It’s been 14 years since Nigeria launched what was supposed to be Africa’s biggest health insurance scheme – the National Health Insurance Scheme, but mismanagement of the programme has left the vision behind it only as a dream. In this report, Martins Ifijeh queries if the recent modification of the Act establishing it and the appointment of a new Executive Secretary would bring the long awaited ‘Next Level’ the scheme clamours for?
When Prof. Eyitayo Lambo, the then Minister of Health under ex-President Olusegun Obasanjo in 2005 supervised the birthing of Nigeria’s National Health Insurance Scheme (NHIS), he said at the time that the vision was to ensure that by 2025, the country meets its bid to achieve Universal Health Coverage (UHC); which became a global drive to ensure every human has access to quality healthcare anytime, anywhere in the world, without having to pay out of pocket for it.
To kick start the drive, on June 6, 2005, the ministry of health launched the formal sector of the scheme, and within two years, it had gradually grown to about seven per cent with a projection that within the next 10 years, it would have passed the 50 per cent mark.
But the dream perhaps left with that administration, as subsequent governments did not grow it more than that. And what seemed like a beautiful idea to save poor Nigerians from healthcare disaster began to evaporate into thin air. It is a fact that it started to decline in strength, coverage, leadership, and as at the last count, the country’s NHIS only covers about four per cent of Nigerians.
This same scheme started about the same time Ghana started theirs. As at today, Ghana has grown their scheme to 45 per cent of its entire population, and indications show from recent data that Ghana’s health sector funding is gradually shifting towards reliance on Ghana-NHIS and less on its ministry of health. And the model adopted in the country has ensured reduced fragmentation within the insurance system signified by the single purchaser and single pool for the benefit package, as well as the publicly financed social health insurance, not individual premiums, is in keeping with best practice in equitable health financing design.
But the Nigerian scheme negates anything that makes it flourish to achieve the set-out purpose. The constant lack of clarity on the mandate of the scheme hasn’t helped much. Today, it is not clear whether the NHIS is a provider and/or a regulator? It is not clear whether it is a standalone ministry or a department under the Federal Ministry of Health, especially with the several events that unfolded between the immediate past Minister of Health, Prof. Isaac Adewole and the immediate past Executive Secretary of the NHIS, Prof. Yusuf Usman.
For decades, it has been a constant fight between the Health Management Organisations and the scheme, or the Health and Managed Care Association of Nigeria (HMCAN) and the scheme, or a fight between the leadership of the scheme and its workers union, or a fight between the scheme and the ministry of health. All at the expense of the Nigerian people who are at the receiving end, with the targeted dream of achieving UHC for the country by year 2025 thrown to the wind.
For refusing to grow itself, the NHIS in lay man terms has indirectly caused the death of several poor Nigerians who otherwise hoped to benefit quality and accessible healthcare from their country but ended up losing their lives because they were unable to pay for healthcare, even though it is entrenched in the constitution that the access to healthcare is the right of every Nigerian.
On specifics, one of those who the Nigerian government failed is Serah Osabuohien, who ran to THISDAY along with her mother sometime in 2017 with a customised bag in her hand. She was desperately fighting for her life, but saw the media as the last hope, having done all she could to raise money for surgery and chemotherapy. The 25-year-old was suffering from colorectal cancer. That customised bag was her mobile toilet. It collects faeces at will.
It was obvious Osabuohien was going to die if she does not start treatment immediately. She needed N10 million. THISDAY did a report on her and she was able to raise around N700, 000. Within days of commencing treatment, the money was exhausted. THISDAY ran another story, and few other monies trickled into her account, but it was not enough. On October 18 2017, Osabuohien died from a disease that could have been treated if there was money. She died from what clearly shouldn’t be an out-of-pocket cost for her, especially considering her class as a poor citizen.
Osabuohien was a poor Nigerian living in Nigeria, but did not benefit from Nigeria. She wasn’t treated any different from how the Nigerian government would have treated any other foreigner. There was no added incentive to show she was a citizen of Nigeria.
Osabuohien‘s own may be cancer, but there are hundreds of thousands of ‘Osabuohiens’ in Nigeria who lose their lives daily because they are unable to pay for the simplest of care like treating malaria, diarrhea, typhoid or other highly preventable diseases. And currently, millions of Nigerians are living in ill health because they are unable to afford treatment cost. Sadly, a lot of them will lose their lives due to the failure of government to provide proper healthcare financing model that should touch the core of the Nigerian people.
Among those who are still counting on government for them to live is Martha Okwachi Anozie, a twin whose family visited THISDAY few days ago to solicit through the medium for the help of Nigerians so she could lead a healthy life. She is suffering from stage two cancer and currently needs N10 million to be cured. She can be reached on +2348080883658. (Diamond Bank, 0013274110, Chibuzor Anozie).
THISDAY receives at least three of these ‘cry for helps’ every month. In a better clime, citizens shouldn’t be this helpless especially with a working healthcare system that ensures every resident, irrespective of class, has access to quality healthcare without necessarily worrying about paying for it.
It is in addressing some of the ills in the NHIS administration that the 8th National Assembly, towards its winding phase, passed a bill for the enactment of the National Health Insurance Commission that will ensure it is mandatory for every resident of the country to contribute a minimum amount to health insurance pool, and by interpretation the scheme will be obliged to provide healthcare services to all Nigerians.
Also, just recently, President Muhammadu Buhari appointed Prof. Mohammad Sambo as the new Executive Secretary of the NHIS in a bid to bring in fresh ideas to run the scheme, and it is hoped that truly, progress comes to the scheme so no Nigerian will die needlessly from clearly preventable and curable diseases.
As President Buhari anchor’s the next four years of his administration on the ‘Next Level’ mantra, it is hoped that this will be felt in NHIS.
Will the scheme give Nigerians what it promised over 14 years ago? Will Prof. Sambo make a difference, or continue to play the political card past substantive leadership of the scheme have been playing? Will Nigerians ultimately be the beneficiary of the Next Level NHIS? Time will tell.