The National Health Insurance Scheme has been given the mandate to provide all Nigerians with universal health coverage, yet after a decade, coverage is still below 10 per cent.   In this interview with Franka Osakwe, Assistant General Manger, NHIS, Dr. Christopher Okah gives insight to the scheme and the bottlenecks. Excerpts

 

The National Health Insurance Scheme (NHIS) has been existing for a decade now yet, many Nigerians are not covered. Why is that?

 

The reason is because implementation is hampered by some challenges such as non-participation of some states. Another bottleneck is that health insurance in Nigeria is optional. In all parts of the world where universal health insurance has been achieved, social health insurance has been mandatory. So to achieve universal health insurance, we expect to have an Act that will stipulate mandatory participation. The National Health Act states that health insurance is optional. We also have duplication of roles by some states in pursuit of universal health coverage, lack of political will on the part of leaders for universal health coverage. Another challenge is the fact that over 75 per cent of the population is in the informal sector hence the need for subsidized funding; we have the refusal of labour to pay the 5 per cent equity contribution hence limited funding for NHIS projects. Again, many Nigerians are sceptical about NHIS due to the bad notion people have about it, there is dearth of skilled manpower resources, the challenge of covering retirees and Poor awareness among Nigerians.

 

With the new Health Act, what are we expecting?

 

With the new health Act, what we will have is a decentralized health insurance scheme, where all the states have their own agency. Remember the National Health Act states that 50 per cent of the one percent consolidated fund coming to the NHIS is seed money. NHIS is going to leverage on other funding, and we are going to make disbursement through the state agencies. Regarding the disbursement, we are working already with the national primary health care development agency for the basic minimum health care package which we expect the states to adopt or make increment, based on their capacity. But NHIS will be doing their disbursement based on vulnerable, and what we call equalization from the funds accrued.

 

When will the disbursement start?

 

For now, the money is not yet with us so we cannot disburse. But we hope to start very soon. For now we are still in the planning process.

 

Tell us more about the scheme?

 

The NHIS is an agency of the Federal Government established under Act 35, 1999 to promote, regulate and administer the effective implementation of Social Health Insurance Programmes in order to ensure easy access to qualitative and affordable health care services to all Nigerians.

 

 

The NHIS has different programmes and platforms that include everyone in the formal and informal sector. For the formal Sector which is about 25% of the population, we have the Public Sector Social Health Insurance Programme, for the public civil servants (states & LGAs), we have the private sector social health insurance programme for the organized private sector  in the State-OPS, the national mobile health insurance programme (NMHIP)/voluntary contributors social health insurance programme (VCSHIP) and the retiree social health insurance programme (RSHIP). For the informal sector, we have the community based health insurance (CBHIP) programme for artisans like the; urban self employed health insurance programme (USEHIP) among artisans, rural community health insurance programme (RCHIP) among rural dwellers, schools health insurance programme (students of  public primary & tertiary institutions). We have the ones for the vulnerable groups like the vulnerable groups health insurance programme (VGHIP)-MCH, PISHIP, etc. Another platform is the state supported health insurance initiative which is a platform for decentralization of  health insurance to the states and the tertiary diseases intervention project – oncology, neurosurgery, cardiac surgery, chronic renal dialysis, orthopaedic surgery that are not covered in the FSBP as part of centennial celebration

 

How do you think Nigeria can achieve universal health insurance?

 

The only way to achieve universal health insurance is through social health insurance. We want Nigerians to accept and buy into health insurance so that this universal health insurance can be a reality in no distant time. What we are doing right now is working with the stakeholders to ensure that the facilities and services for health insurance are provided everywhere in the country. We are looking at innovative funding of health insurance so as to leverage on all funding sources to enlarge the financial strength of the pool in order to subsidize for those who cannot pay. Looking at our economy, we can see that about 70 per cent of our economy is in the informal sector while only about 25 per cent is in the formal sector. We are thinking of pursuing an aggressive innovative financing to make more money and ensure that health is available to all through the social health insurance scheme. We want governments, both state and federal, to support health insurance scheme. If you look at some of the health programs government has pursued in about 13 states, such as maternal and child health schemes, you will see that one of the issues were limited funding from the MDG office. But if government is able to operationalize the national health Act and state governments are able to pursue the scheme by way of innovative funding such as using money from the accrued ‘Save one million lives funding’, to set up health insurance agencies, we will be able to work together to ensure all Nigerians have health insurance on their table.

 

Is there any package for those with some terminal health issues?

 

Yes. The NHIS started the tertiary disease intervention project for terminal disease issues such as oncology, neurology, cardiac surgery, chronic renal dialysis, orthopaedic.  The criteria is that you must be an enrollee of NHIS to benefit from this package. It started last year shortly before the centenary celebration. One of the intentions was to give back, like a bonus to our enrollees who are suffering these conditions. What we did was to write to our centres of excellence that can provide these services and to our HMOs telling them to identify patients that have these conditions. In the areas of oncology, renal and orthopaedics, we have lots of patients in National Open Hospital Abuja who are benefiting from this package already, we have done a lot of successful cardiac and neurosurgeries in Garki hospital Abuja and in Enugu. We have done successful renal transplant in Ife with about 13 patients also about to undergo their renal transplant soon. We have done successful knee and hip replacement. We are discussing with some renal hospitals such as Ife, Primus hospital India for collaboration.

 

Why the collaboration with an Indian hospital instead of an indigenous hospital?

 

One of the reasons for the tertiary disease intervention is to make Nigeria tourism destination for medical excellence. We want to reduce the capital flight, we also want to tell Nigerians that the surgeries they go abroad to have can be done here in Nigeria. And it has worked and is now changing the perception of Nigerians. A lot of it has been done here successfully. We are working with some non- governmental organizations for intervention in other diseases such as spinal bifida, we are supporting them to fund some surgeries even though the patients are not NHIS enrollees. So NHIS is willing to assist Nigerians to access these services as much as possible.

 

You mentioned earlier that some health conditions such as fire disaster are not covered by the NHIS. Why is that?

 

Now let me tell you, you cannot cover all diseases in health insurance. Some disease conditions are not covered in the formal sector benefit. These are; Occupational injuries to the extent covered by the Workman Compensation Act, injuries arising from natural disasters, social unrest, riots, sports, etc, epidemics, family planning commodities e.g condoms, drug abuse e.g substance abuse, domiciliary visit, surgery – mammoplasty, ophthalmology – provision of contact lenses, medicine – anti-TB and anti-leprosy drugs, paediatrics – treatment of congenital anomalies. NHIS is not covering some cases such as occupational injuries because it is covered in the Workman Compensation Act and disaster is covered by NEMA, so there are actually some cases of overlap. However, NHIS is doing its best to ensure that we cover all Nigerians irrespective of the situation.  In emergency situation you are free to access health care in any NHIS facility, whether you choose the facility or not

 

If war disasters are not covered, how can victims of war in Northern Nigeria access health insurance?

 

Health insurance becomes a very difficult arrangement in war torn area, however, we are working with relevant agencies to provide health packages, because we know that people in the IDP camp need health care. I think the refugee commission is doing something to that effect. They are trying to put in place some private health insurance in the interim. We are working with them to get a sustainable package.

 

By: FRANKA OSAKWE

National Mirror