TOWARDS UNIVERSAL HEALTH COVERAGE IN NIGERIA

May 2022 signifies a landmark in the healthcare delivery history of Nigeria as the National Health Insurance Scheme (2004) was repealed by the National Health Insurance Authority (NHIA) Act. The golden provision in the new legislation is that health insurance coverage has been made compulsory for all Nigerians and the country’s legal inhabitants. It is a laudable provision as it has provided a legal foundation for large scale uptake of health insurance coverage in Nigeria – a step toward the attainment of Universal Health Coverage (UHC) in Nigeria.

UHC connotes a situation where everyone has access to the health care services they need, when and where they need them without any financial difficulty. The National Health Insurance Scheme Strategic Plan (2020-2030) stated that only about 4.2% of Nigerians are covered under the Social Health Insurance. This translates to about 8.4 million persons out of an estimated population of 210 million Nigerians underscoring the level of effort that is required from all relevant stakeholders in the health care delivery space in the journey towards the actualization of this global health care goal.

To kick-start the implementation of the laudable provisions of this new legislation and in keeping with its section 4, a Governing Council that would serve as the policy arm of the authority is to be constituted. They are to perform key roles such as the approval and registering Third Party Administrators (e.g. HMOs); lead the implementation of the policies and guidelines; regulate and supervise the various health insurance schemes under the Act; mete out disciplinary actions against any erring HMOs, among others. In essence, without the board being constituted more than four months after the NHIA Bill became an Act, carrying out the full duties of the National Health Insurance Authority in driving the attainment of Universal Health Coverage would thus be pending. It is therefore advocated to the Office of the President of Nigeria to set up the Governing Council for the NHIA to commence its full duty.

In some states of the federation, the States’ Health Insurance Scheme Laws provide for the compulsory uptake of health insurance by all inhabitants of the states. For the health insurance agencies to operate optimally, its policy arm being in place is critical. The challenge is that the executive arm of government in some states are yet to set up the Governing Council/Board for the State Health Insurance Agencies, limiting the capacity of the health insurance agencies to deliver on their mandate of effectively regulating the health insurance schemes in the states among other crucial roles. It is indeed an advocacy point to be taken forward by the Civil Society Organisations to the relevant stakeholders (notably to the office of the Executive Governors).

On health care provision for the indigent and the poor, the new NHIA Act provides for a Vulnerable Group Fund that is to cater for the health care coverage for vulnerable persons and payment of their insurance premiums. The Vulnerable Group Fund is to be funded from sources such as: Basic Health Care Provision Fund; Health Insurance Levy; special intervention by the government; earnings on investment of the authority’s idle funds by the governing council; grants, donations and other gifts. In most states health insurance scheme laws, these categories of persons are clearly defined to include: pregnant women, children under five, people with special needs (PWDs), the elderly and the poor. In the new NHIA Act however, who constitute the vulnerable is left for the governing council of the authority to determine, raising a clarity question.

There is also a funding concern to be addressed at the subnational level. The Equity Fund in most states’ Health Insurance Agencies Laws, which is the equivalent of the Vulnerable Group Fund in the NHIA Act, is bedeviled with funding challenges.

Fidelis Toochukwu Onyejegbu, Programme Manager, PFM, Centre for Social Justice