The result of a recent survey, which shows that ‘only nine percent of the country’s population have subscribed to the National Health Insurance Scheme [NHIS]’ is appalling. The survey also indicates that as many as 89 per cent of Nigerians pay for their health care services out-of-pocket. This situation negates the goal of NHIS, which primarily targets securing universal health coverage and access to adequate and affordable health care in order to improve the health status of Nigerians.
The survey was conducted by NOIPolls, an opinion research developer. It reports that about 78 per cent of Nigerians who were not under any insurance policy expressed willingness to pay a small amount of money monthly/yearly to get enrolled for health coverage. The poll also showed that 63 percent of Nigerians make use of health care facilities provided by governments (primary, secondary and tertiary health facilities). While about 39 per cent make use of health facilities from private hospitals, 17 per cent get their services from pharmacy/chemist stores. The report states that 13 percent of Nigerians rely on self-medication.
NHIS was established under the NHIS Act, Cap N42, Laws of the Federation, 2004 with a mandate to improve the health of all Nigerians at an affordable cost through various prepayment systems. The scheme is essentially geared towards reducing out-of-pocket health expenditure. With three levels of care offered at primary, secondary and tertiary health care facilities, NHIS has different health insurance programmes that include Formal Sector Social Health Insurance Programme, which is for employees in the public sector and organized private sector (OPS). OPS is a private company that has 10 staff and above. Formal sector covers staff, spouse and four biological children.
Another product of the scheme is the Health Insurance Programme designed for communities such as villages, market people and groups with membership of a thousand people and above. Other programmes include Tertiary Social Health Insurance Programme planned for students in tertiary institutions; Public Primary School Social Health Insurance Programme for pupils in public primary schools; and the Voluntary Contributors’ Social Health Insurance Programme (VCSHIP), which is for individuals who neither work in formal sector nor belong to a community of tertiary institutions that is covered under NHIS.
Besides reducing out-of-pocket expenditure of Nigerians on healthcare, NHIS which is founded on a shared-responsibility pact avails contributors the opportunity to mutually benefit from the scheme. The whole idea of NHIS is to pool funds together to take care of contributing Nigerians when they need health care so that people will not need to pay at the point of service. This is the whole essence of health insurance in Nigeria. Furthermore, the more the number of Nigerians in the scheme, the better the agency is positioned to expand its coverage areas to include certain categories of drugs, laboratory tests and other health services that are currently excluded from the services offered by healthcare providers.
Given the huge financial resources at NHIS’ disposal, the one-digit enrollment figure of citizens on its programmes is an inexcusable failure on the part of the agency, which in recent times became a hub to corruption allegations and counter allegations between its chief executive officer and staff. The agency hasn’t done enough to get more Nigerians to take advantage of the benefits of the scheme. The leadership of NHIS owes Nigerians detailed explanations for its inactions. After about two decades of existence, nine percent enrollment is certainly abysmal. A deeper analysis of the situation reveals the critical need for sensitization to mobilize the citizenry on the need and benefits of health insurance.
While we urge authorities at NHIS to improve upon their advocacy strategies, we encourage the remaining 26 states of the federation that have not signed health insurance laws to do so. Functional state health insurance schemes in the country would help increase the pool of individuals with health insurance, thereby driving down premium.