THE PUSH FOR UNIVERSAL HEALTH COVERAGE
The authorities at all levels should buy into the health insurance scheme
As Nigerians join the rest of the world to mark the 2024 Universal Health Coverage (UCH) Day, there could not have been a more apt theme: “Health: It’s on the government”. 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. While there can never be a one-size-fits-all model for guaranteeing health insurance for the people, we believe that the defining problem with the National Health Insurance Scheme (NHIS) in our country is the system-wide inequalities in its implementation which has resulted in the lack of financial protection for the health care needs of most Nigerians.
On a day such as this therefore, questions must be asked as to why, despite a comprehensive reform of the sector 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. Many of the states and local governments are yet to come on board.
According to the World Health Organisation (WHO), the UCH Day 2024 focuses on the role of financial protection in accelerating progress. This is to ensure that people don’t fall into poverty because of having to pay out-of-pocket for health costs. “Over the last 20 years, financial protection has progressively deteriorated, with two billion people experiencing financial hardship and 1.3 billion others pushed into poverty due to health spending,” WHO said in a statement. “This means that mothers may miss out on the life-saving intervention they need for themselves or their children, people are not diagnosed and treated for noncommunicable diseases (NCDs) on time, with delays in early treatment leading to severe, untreatable or life-threatening illnesses.”
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.” This is in order to contain high cost of healthcare, through various pre-payment programmes prior to people falling ill. But a scheme that is voluntary in practice cannot guarantee proactive protection for the country’s sick population. 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 critical stakeholders.
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 lead or keep a healthy population. To therefore achieve the UHC which the country has signed on to, there is urgent need to adopt and strengthen a comprehensive social health insurance scheme. We 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 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. The idea of cashless treatment for those insured makes it imperative for them to get immediate treatment during 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 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.
