage was initiated by the Obasanjo administration. This of course led to the creation of National Health Insurance Scheme (NHIS). The aim is to ensure that all Nigerians irrespective of gender, social standing or income are given the opportunity to access care with ease whenever the need arises.
“It is a shame that (since then) the population of Nigerians that have signed on in terms of percentile are not up to 10 percent. Even five percent I suppose, but this is 2018 for God’s sake,” a rather disappointed Ogbonnaya Igbokwe, CEO, Heartwells Group, told BusinessDay.
Francis Faduyile, president, Nigerian Medical Association, also reiterated that “Today, enrolees are so few. But if we can open up and get more enrolees, I am sure that the national health insurance will help in achieving the Universal Health Coverage.”
Currently, Nigeria is ranked 187 out of 191 countries, and Faduyile explained that for the country to improve there is a need to encourage more private sector driven operators, “in such a way that once the sector is properly deregulated, private institutions can have their own enrolees, whom they can cater to. And with these if we have the federal government, state government and the private sector coming into health insurance, it will help in achieving the universal health coverage.”
Tope Adeniyi, CEO, AXA Mansard Health Limited, also told BusinessDay in an exclusive interview that, with competitiveness, and compulsory health insurance, more health insurers and particularly medical centres will be striving to offer the public the possible best in terms of facilities and infrastructure.
“The health insurance system itself is not mandatory, but still optional. Some employers can do without health insurance for their staff and family members, even individuals do not possess health insurance.
“However, it is just reasonable that health insurance is in fact a priority list in terms of being mandatory by all employers of five and above just like we do in pension. Just like we do in other critical areas of people’s welfare, health should come on top. So by law, it should become mandatory so as to make sure that people understand that this is very important,” said Adeniyi.
Some state governments however appear to be taking the lead to reform the health sector by making health insurance mandatory.
A document exclusively made available to BusinessDay, indicated that 15 states are in the process of implementing their legislation on compulsory health insurance.
They include; Lagos, Cross Rivers, Kwara, Delta, Oyo, Abia, Anambra, Bauchi, Ebonyi, Kano, Ogun, Sokoto, and Kaduna. In two places; Bayelsa, and Abuja, FCT, they are currently implementing Health Schemes, however legislation to transition to SSHIA is in progress.
Other states with “on-going plans” to make health insurance compulsory are Adamawa, Akwa Ibom, Ekiti, and Enugu. Those with “Legislation in Progress” are; Benue, Borno, Edo, Gombe, Imo, Jigawa, Katsina, Kebbi, Kogi, Nassarawa, Niger, Ondo, Osun, Plateau, Rivers, Taraba, Yobe, and Zamfara.
In the case of Lagos, whose plans appear to have been widely circulated, Igbokwe described it “as quite commendable, and a step in the right direction. However, a lot of work still needs to be done.
“The scope of coverage and the capitation costs must be looked at very closely if the objective must be realized,” he said.
Many experts also emphasised the need for a truly competitive health insurance sector, in order for the public to get the best services. One source who pleaded anonymity said, “Very soon, PENCOM will open the window for people to choose (their preferred PFA). So you can choose your administrator at any point in time. In the same vein you must be able to choose your HMO.
“This will invariably make the HMOs to step up their game. So in the instance of complaints such as HMOs not paying hospital, by the time the enrolees move the next month or next three months, what will happen? It is either they swim (by getting competitive) or sink (by remaining complacent).
You either drown or you swim back to life. It is the view of industry sources that it is very easy to improve the quality of service delivery by HMOs by simply “giving power to the users”. Until this liberalisation of the sector is done, the country may continue to struggle with under-performing HMOs.
In the same vein, when hospitals are aware they can be easily dropped by users on account of poor services, they will also have to either innovate to survive, or get run over by the competition.
