Improving Nigeria’s Health Insurance Coverage

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As Nigeria joined the rest of the world to mark the 2017 Day for Universal Health Coverage, the Chairman, Senate Committee on Health, Senator Lanre Tejuoso and other stakeholders were of the view that making the health insurance scheme mandatory will help to improve Nigeria’s health indices, writes Martins Ifijeh

While other nations of the world on 12th December 2017 celebrated Universal Health Coverage Day to commemorate the fifth anniversary of the United Nation’s day for health insurance across the world, Nigeria showed no sign of celebration as no significant growth has been made in increasing the number of Nigerians accessing healthcare irrespective of their financial strength.

This was somewhat expected as only about one per cent of Nigerians are covered in the country’s National Health Insurance Scheme (NHIS) which started 12 years ago; showing that there was indeed no reason for the country to path itself in the back for a job well done to mark the day.

But same cannot be said of Ghana which started its health insurance scheme same year with Nigeria in 2005 but has grown their scheme to more than 50 per cent. They not only used the day to celebrate the successes made so far, they also used the opportunity to push for coverage of 100 per cent of its entire population by 2030. Nigeria is still trying to stand its feet, and perhaps grow the scheme beyond one per cent.

Health experts say Nigeria’s stunted growth of the scheme has made major chunk of the citizens, especially the poor, to pay for healthcare from their pockets; an approach that has not only made them poorer but has increased mortality rate.

No wonder statistics have shown that the level of out of pocket expenditure as a share of total health expenditure in Nigeria is still placed at 72 per cent, the highest on the continent and one of the highest in the world. Even poorer countries in sub-Saharan Africa like Kenya (26 per cent), Gabon (22 per cent), among others are doing better.

Information also show that countries afflicted with conflict and post-conflict like South Sudan (54 per cent) and Sierra Leone (61 per cent) are still better than Nigeria, leaving stakeholders in the healthcare industry to ponder on the model used by the government to run the scheme.

But few years ago, the tireless work of healthcare activists and various stakeholders prompted approval by the National Council on Health empowering states to sign their own health insurance bills. A move which made various states, including Lagos, Oyo, Ekiti, Delta, Bayelsa, Cross River, Akwa Ibom, Kwara, Abia, Adamawa, Kano, Anambra, Sokoto, and Enugu pass health insurance bills into laws in their various states.

To further smoothen the pace for a universal coverage for Nigerians and increase the percentage of Nigerians in the scheme, stakeholders, including the Chairman, Senate Committee on Health, Senator Lanre Tejuoso are pushing for policy change to make the scheme mandatory for Nigerians, just as it applies in most countries where it has worked.
Universal Health Coverage refers to a system that provides healthcare and financial protection to all citizens of a particular country. It is organised around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.

Universal Health Coverage Day is celebrated annually on December 12 and is promoted by the World Health Organisation. The day was first celebrated in December 12, 2012 when the United Nations unanimously endorsed a historic resolution urging all countries to accelerate progress toward universal health coverage as an essential priority for international development.

With the global agenda to create a movement for accelerating equitable and sustainable progress towards universal health coverage (UHC), the United Nations and it allies have continued to push for all countries to be able to provide total healthcare access to their citizens irrespective of whether they can afford it or not by the year 2030.

So each year on 12.12, masses of people in various countries gather to raise their voices to share the stories of the millions of people still waiting for health, to call on leaders to make bigger and smarter investments in health, and to remind the world that health for all is imperative for the world we want.

According to Senator Tejuoso, processes have begun towards the amendment of the health insurance scheme, such that it will be mandatory and more encouraging for Nigerians to key into. “We have started putting measures in place to achieving a more robust universal health coverage in Nigeria.

“We are proposing that if every Nigerian, whether an okada rider, barber, tomato seller, or recharge card seller contribute N200 monthly towards their health insurance, the pool will significantly change healthcare for good in his country.

“For instance, assuming 100 million Nigerians pay N200 monthly, that will amount to N20 billion, and with this, poor Nigerians needing healthcare access will get it without them paying money from their pocket for it. Once you are a contributor to this pool, you will have access to any of our health facilities. This will significantly settle some basic healthcare issues in the country,” he said.

The medical doctor, who is also a prince from Ogun State, said the public hearing done on the initiative few months ago was successful, adding that before the end of first quarter of next year, the process would have been completed, paving way for a better healthcare for all Nigerians.

He said the law met on ground by the present government did not give room for mandatory health insurance, hence the new approach, adding that the initiative was even more necessary now considering the fact that health allocation in the national budget was declining every year.

He lamented that the allocations does not reflect the Abuja Declaration where all African countries met, and agreed in Abuja to give at least 15 per cent of their entire national budget to health.

“Every year our health budget continues to decline. How can we tackle all the various health challenges in the country if no adequate funding provision is made for the sector? All the countries that have honoured that decree are now healthcare destinations, which means the provision of 15 per cent allocation for health worked. Here in Nigeria, we are not up to five per cent. We shouldn’t expect harvest when we have not sowed. In Sokoto for example, only three per cent of the children are immunised and we are not doing what we are supposed to do because of poor funding,” he added.

Tejuoso also explained that he has also proposed to the government instead of using money to buy cancer machines, such money should rather be used to pay for treatment of cancer patients.

“If investors know that the Nigerian Government has allocated certain money to pay for the treatment of 10,000 cancer patients, they may on their own decide to get the machine for the service. That is the public private partnership we have been talking about. We have tried our best but the government cannot do it all. Every year we keep budgeting for cancer machines for more than 190 million. But as at today, we have one or two cancer machines working in the entire country. The machine we have in Nigeria cannot take care of our population. That is the reason Nigerians travel abroad to seek cancer treatment. To set up a radiotherapy centre will take a minimum of about three years. That’s why I am saying we should fund services rather than buying equipments.”

The Senate Committee Chairman on Health also noted that with the several problems of malaria, diabetes, malnutrition, among others affecting Nigerians, it was important the little funds allocated to healthcare be used to cater for them.

He called on the federal government to give 10 per cent of the one billion budgeted to tackle Boko Haram to health. “$1billion dollars is N360 billion naira, and 10 per cent of that money is N36 billion. Just imagine what N36 billion will do for our health sector. That is the issue, if we give health priority.

In the same vein, the Medical Director, Graceville Clinic, Lagos, Dr. Irawo Dayo, called on President Muhammadu Buhari to prioritise funding for the health sector, adding that the poor funding for the sector was part of reasons the country’s healthcare indices are not improving.

“The government should also make health insurance mandatory. The informal sector should be inculcated into the scheme, otherwise growing the scheme will continue to be a herculean task,” he added.

Meanwhile, the Minister of Health, Prof. Isaac Adewole, during a function to mark UHC Day in Abuja recently, he said that Nigeria has over the years demonstrated common interests, partnership in health and collective action to lend her voices in unison to the tenets of UHC for the benefit of the Nigerian people.

He said: “Universal Health Coverage as we are all aware is enshrined in the National Constitution- the right to health. It is the statutory role of government to ensure that all citizens, irrespective of the geographical divide have access to affordable and needed health services in an equitable manner without falling into financial catastrophe.”

In operationalising the provisions of the National Health Act, the minister said that implementing initiatives and strategies towards accelerating UHC would require huge capital commitment. “The Act provides a window of opportunity to facilitate mobilisation of resources needed for funding UHC through the provision of a basic minimum package of health services for every Nigerian. This will be achieved through contributions from at least one per cent consolidated revenue fund, donor contributions and through other sources,” he added