Doctors perfoming surgery on a patient
Years after the National Health Insurance Scheme was introduced in Nigeria, not many people have enbraced it. Besides, the impact of the scheme leaves much to be desired, Steve Dada writes
The introduction of the National Health Insurance Scheme (NHIS) in 2007 came like a saviour to bail the country out of its health care debacle. The health care delivery before the introduction has been in a moribund state.
The introduction raised the hope of most Nigerians, particularly the less privileged who before then were paying out of their nose to settle the hospital bills. So much noise was made about the scheme before its final debut. History has it that efforts to introduce the scheme in the country has commenced since 1962, during the first republic, but due to lack of political will successive administrations made attempts which do not translate into action.
It is not likely that much has changed in the lives of Nigerian masses. Five years down the line, majority of Nigerians are still paying out of their pockets to access health care services in the country. The people for whom the scheme was designed to benefit mostly have been kept absolutely in the background, ironically, those who have socio-economic advantage are benefitting.
Does it mean that the government was not well prepared for the introduction of the scheme or the right people to implement the programme are not engaged to manage the scheme? As it is, there is no doubt something is wrong somewhere.
Even when the scheme becomes beneficial to all Nigerians, there are still more questions than answers. For example, NHIS as it currently stands does not cover all diseases as many killer diseases are not enlisted in the category of ailments the scheme can cater for. The spread of cancer around the country at alarming and worrisome notwithstanding, the federal government is yet to include cancer treatment into the ailment NHIS will care for.
Also, kidney disease is very rampant in the country as many people comes down daily with renal failure and several others have lost their lives to the disease, yet the scheme is not caring for people with kidney failure.
That is not all, the scheme is not designed to cater for dental complications, if the scheme is taking care of any of the aforementioned conditions, it is to a very limited level that does not go beyond the diagnostic level.
Right now, the scheme is only benefiting not up to 5million Nigerians who are mainly the people in the former sector of the economy, such as the civil servants, the uniform people like the armed forces, the police, custom, immigration and other uniform groups. The figure of the beneficiaries is quite very low compared to the total population of the country of about 160 million people.
In February this year, the former Secretary General, Dr. Dogo Mohammed left the services of the scheme in an un-ceremonial manner suggestive of a vacuum being created in the leadership of the scheme, considering the fact that anybody appointed in an acting capacity has limited period to act before confirmation.
Stakeholders in the health sector say such exit at a time NHIS is just being implemented shows the government is not committed to accelerating the expected progress of the healthcare programme.
Mrs. Grace Eriaku, a single parent had a bitter experience over her daughter Marion, who had cancer attack at the second year of her four year course in one of the tertiary institutions in the country. From her limited resources, she had trained her up to the University. She has four other children she sponsor at different levels of educational pursuits, having lost her husband to ghastly motor accident that claimed his life five years ago.
Eriaku is bitter over the government’s response to the plights of the masses in the country, ‘’We don’t know what the government is doing about the NHIS, they made so much noise about the scheme and what it portends for the people, today we have not seen the benefit of the scheme, if other people have been benefiting, I have not, it is so difficult and disheartening,’’ she lamented.
Eriaku is not the only person with this experience, there are several other people with similar problems. For instance in most hospitals, people present with such ailments as kidney failure, which also falls within the category of conditions the scheme is not designed to manage. What is the hope of such people?
The Acting Executive Secretary of the NHIS Dr. Abdulraman Sambo recently explained that with the delay in the scheme getting to the nooks and crannies of the country, the most important thing for people is to engage in community insurance scheme in which people can form themselves into groups and contribute money based on voluntary agreement on what they have the capacity to pay in terms of premium per year.
Through such contribution, the Executive Secretary said the quality of treatment expected for any ailment would be given to any member of a group who needs the service of the NHIS. In order words, quality would not be compromised not minding the fact that it is not a conventional health insurance scheme.
According to him, most of the countries that have practiced the insurance scheme before Nigeria have had to pass through this stage, but with time the scheme would benefit every Nigerians he assured, but how soon? One of the challenges being encountered is the difficult determining the income of the people in the informal sector.
Dr. Segun Ogundimu is the Chief Executive Officer (CEO) of one of the notable Health Maintenance Organisations (HMO), in the country, Clearline Limited.
He said due to the delay in getting the scheme enrolling all eligible Nigerians, his organisation has been trying some other means to get health services to the door steps of the people, through what he described as Retail Health Insurance (RHI) Scheme.
According to him, with the RHI, the poorest Nigerian would be able to access health care services with payment of premium as low as N50 only. He said individual has the opportunity of registering with Clearline and decide how much he/she is capable of paying per month.
He added that, to make it convenient for enrolee, the payment has been designed in form of the recharge card like that of the Global System Mobile (GSM), in such a way as one recharges his/her phone, such person can also buy card for RHI from vendors.
Also, Mr. Kolawole Awokoya the Managing Director of another leading HMOs, Hygeia, explained that his company has already taken the services of NHIS beyond the level it is currently operating, saying, the company has introduced community Health Insurance Scheme, which is flourishing in Songai area of Kwara State.
According to him, community people are already benefiting from the scheme through the contribution of as low as N200, which could fetch them the best of health care each time they fall sick, without compromising quality and standard.
Awokoya also explained further that apart from the community health insurance, the company has introduced a scheme that can benefit people who can form themselves into groups and contribute towards their health care. He gave the example of the women mechanic who are currently benefiting from the scheme.
But how far can the various HMOs go in providing health care for a population of about 160million people, without the government going extra miles to move healthcare services to a priority list in the country? The Federal government experts say, must do more.