Despite being in operations for over 10 years, National Health Insurance Scheme (NHIS) seems to be failing in meeting its stipulated objectives, as Nigeria still ranks low of 187 among the World Health Organisation (WHO) ranking of 191 countries.
The NHIS was expected to provide social and financial risk protection by reducing the cost of health care and providing equitable access to basic health services to the most vulnerable populations in Nigeria, including children, pregnant women, people living with disabilities, elderly, displaced, unemployed, retirees and the sick.
Although these vulnerable groups sometime benefit from free health care services and exemption mechanisms, however, they largely have to pay for health care services. Free health care services and exemption mechanisms are often politically motivated, and are poorly implemented, and do not become fully operationalised, and sometimes only last a few years.
Key among its failures is the non-realisation of the objective of making health care available to Nigerians at an affordable cost as many Nigerians still pay out of their pocket for medical expenses, a scenario which has continued to drive many families to catastrophic health expenditures and poverty.
As of February 2018, the country was ranked 187 out of 191 countries in the world in assessing the level of compliance with the Universal Health Coverage (UHC), as very few of the populace are health insured, whereas even government provision for health is almost insignificant.
The NHIS was set up with the objective of making health care accessible and affordable to many Nigerians. The scheme was aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems and also to improve the health status of Nigerians, especially participants of the Scheme.
A report by the second largest professional services firm in the world PricewaterhouseCoopers states that “Access to affordable healthcare continues to be a challenge for most Nigerians due to high levels of poverty and significant reliance on out of pocket payments.
“Health Insurance coverage throughout the country has barely scratched the surface in terms of the country’s population,” the report noted.
PwC the report further stated that several issues contribute to the failure of the scheme, which includes financial constraint, substandard services from the hospitals, poor patronage due to the reluctance of corporate bodies to engage in the scheme and many other reasons.
Another report released by Axa Mansard Plc a member of the AXA Group, the worldwide leader in insurance and asset management showed that Nigeria’s NHIS which was first mentioned in 1962 and implemented 27 years later in 2005 is yet to fully deliver its purpose as a greater part of the populace is yet to access good healthcare much less health insurance.
Another alarming factor was a report by NHIS, which revealed as at 2016 the scheme covered less than 5 per cent of the population and the 5 per cent was largely made up of Federal Government employees and their dependents.
10 years after its existence, the lofty objective of NHIS is still being undermined by many factors ranging from inadequate legal framework for a successful scheme, to poor implementation of the Act, poor government funding of health, Optional enrolment policy, inappropriate practices by the regulatory agency, and lack of political will.
Several statistics also reveal that Nigeria has one of the worst health care delivery records in the world. As of 2017, Nigeria was rated 187th out of 191 countries in terms of health care delivery, according to WHO. It said that one-third of more than 700 health facilities have been destroyed in the country and about 3.7 million people are in need of health assistance.
The health body placed Nigeria at third highest in infant mortality rate in the world. Medical experts described as worrisome the recent figure released by international agencies which put Nigeria’s maternal mortality rate at 58,000 in 2015. This showed that Nigeria recorded the second highest maternal death rate in the world.
Tope Adeniyi MD/CEO, AXA Mansard Health Limited in an interview said “While the adoption health insurance adoption is at its growing stage although it is not yet as significant as we expect it to be, but it is still growing gradually. There is huge opportunity and potential for the health insurance adoption in Nigeria because it is necessary for citizen of every economy to be healthy as health is paramount to productivity”
In order for the health insurance scheme to function properly, stakeholders have said there is a need to first reform the health sector and effect necessary changes in services provided, infrastructure, manpower and policy framework.
It is also recommended that for improved efficiency and sustainability, the scheme requires adequate funding besides its premium payment while there should be outlined policies guarding the scheme as well a feasible and viable framework.
Furthermore, health insurance must be made compulsory in various organisations, accommodating a reasonable number of dependents while those enrolled in the scheme must be compelled to pay a percentage of their income to the cause of the scheme.
