Improving Healthcare Delivery Through NHIS

There is no gainsaying the fact that access to quality health care in Nigeria today is somewhat limited to affluent citizens.

Observers, however, note that the poor quality of most of the health services and facilities in the country could be attributed to inadequate finance.

Such concerns are rational and justifiable because many health care facilities in the country are dilapidated, poorly equipped or dysfunctional.

The poor management and deployment of the available health personnel also contribute to the menace of inefficient health care delivery across the country.

As part of efforts to reposition Nigeria’s health system for effective health care delivery, the Federal Government initiated the National Health Insurance Scheme in 2006.

Like all insurance schemes, the NHIS entails the setting aside of funds to cater to people’s health care needs whenever they are sick. It entails contributions from the government, employers of labour, workers and other prospective beneficiaries.

The NHIS is aimed at providing unfettered access to quality health care services to Nigerians at affordable costs.

The NHIS is primarily designed by the Federal Government to complement sources of finance for the health sector, while improving the citizens’ access to health care delivery.

The idea of initiating a health insurance scheme for Nigerians was first mooted in 1962, when the Halevi Committee, set up by the then Minister of Health, Dr Majekodunmi, proposed such a scheme.

A bill on Health Insurance Scheme was introduced to the then Parliament in Lagos. It was, however, opposed for reasons which included the dearth of health care providers in the country.

The concept, however, resurfaced in the early 1980s. In 1984, the National Council on Health, under the then health minister, Vice Admiral Patrick Koshoni, set up a committee to advise the government on the desirability or otherwise of an health insurance scheme.

The committee recommended the adoption of the health insurance scheme.

In 1985, Dr Emmanuel Nsan, the Minister of Health, set up a committee on National Health Review that was chaired by Mr Yemi Lijadu. The committee also agreed that health insurance was viable in Nigeria.

However, the implementation of the health insurance scheme started on June 5, 2005.

Commenting on the NHIS mode of operation, Mr Waziri Dogo-Muhammad, the Executive Secretary of NHIS, said that the agency was a regulatory body mandated to scrutinise the services being rendered to patients by health care providers.

He stressed that the scheme’s primary objective was to ensure the satisfactory treatment of patients accessing health care via the scheme.

Dogo-Muhammad stated that the scheme regulated health care providers, pharmacists; Health Maintenance Officers (HMOs), among others, so as to ensure the provision of quality health care services to the patients.

He said that the scheme covered the public sector, the organized private sector, the armed forces, the police and allied organisations and students of tertiary institutions, among others.

Nigerians are increasingly becoming aware of the purpose of the health insurance scheme, as many people are signing up for the programme.

The NHIS says over five million public servants are already accessing health care through the scheme, while Cross River and Bauchi states have already commenced similar health insurance schemes.

It says that plans to initiate health insurance schemes in 20 states have reached various stages of implementation, while about 7,850 health facilities across the country have been accredited with 61 accredited HMOs to run the scheme.

Other programmes of the NHIS include the informal sector health insurance programme, the community-based health insurance programme and the tertiary institutions’ health insurance programme.

Besides, the NHIS has secured approval to implement the MDGs Office’s subsidy funding for the health care of pregnant women and children under the age of five, generate employment for new HMOs and expand the capacity of health care providers.

The NHIS has almost completed its IT platform — e-NHIS — to drive the agency’s operations, while plans are underway to establish a national call centre and a central data centre.

Furthermore, a new NHIS Act has been drafted, the NHIS is being re-organised and restructured to meet future challenges, while a potent monitoring and evaluation system is being put in place for HMOs and health care providers.

Almost six years after the NHIS began operations, the scheme is still fraught with some challenges, as many beneficiaries complain about the poor service delivery of the HMOs, in particular.

The NHIS is, however, aware of such complaints, as its Executive Secretary warned the HMOs at a recent meeting in Abuja that anyone found to be working against the objectives of the NHIS would be sectioned.

“The aim of the NHIS management is to provide quality healthcare to Nigerians and anyone who distorts this will be sanctioned,’’ Dogo-Muhammad said, adding that an enforcement division had already been created within the agency to specifically monitor activities of the HMOs.

He encouraged Nigerians, who were not satisfied with the services of the HMOs or health care providers, to always lodge their complaints with the NHIS, which would investigate the matter.

In line with the executive secretary’s warning, some HMOs were suspended for non-performance some months ago.

Dr Sambo Abdulrahman, General Manager (Standards and Quality Assurance) of the NHIS, said that three HMOs were suspended early in the year for non-performance, as part of the agency’s efforts to stem bad service delivery of HMOs.

He said that the suspended HMOs were performing below expectation because they felt that they had attained the minimum requirements for accreditation.

Abdulrahman stressed that the NHIS had now realised that the initial requirements for HMOs’ accreditation were no longer feasible, hence the need for an upward review of the conditions.

“Paid-up share capital was N5 million when we started, it was later increased to N10 million but now it will be increased to N750 million and we are going to compel each HMO to have offices in each state of the federation.

“They must also have ICT facilities to enable them to interact with us and the enrollees.

“We are also separating them into two groups; there would be National HMOs and there would be Zonal HMOs.

“National HMOs can be anywhere in the country but must have offices in all the states.

“Zonal HMOs will limit their operations to their specific domains and if they have adequate resources to operate beyond the boundaries of their zones, they can then move up,’’ Abdulrahman said.

“We are also going to establish what we called Mutual Health Associations (MHAs) and these associations will operate on a community level,’’ he added.

Abdulrahman, nonetheless, noted that those HMOs who could not perform well at the national and zonal levels would be advised to operate at the local community or village level.

As part of its efforts to cover all Nigerians, irrespective of their social status or other considerations, the NHIS designed the Community-Based Social Health Insurance Programme (CBSHIP) to take care of people living in rural communities.

Dogo-Muhammad stressed the need to develop a home-grown approach to tackling health care issues which would take cognisance of economic and population peculiarities.

He said that the CBSHIP was also targeting the urban self-employed and cooperative societies.

The executive secretary said that other similar groups within the Nigerian population were also covered by the new programme.

“ The Voluntary Contributory Health Insurance Programme is designed to target political appointees, employers and employees of micro and small enterprises, and other Nigerians who do not fit into the other NHIS programmes,’’ he said.

The Minister of Health, Prof. Onyebuchi Chukwu, who commended the CBSHIP initiative, noted that the people of the rural areas were facing harrowing times in accessing quality, affordable health care.

“The rural dwellers bear 60 per cent of the country’s disease burden, struggling with financial and physical barriers to quality health care,’’ he said.

The minister said this at the NHIS workshop on “Improving Financial Access to Health Services for the Poor in Nigeria’’ in Calabar early in the year.

Chukwu described the CBSHIP as a practicable option of easing the burden of paying for health services on indigent citizens.

“CBSHIP is about the fastest way of creating access to health services for Nigerians at the community level; it is the most appropriate option, pending the time when more states adopt the substantive NHIS scheme.

“So, while we are trying to convince more states to join the NHIS, we can always take the benefits to the people through the CBSHIP,’’ the minister said.

As the NHIS is examining other innovative ways of caring for vulnerable groups, particularly women and children, analysts hope that the high maternal and infant mortality rates in Nigeria will be reduced significantly via the CBSHIP.

Bola Akingbehin