The National Health Insurance Scheme should be comprehensive and compulsory

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 comprehensive reform of the sector and the law already put in place, a large percentage of the population is 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. Many of the states and local governments are yet to come on board.

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. Admitted that there can never be a one-size-fits-all model for guaranteeing health insurance for the society, we however believe that the defining problem 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 the vast majority of Nigerians.

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 a scheme that is voluntary in practice cannot guarantee proactive protection for the country’s sick population.

The Health Minister, Prof Isaac Adewole, recently disclosed that the act establishing the NHIS requires a comprehensive review in order to make it work more efficiently for Nigerians who desperately need comprehensive healthcare coverage. While we agree with Adewole on the need to strengthen the law governing health insurance with a view to getting wider participation and ensuring effectiveness, we do not agree that a review of the act should be concerned about the power of the governing board. The fact that other federating units outside the federal government do not participate in the NHIS makes it somewhat ineffectual. How to get the states and local governments, as well as private sector organisations enlisted in the scheme should therefore be the overriding objective of any attempts to review the NHIS Act.

Indeed, as it stands with the NHIS, only a small proportion of Nigerians have prepaid health care, and this is not right if we must keep a healthy population. To therefore 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. We also believe that reforming the country’s healthcare financing through a review of the NHIS Act is critical to achieving the objective. The effectiveness of a social health insurance in Nigeria would also be strengthened with the inclusion of 36 states into the scheme, and getting them to set up 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 in the course of sudden ill-health while the premium paid on health insurance is usually tax deductible. It is therefore important for the National Assembly to take into consideration all the factors that militate against the implementation of the NHIS Act and amend the law appropriately. Until we can extend health insurance to all citizens, the country’s push for UHC will be a mirage.