When the National Health Insurance Scheme (NHIS) was established under Act 35 of 1999 by the Federal Government of Nigeria, it was aimed at providing easy access to healthcare for ‘all’ Nigerians at an affordable cost through various prepayment systems. According to the government, NHIS is totally committed to securing universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians.
However, 16 years down the line, only about 4 to 6% of the populations have been covered in the scheme. Most significant of all is that these 4 – 6 percent fall within the formal sector alone, leaving the informal group, which forms the bulk of the population, all to themselves.
This idea does not go down well with many stakeholders especially members of the Health Care Providers Association of Nigeria (HCPAN) who view Health insurance as a vehicle for providing qualitative healthcare to Nigerians.
HCPAN opined that a well-designed prepaid scheme such as National Mobile Health Insurance Programme, Primary School Healthcare Insurance Programme and State Health Insurance Scheme will accelerate the number of Nigerians covered by the NHIS.
To chart a way forward for Health Insurance in Nigeria, HCPAN, an association recognised by the NHIS Act of 1999 to serve as providers for the NHIS, recently held an AGM where justice was done to the topic: ‘Health Insurance as vehicle for providing qualitative healthcare in Nigeria, by many stakeholders’.
According to a write up in the NHIS website, NHIS is a pre-payment plan where participants pay a fixed regular amount. The amount/funds are pooled, allowing the Health Maintenance Organisations (HMOs) to pay for those needing medical attention. It is primarily a risk-sharing arrangement, which can improve resource mobilisation and equity. It is indeed regarded as the most widely used form of health care financing worldwide.
If health Insurance is of immense benefit to the citizenry, why is the figure covered so poor?
According to Dr. Oluwole Sanda, National President of HCPAN, the main challenges responsible for the stagnant figure of 4 – 6% inclusion are poor awareness among the population, unwillingness of Nigerians to accept the scheme and a lack of willpower by the government.
Dr. Sanda affirmed that, “If the NHIS Act can be changed from ‘May’ to ‘Shall’, definitely it means that health insurance coverage would become compulsory for every Nigerian.”
How to accelerate number of people under the NHIS.
Stakeholders have stressed the need to induct a thing universally acceptable and used by a greater percentage of the population to sell the scheme. They have unanimously voted for the use of mobile phone as a more reliable venture to sell NHIS.
Dr. Earnest Ndukwe, former vice chairman of NCC and Chairman Salt and Eistein in a chat with Daily Sun said, “You need a technology like the mobile phone technology that captures a large number of our population to build a platform for reaching that population irrespective of where they are in the country.
“We have tried health insurance by individual face to face registration of people, today the number of people under the health insurance scheme is less than 5 percent of the population and what we are saying is that we need to capture every one, we need to provide health service to as many Nigerians as possible. So it is not too difficult to understand that a technology like mobile technology provides the base for reaching out to those people. That’s why we have what we call mobile health insurance scheme today, which makes it possible for people to register for mobile insurance or for health insurance, using their mobile phone.
How do you think telecommunication will be of help to the insurance scheme?
Ndukwe said: “ICT generally is a very important aspect of health care provision today. It’s almost like conjoined twins that you can’t really have good medical practice today without technology. On the aspect of insurance, you also need a lot of technology especially in linking those who are supposed to be enjoying the health insurance with the providers, there is a lot of technology that goes in between to be able to capture all the health insurance providers, all the enrollees, and also capture details of the kind of services they are getting.
“So there is a very strong link between them and what we are offering today is Mobile Technology because today, over 70 million discrete Nigerians and non Nigerian residents for that matter actually own a mobile phone; some own two, some have three and that is why the total number of phones in Nigeria today is over 140 million. That’s a very massive number.”
