How Accessible Is National Health Insurance Scheme?

A section of the ultra-modern Mother & Child Hospital being built in Port Harcourt by the Governor Nyesom Wike administration.

Since it became operational in 2005, the National Health Insurance Scheme (NHIS) has been contending with many challenges in the course of defining its objective of making healthcare accessible and affordable to Nigerians.
The scheme has Formal Sector Social Health Insurance Programme which covers the federal, state and local governments as well as the organised private sector.
It also has Informal Sector Social Health Insurance Programme which covers the Community-Based Social Health Insurance Programme and the Voluntary Contributors Social Health Insurance Programme.
The third category is the Vulnerable Group Social Health Insurance Programme which covers the physically challenged persons, prison inmates, children under five, pregnant women and immigrants, among others.
Analysts, however, note that lack of political will, inefficiency of the regulatory agency, the Health Maintenance Organisations (HMOs) and optional enrollment policy, among others, remain contending issues that the scheme has been grappling with in recent times.
According to them, one of the issues is the role of HMOs that are privately owned but play an important role in the operation of the scheme.
They note also that there is a service-gap with the public hospitals that have the distribution of enrollees, playing a dominant role in its healthcare delivery.
They cite instances when enrollees have complained of poor service delivery with long waiting time, use of substandard drugs and poor attitude of healthcare providers.
Concerned citizens have also expressed grave concern that the primary purpose of the scheme, which is to make healthcare financially available and affordable to all Nigerians, is seemed to have been compromised.
Besides this, they note that out-of-pocket payment for healthcare services has, indeed, been a challenge in Nigeria as such affects the ability of households and individuals to meet basic needs.
However, the management of NHIS says it has been making efforts at ensuring commitment and political will to achieve Universal Health Coverage as recommended by the World Health Organisation.
Malam Attahiru Ibrahim, former Executive Secretary of NHIS, said that 98 per cent of the Formal Sector Social Health Insurance Programme has been covered.
“One of our mandates in the scheme is to cover the formal sector and presently we have covered 98 per cent of the work force at the federal level.
“The formal sector consists of the public sector, organised private sector, armed forces, police and other uniformed services,’’ Ibrahim said.
Prof. Usman Yusuf, Executive Secretary, NHIS, nonetheless, acknowledged that the major challenge in the accessibility of health insurance to many Nigerians was the inability to extend the benefit package to the informal sector.
Yusuf also expressed his determination to reposition the scheme to deliver healthcare for all Nigerians, especially to the poor and vulnerable in the society.
He said that the scheme would design and implement strategies that would make NHIS a good steward of the nation’s commonwealth.
He stated that the Community-Based Social Health Insurance Programme with a well-developed design and implementation manual in place was a strategy to reach out to the informal sector.
“So far, more than 48 Community-Based Social Health Insurance Programmes are operational in Nigeria.
“The scheme has inaugurated the programmes in Emoriko and Egbe both in Kogi State, Nkana West Ward 11 of Akwa Ibom, Lamodi-Offa in Kwara and Igarra in Edo, among others.
“The Tertiary Institutions Social Health Insurance Programme, Voluntary Contributors Social Health Insurance Programme and private health plans are part of the programmes to boost health coverage by the scheme,’’ he said.
According to him, the Federal Capital Territory, Kwara, Lagos, Delta, Cross River, Kano, Kebbi, Plateau, Gombe, Osun, Imo and Rivers States have adopted the scheme to boost access to healthcare services.
Similarly, Dr Emmanuel Uba, General Manager, Formal Sector Department, said that the Vital Contributor’s Social Health Insurance Programme was designed to cover the healthcare needs of senior citizens, retirees, aged and Nigerians who are not on the platform of NHIS.
“The programme allows individuals to pay N15, 000 annually for their own contributions, renewable annually and provides access to quality healthcare services for the enrollees.
“NHIS is a contributory scheme, which means, is either you contribute or someone else contributes on your behalf which keeps you covered.
“When people retire from service, they are out of government payroll and they do not contribute to the contributory fund. This programme, therefore, enables them to have access to healthcare after retirement.
“Also for the vulnerable groups to have access to healthcare insurance there is need for equity funds that would cater for the vulnerable group such as the physically challenged persons, prison inmates, children less than five years of age, pregnant women and immigrants, among others.
“There is also need to explore Innovative Financing where various companies such as telecommunications, beverages and alcohol companies can be taxed and some percentage could go into the pool for the vulnerable groups.
“For this to work we will need a legislation by the National Assembly, the president’s assent to it as well as the support from stakeholders and political will from the state government,’’ Uba said.
To ensure unhindered access to healthcare services, Mr Roberts Ukeje, FCT Chapter Manager, Managed Healthcare Services, a HMO, sought the cooperation of enrollees to give feedback on service delivery in healthcare facilities and to insist on their rights to quality healthcare.
He said that regular feedback by enrollees would enhance improvement on services as well as quality standard in hospitals across the country.
He noted that there ought to be feedback from enrollees on their experiences at service delivery points and health facilities to assist the scheme in sustaining and improving quality healthcare.
Ukeje also said that every enrollee registered in the scheme had a right to access medical treatment as outlined in the NHIS benefit package, “such as the right to select a healthcare facility of their choice as long as the facility is accredited by the scheme.
“The right to change a primary healthcare facility after six months of access if not satisfied with the services provided and the right to choose an alternative facility for dependents if they are living in a different location, among others’’
Tola writes for the News Agency of Nigeria.

Mohammad Tola