The National Health Insurance Scheme (NHIS) brought along with its introduction in 2005 a lot of enthusiasm, as it was seen as the panacea to the perennial problem of the lack of fund for healthcare in Nigeria. Established under NHIS Act 35 of 1999, it was designed, according to a statement on its website: “to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.” From all indication, this objective is far from being achieved.
In many developed countries, NHIS is prominent as it is seen as the hope of the common man in accessing quality healthcare. But the scheme is dogged by numerous problems bordering on service delivery, accountability and transparency. An investigative report by Daily Trust recently revealed several shortcomings of the scheme. They include complaints that funds are not promptly remitted to hospitals by Health Maintenance Organizations (HMOs); poor customer service delivery; lack of drugs covered under the scheme at pharmacies in hospitals; the prices of some drugs are higher for NHIS patients than they are in the market; lack of emergency services for enrollees; and even the fact that the percentage of Nigerians covered under the insurance scheme is small.
As a result of these problems, some Nigerians who have enrolled under the scheme have to engage in out-of-pocket medical expenses in spite of the fact that their salaries are being deducted by their employers as their contributions to the health insurance policy. Nigeria’s out-of-pocket expenses for healthcare is deemed to be very high compared to those of citizens of many developing countries. In some extreme cases, due to the sloppy nature of the NHIS scheme, some enrollees have to engage in self-medication or even resort to seeking help from quack doctors and dubious herbalists. It is very unfortunate that a system that has worked in other parts of the world is being mismanaged and made to fail in Nigeria.
We call on the management of NHIS to ensure that the scheme works in Nigeria. The current Executive Secretary of NHIS, Professor Muhammad Sambo, has acknowledged that he has noticed the challenges facing its implementation. Nigeria has some of the highly trained medical doctors in the world, and many of them are good administrators. There is no reason why they would not be able to manage NHIS. Perhaps, the take-off point for the management has to redeem the image of the scheme. The perception among Nigerians is that the scheme is not being managed with the kind of transparency necessary to deliver healthcare to Nigerians. Allegations of conflict of interest, nepotism and even corrupt practices still overshadow NHIS. To deal with this image problem, the management must put in place the kind of system that would track and prevent wrongdoing.
It is also necessary for the managers of the scheme to focus more on service delivery and ensure that all HMOs and hospitals that deliver healthcare under NHIS scheme are constantly monitored, and those found wanting are blacklisted. It is absolutely unacceptable that inferior drugs are administered to patients who visit hospitals as enrollees of NHIS. This defeats the vision of the scheme which is to be “a strong, dynamic and responsive government parastatal (Agency) that is totally committed to securing universal coverage and access to adequate and affordable health care, in order to improve the health status of Nigerians especially for those participating in the various programmes/products of the Scheme.” There is no way “adequate and affordable healthcare” can be made available if inferior drugs are administered to patients.
Nigerians expect much from NHIS. We call on the management to overcome these problems besetting the scheme so that they may embark on the important challenge of expanding the health insurance net in Nigeria. If other countries can improve on their healthcare delivery through NHIS, there is no reason why Nigeria cannot.