On whether Nigerians will really buy into this idea Ndukwe said: “You will be surprised what is going on in the mobile arena. Nigerians have embraced mobile technology wholeheartedly. They are buying all kinds of things over the mobile phone. When people started talking about online shopping, people didn’t believe that it was possible to shop online but today, all the online businesses are providing fantastic services over the mobile platform not to talk of people’s health because when you want to be healthy, you are looking for whatever way is possible to make sure you are able to buy affordable health because what mobile health insurance offers is affordable health, which means you can be contributing a small amount of money everyday or month in order to give you insurance for that rainy day when yourself or family member become sick and there is no money. You fall back on your mobile or health insurance to be able to obtain health care.”
Sanda also threw his weight behind this when he said, “If we use telecommunication as a vehicle to spread health insurance to majority of Nigerians that are not in the formal sector, at least we will cover 40 to 60% of Nigerians and that is a large figure as against only 4 to 6% presently covered nationwide.”
Expressing optimism that mobile phones would work perfectly for Health Insurance, Dr. Leke Pitan, former Commissioner for Health, Lagos State said, “the idea of it working out or not working out is not really a problem, it will certainly work out in the sense that, some people are a bit confused, they don’t understand the fact that the issue of mobile health is not a programme; it’s a platform for people to access health insurance. So you have three different issues here: health care that has issues to do with quality as an entity; health insurance as a means of financing, letting people be able to afford health care; mobile health is a platform which is voluntary for people to be able to comfortably and conveniently get on board.
“What we are talking here is for you to be able to use your mobile phone in the comfort of your office or of your canoe if you are a fisherman or in your shop if you are a hairdresser. Even a beggar has a mobile phone and all he has to do is register it and a certain amount of money which he would have agreed to, either N20 or N35 daily or if he likes, depending on the plan he subscribed to, it could be N100 daily. So the issue of it working out does not come up.
“I want to say that I have been part of several meetings where different stakeholders including the telecomm companies, health care providers, health management organisations, even citizenry and other stakeholders, have come together to discuss the percentages of sharing the premium and a lot of meetings have gone into that. So, what is being awaited is a form of ministerial action committee along with NHIS, and I must say all those meetings in fairness, NHIS has been involved and I was physically present, some of them I chaired and therefore, I think what we are waiting for is to kick-start and it will certainly work out.
“It makes it very easy so that no matter who you are, you can key in one day and after that day, your subscription automatically gets taken from your credit in your phone on a daily basis.
“But more importantly is that it is voluntary. You can choose that you want to go to the HMO office to do your own registration, negotiate the plan you want and pay your premium directly, so it is just an optional platform for you to access health insurance.”
“But more importantly is that it is voluntary. You can choose that you want to go to the HMO office to do your own registration, negotiate the plan you want and pay your premium directly, so it is just an optional platform for you to access health insurance.”
Responding to the issue of health insurance enrollees dwindling by the day, Pitan said, “the reason for this is because of some gaps between those who want to access and the opportunities they have to access and then more importantly is that at the supply side, they are no more getting the result. And the reason why the supply side is not responding enough is because the infrastructure is not adequate, the number of accredited facilities is not yet enough and that is why part of our proposal to NHIS and government generally is to now widen the base of the pyramid of the primary health care level by reducing the accreditation requirement in order to include the primary health centres which are many and are wide spread so that the primary health care package will be what the average primary health centre can give. That way, the primary health care centres can now be in NHIS scheme; as at now, they are not accredited.
“Private hospitals and clinics, general hospitals, teaching hospitals are accredited. So what we are asking is a kind of restructuring such that the base of that pyramid will be widened and you know there are many parts of Nigeria where all you have are just government primary health centres. If you want people there to come on board NHIS, the facilities to take care of them must be within their vicinity, so if that base is broadened and primary health centres are accredited and included, more people in those hard to reach areas will come on board and the issue of it going down will not arise, especially when you consider the National Health Act makes provision for some fund being set aside from the Consolidated Revenue Fund of the Federal Government and a certain percentage of it used to upgrade the primary health care centres. So we are looking at a scenario where the primary health care centres get those forms directly and they get upgraded and accredited to come on board the NHIS and people in those rural areas can be able to register even using their mobile phones. And of course, for the very poor who cannot pay their premiums, we make proposals that government help them pay it so that there is true universal health coverage.”
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