NHIS: Way to achieving Universal Health Coverage
NHIS: Way to achieving Universal Health Coverage
An Analysis
By Talatu Maiwada/M S Tola
Healthcare
Abuja, Jan. 25, 2019 (NAN) The present administration of President Muhammadu Buhari have shown commitment and political will to achieve Universal Health Coverage (UHC) in Nigeria. The World Health Organisation (WHO) has prescribed UHC as the surest vehicle to making affordable, effective and accessable healthcare services to all people in the world.
Countries committed to delivering basic healthcare services through the primary healthcare services and health insurance schemes. However, strategies being put in place to achieve this in Nigeria had been termed by some analysts as slow.
In Nigeria, the National Health Insurance Scheme (NHIS) is the implementing agency that has been selected by the Federal Government to help fast track the implementation and achievement of the UHC master plan.
The NHIS was established in 2005 with the aim of providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems as well as to serve as a social and financial security for the citizens against unforeseen illness.
Nigerians today have expressed grave concern that the primary purpose of the scheme, which was to make healthcare financially available and affordable to all Nigerians, was becoming far-fetched, as a review from Health System Financing for UHC in Nigeria shows high Out-of-Pocket Expenses (OPE) and a poor health insurance penetration.
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.
Furthermore, the scheme which took off in 2005 is still lagging behind in achieving its mandate of UNC as only about four per cent of Nigerians are covered under the scheme, with most enrollees covered in the formal sector and a poor coverage attained in the informal sector.
The scheme has three different programmes to address the various segments of the society. First is the Formal Sector Social Health Insurance Programme which covers the federal, state and local government as well as the organised private sector.
Secondly, the 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.
Counting on its gain, in 2017, Malam Attahiru Ibrahim, then acting Executive Secretary of NHIS, said 98 per cent of the Formal Sector Social Health Insurance Programme (FSSHIP) has been covered which was one of its greatest achievements since the scheme commenced operation in 2005.
“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.
In 2016, the Executive Secretary of National Health Insurance Scheme (NHIS), Prof. Usman Yusuf, 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.
According to him, Nigeria has a very huge informal sector which forms 80 per cent of the total population.
He said the scheme has also recognised the fact that the achievement of their targets and goals are only possible if the scheme was able to provide health insurance cover for 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 and also to 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 (CBSHIP), with a well-developed design and implementation manual in place was a strategy to reach out to the informal sector.
“So far, over 48 Community Based Social Health Insurance Programme (CBSHIP) 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 state, Lamodi-Offa in Kwara state and Igarra in Edo state, 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.
Among the programmes, he mentioned, was the State Social Health Insurance Programme (SSHIP); an initiative where state governments are encouraged to create their own health insurance agencies and enact appropriate enabling laws.
The SSHIP requires development and passage of appropriate laws that would guide both the implementation and mandatory healthcare for their citizens.
He restated that such strategies would deepen health insurance penetration in an overwhelming population of the informal sector as well as quicken the pace towards attainment of universal health coverage. So far, not less than 11 states and FCT have adopted the scheme. The states implementing the scheme include Kwara, Lagos, Delta, Cross River, Kano, Kebbi, Plateau, Gombe, Osun, Imo and Rivers.
Dr Emmanuael Uba, General Manager, Formal Sector Department, NHIS, in 2018, said the Vital Contributor’s Social Health Insurance Programme (VCSHIP) was designed to cover the healthcare needs of senior citizens, retirees, aged and Nigerians who are not under any programme of NHIS.
The programme allows individuals to pay N15,000 annually for their own contributions, renewable annually and provides access to quality health care 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.
“However, when people retire from service, they are out of government payroll and they do not contribute to the contributory fund, the VCSHIP 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 under five, 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.
“However, for this to work we will need a legislation by the National Assembly, after which the President will assent to it, as well as the support from stakeholders and political will from the state government,’’ Uba added.
It is universally acknowledged that health insurance is the fastest way to achieve UHC and in ensuring health insurance works in the country, the Managed Healthcare Services, a Health Management Organisation (HMO) has sought the cooperation of enrollees to give feedback on service delivery in healthcare facilities and to uphold their rights in order to enjoy prompt and top quality care.
According to Mr Roberts Ukeje, every effort and activity within the operations of NHIS was the satisfaction of lives and the quality of care available to them at the points of service.
Ukeje, the Branch Manager, Managed Healthcare Services Abuja Chapter added that regular feedback by enrollees would enhance visibility to areas of improvement as well as the enforcement of quality standard in hospitals across the country.
He mentioned that for the scheme to work for all Nigerians while enrollees receive quality healthcare services there is need for feedback from enrollee experiences at service delivery points and health facilities which would assist the scheme sustain and improve quality care.
Ukeje said every enrollee registered under the scheme has 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 the right to choose an alternative facility for dependents if they are living in a different location, among others.
He stated the scheme deploys members of staff to hospitals where regular complains are received, to guarantee compliance with the required standards while ensuring enrollees rights are not trampled upon.
According to WHO, health system financing system are critical for reaching UHC in three related areas, including raising funds for health, reducing financial barriers to access through prepayment and subsequent pooling of funds in preference to direct OPE payments, and allocating or using funds in a way that promotes efficiency and equity.
Development in these key health financial areas would determine whether health services exist and are available for everyone and whether people can afford to use health services when they need it. (NAN)
TIM/MST
Edited by Muhammad Suleiman Tola
NB: If used, please credit the author and NAN