Accelerating Implementation of the NHIA Act to Improve Health Insurance Coverage in Nigeria

Stakeholders at the 2023 Nigeria Health Watch, NHW, health financing policy dialogue recently held in Abuja with the theme, ‘Accelerating the Implementation of the NHIA Act to Improve Health Insurance Coverage in Nigeria’, have harped on the need to hasten the implementation of the National Health Insurance Authority, NHIA, Act so to improve health coverage in Nigeria. Sunday Ehigiator reports

The NHIA, formerly known as the National Health Insurance Scheme (NHIS) is a body established under the NHIA Act 2022 by the Federal Government of Nigeria to improve access to quality and affordable healthcare for all Nigerians.

The NHIA Act, which repealed the previous NHIS legislation, was signed into law on Thursday, May 19, 2022, by President Muhammadu Buhari.

The Law mandates NHIA, amongst other things, to ensure that health insurance is mandatory for every Nigerian and legal resident, to promote, regulate and integrate health insurance schemes in the country, and to improve and harness private sector participation in the provision of health care services.

The ultimate aim is to ensure the achievement of Universal Health Coverage (UHC) for all Nigerians.

It is against this backdrop that the stakeholders seek the speedy implementation of the act to improve health insurance coverage in Nigeria and minimize the out-of-pocket (OOP) spending on healthcare among Nigerians

Negative Indices of OOP Expenditure among Nigerians

Healthcare is becoming more unaffordable for many Nigerians, particularly, the masses that still cater for their health concerns largely through out-of-pocket expenses.

According to the World Health Organisation (WHO), out-of-pocket payments can make households and individuals incur catastrophic health expenditures and this can exacerbate the level of poverty.

According to a study published in the journal PlumX Metrics and titled ‘Out-of-pocket payments in Nigeria’, less than five per cent of Nigerians in the formal sector are covered by the NHIS.

The study revealed that only three per cent of people in the informal sector are covered by voluntary private health insurance.

The Lancet Nigeria Commission, a multidisciplinary group of Nigerian academics based in Nigeria and around the world, working in close collaboration with University College London’s (UCL’s) Institute for Global Health and Policymakers, over two years reviewed existing disease burden, and opportunities to improve health.

Their report noted: “Government health expenditures have risen somewhat under the Fourth Republic, however, Nigeria’s total government spending as a share of overall health spending was at 4·6 per cent in 2017, lower than the African average of 7·2 per cent and the world average of 10·3 per cent.

“In contrast, out-of-pocket expenditure is extremely high, at 77 per cent of total health spending in Nigeria, compared with 37 per cent for the African average, and a much lower 18 per cent for the world average. Compounding Nigeria’s health inequities are low investment in water and sanitation infrastructure compared with other low-income and middle-income countries (LMICs), as well as generally low government spending across sectors.

“Overall, Nigeria’s model of healthcare financing since the First Republic has gradually transformed into one focused on the generation of revenue for hospital management through the charging of user fees.

“Public health centres have been pseudo-commercialised as they are restructured to generate funds to work efficiently and independently. In the public and organised private sectors, neoliberal reforms have led healthcare providers to be more market-oriented, even though 60 per cent of the Nigerian population is estimated to have minimal disposable income.

“As a result of underfunding, the capacity and quality of government health facilities and health services dwindled due to the persistent unavailability of drugs and equipment, resulting in increasing reliance on home treatment, medicine sellers, traditional medical systems, and faith healing by the Nigerian populace.”

The Role of Health Insurance

Speaking at the forum, the Executive Secretary of the National Health Insurance Authority (NHIA), Prof. Mohammed Sambo highlighted the critical role of health insurance in driving health outcomes and its strong connection to productivity and socioeconomic development.

He shed light on the importance of government support, adequate funding, strengthened governance structures and a conducive environment for the NHIA to flourish.

He emphasised that health financing should consider a country’s level of socioeconomic development, and Nigeria cannot rely solely on traditional methods but must explore innovative approaches.

He stressed the collective responsibility of all stakeholders, both within and outside the health sector, to collaborate and improve health insurance coverage in the country.

According to him, “Developing relevant policies and optimising available resources is crucial to ensure equitable access to essential healthcare services, leaving no one behind.”

Need for Innovative Health Financing Mechanism

Also speaking, the Director-general of the Budget Office of the Federation (BoF), Mr Ben Akabueze discussed the need for innovative health financing mechanisms to cater to vulnerable groups in the country.

He acknowledged the financial constraints that hinder adequate health insurance coverage in developing nations like Nigeria, where limited budgets from governments and donors have impacted healthcare funding.

He, therefore, emphasised the importance of implementing accountable and transparent systems to maintain public enthusiasm and ensure value for money in healthcare provision.

In her address, the General Manager of NHIA, Barr. Blessing Nienge highlighted the efforts made since the signing of the NHIA Act in May 2022 to establish a reliable and sustainable framework for mandatory health insurance. She emphasized the role of mandatory health insurance in achieving Universal Health Coverage (UHC) and emphasised the need to bridge gaps and improve health insurance coverage swiftly.

Significance of the NIHA

Earlier in her address, the Managing Director of Nigeria Health Watch, Vivianne Ihekweazu commended the country’s progress in striving for health for all. She acknowledged the significance of the NHIA Act in providing mandatory health insurance to all Nigerians, protecting them from the high cost of healthcare services.

However, she decried the slow implementation of the scheme, with less than five per cent of the population covered as of 2018.

“Factors such as the non-compulsory nature of the Act and poverty contributed to these challenges. The NHIA Act passed in May 2022, aimed to address these gaps by making health insurance mandatory for every Nigerian and authorising the NHIA to improve healthcare provision through private sector participation.”

Ihekweazu emphasised the critical role of effective communication in promoting health insurance uptake among the public.

“Ensuring that people understand the benefits of health insurance and the importance of enrolling in the scheme is key to its success.”

The Forum

The forum brought together various stakeholders, including the national and sub-national governments, healthcare providers, civil society organizations, the private sector, development partners, and the media.

It provided a platform for sharing experiences, insights, and perspectives on NHIA implementation in Nigeria. The discussions centred on identifying challenges, exploring opportunities and developing strategies to accelerate the implementation of the NHIA Act.