TIME FOR UNIVERSAL HEALTH COVERAGE  

There is need to improve on the health insurance scheme

Most of the countries that have made appreciable progress in achieving universal health coverage (UHC) have also implemented some form of comprehensive government-led health financing reforms. Unfortunately, despite a reform of the sector in the country and the law already put in place, most Nigerians are not covered by any health insurance schemes. That is perhaps because the scheme is driven by the executive at the federal level rather than by the three tiers of government and the private sector while many of the states and local governments are yet to come on board. For the health of our people, it is important that critical stakeholders begin to address this challenge, especially since long-term sustainability of the scheme depends on expanding the pool of enrolees.

Even when there can never be a one-size-fits-all model for guaranteeing health insurance for the society, we believe that one of the defining troubles with the National Health Insurance Scheme (NHIS) is the system-wide inequalities in its implementation which has resulted in the lack of financial protection for the health care needs of most citizens. That perhaps accounts for why in Nigeria today, hundreds of thousands of citizens die on account of lack of access to quality healthcare which a functional health insurance scheme could have guaranteed at all levels. 

We commend the current partnership between the NHIA and Roche, a globally renowned biotech company, under an arrangement that would enable both to subsidise costs while patients pay a reduced portion. “Healthcare is a shared responsibility. When the system works, families are protected and the economy benefits,” Roche general manager, Bolarinwa Oyedeji, said last week. “Many Nigerians are just one illness away from financial catastrophe. Access to timely care is critical.”

Ordinarily, the main goal of the NHIS is “to facilitate fair-financing of healthcare costs through pooling and judicious utilisation of financial resources to provide financial risk protection and cost-burden sharing for people, against high cost of healthcare, through various pre-payment programmes prior to their falling ill.” But, as we have always pointed out, a scheme that is voluntary in practice cannot guarantee proactive protection for the country’s sick population.   

In recent years, there have been efforts to strengthen the law governing health insurance in the country. But the challenge goes beyond merely reviewing the Act. The fact that other federating units outside the federal government do not participate in the NHIS is a key issue that needs to be addressed. How to get the 36 states and the 774 local governments, as well as private sector organisations enlisted in the scheme, should therefore be the overriding objective of critical stakeholders. Indeed, as things stand today, only a small proportion of Nigerians have prepaid health care, and this is not right if we must lead or keep a healthy population.

To achieve the UHC which the country has signed on to, we are of the strong view that strengthening and adopting a comprehensive social health insurance scheme would have to happen and quickly too. The effectiveness of a social health insurance in Nigeria would also be strengthened with the inclusion of public and private sectors actors into the scheme and getting them to setup and manage their own insurance schemes in line with the provisions of a reviewed NHIS.  

The benefits of a health insurance scheme that works in a country like ours are many. One, the idea of cashless treatment for those insured makes it imperative for them to get immediate treatment during sudden ill-health. Two, the premium paid on health insurance is usually tax deductible. It is therefore important to take into consideration all the factors that militate the implementation of the NHIS Act and work to put them right.