THE IMPERATIVE OF HEALTH INSURANCE  

The country should strive to extend health insurance to all citizens

A year after President Muhammadu Buhari signed the National Health Insurance Authority (NHIA) Bill into law, stakeholders in the health sector are expressing concerns that there are still huge gaps to cover if Nigeria is to attain Universal Health Coverage (UHC). “We need to have a metric in terms of how much we are spending, who is getting it, and if there is deviation from what one is supposed to be achieving. Accountability is very important,” said health expert, Gafar Alawode, who recently highlighted the low insurance coverage penetration in the country.  

As we noted when the NHIS was signed into law, the bulk of the work lies in its implementation. The repealed NHIS could not grow the scheme beyond five per cent of the population due to lack of political will. As a result, the country was losing hundreds of thousands of its citizens yearly due to inability to pay out of pocket for their healthcare. The defining trouble with NHIS at the time was the system-wide inequalities in its implementation, including the lack of cohesion between the federal scheme and the ones promoted by the state governments, private sector, and healthcare providers.    

Although many countries, including Rwanda and Ghana, have recorded successes in Universal Health Coverage (UHC), it took Nigeria 18 years after first establishing the National Health Insurance Scheme (NHIS) to own a document that now mandates every citizen to be enrolled into an insurance programme for their future health needs. Last year, the president described the scheme as a path towards providing universal health for at least 83 million poor Nigerians who cannot afford to pay premium. He added that the NHIA will collaborate with state governments to accredit primary and secondary healthcare facilities to ensure the enrolment of Nigerians.    

We have not seen efforts in that direction in the past one year. The NHIA, in collaboration with state governments, private sector, healthcare providers, among others, must set processes in place to see that every Nigerian – from the formal to informal sector, to the unemployed, and other bodies – are enrolled into health insurance schemes. The stakeholders must ensure, this time, there is synergy between themselves. With Universal Health Coverage as the goal, all tiers of government, healthcare providers and the various schemes must ensure the previous disparities they had that limited the implementation of NHIS are put behind them since NHIA promises to start on a clean slate.     

As the president stated last year, the effectiveness of a social health insurance in Nigeria would be strengthened with the inclusion of 36 states into the scheme and getting them to set up and manage their own insurance schemes in line with the provisions of the reviewed health scheme. States that are yet to start their health schemes should take models of those who are making progress. They should as well trickle this down to their local governments, communities, wards, and families.     

Ordinarily, the main goal of the NHIS is “to facilitate fair-financing of healthcare costs through pooling and judicious utilisation of financial resources to provide financial risk protection and cost-burden sharing for people.” But only a small proportion of Nigerians have prepaid health care. The benefits of a health insurance scheme that works in a country like ours are many. One, the idea of cashless treatment for those insured makes it imperative for them to get immediate treatment during sudden ill-health while the premium paid on health insurance is usually tax deductible.  

Until we can extend health insurance to all citizens, the country’s push for UHC will be a mirage.