There is urgent need to overhaul the National Health Insurance Scheme

The essence of setting up the National Health Insurance Scheme (NHIS) is to make health care service delivery accessible, affordable and cost-effective to the average Nigerian. It is aligned with the intention of Universal Health Coverage (UHC) which, according to the World Health Organisation (WHO), is geared towards reducing the burden of costs on individuals and to drastically minimise out-of-pocket spending on healthcare for most Nigerians. Unfortunately, there has not been much success.
This is not because these target goals have not been met, the performance of the NHIS has not inspired much hope. Even the attempt to promote community health insurance to boost rural dwellers’ access to quality health care has not yielded positive outcomes. The only success in that regard remains the cooperative contributory scheme launched in some communities in Abuja.
In a recent peer review by the Global Advanced Research Journal of Microbiology, the authors pin-pointed the various obstacles in the implementation of the scheme. It said that why about 82 per cent of enrolled respondents were aware of NHIS and preferred it to the- fee- for- service system, about 26 per cent were dissatisfied with the scheme.
According to the authors, sources of dissatisfaction included poor registration services, poor referral system, delays in receiving required services and unavailability or non coverage of some required services. It was statistically determined by the tool of analysis that there was a direct relationship between the percentage of enrollees and the poor health indices of the populace. “We strongly recommend modification of existing policies to enable enrolment of the self employed and unemployed as well as improved coverage and quality of services within the scheme,” report said.
It is in the light of the above existing gaps that the new NHIS Executive Secretary, Prof. Usman Yusuf recently challenged stakeholders to brace up, warning that he was ready to ditch any Health Management Organisations which failed to join the train of change. “What we have here is not healthcare financing. This is worse than fuel subsidy. I need to see monies returned by HMOs, through the NHIS that were not used. The waste I see, the impunity I see, and the political patronage I see makes me want to throw up”.
Besides these challenges, there are other problems to contend with the nearly 10-year scheme. Instead, the NHIS scheme has over the years turned itself to a conduit pipe for HMOs and other cronies in government circles. Sadly, there are also accusations that even the newly appointed NHIS Executive Secretary has been promoting nepotism by pushing aside competent hands within the agency only to bring his cronies on board. The recent exchange between him and the Senate on the lopsided appointments made so far is a pointer to that discontent.
With several challenges confronting the scheme, we urge Usman to focus not on petty sectional politics but on how to achieve universal coverage. Usman should strive to leave a legacy of service by making the NHIS to work in the interest of all Nigerians. That only the public sector at the federal level has keyed into the scheme shows clearly that the scheme still has a long way to go.
The task before the new NHIS team is therefore enormous. First, there is need to overhaul the scheme. The issue of abuse perpetuated by HMOs should be curtailed in all ramifications. And finally, there is an urgent need to expand its reach beyond the public sector to the private sector. It should be all inclusive.

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