Repositioning the National Health Insurance Scheme
The National Health Insurance Scheme (NHIS), conceptualised as a strategy to ensure that Nigerians have easy and affordable access to quality health care delivery, is no doubt due for retooling. This is not just for the purpose of tackling the challenges besetting it, but to unshackle the concept in itself, in order to make it truly effective in the provision of universal health care.
When the scheme became operational in 2005, even though the law that established it was signed way back in May 1999, the then president, Olusegun Obasanjo, gave a presidential mandate that was to ensure that by 2015, the NHIS should have had universal coverage of all Nigerians through the social health insurance.
Sadly, however, even though the scheme has more enrolees than when it first started, the presidential mandate given at its inception was not realised in 2015. In actual fact, only about 11 per cent of Nigerians subscribed to it; and worse still, the players and managers involved in the scheme now seem more interested in in-fighting, instead of pulling in the same direction to help take the scheme to the next level.
While doctors are complaining of being underpaid by the Health Management Organisations (HMOs) for services rendered, pharmacists and other health professionals are equally vociferous in flaying the global capitation template which makes them wait on the doctors for payment for services they render to patients under the scheme. Some enrolees of the scheme, too, have complained of either being ignored while trying to access treatment or being ill-treated while receiving care.
It is therefore heartening that the newly appointed Executive Secretary of the NHIS, Prof. Usman Yusuf has not only acknowledged that there are rots to be purged from the scheme but also reiterated that it is now imperative to reposition the scheme for effective service delivery. Speaking during the NHIS management retreat held in Kaduna, recently, Prof. Yusuf said he had a fresh mandate from the presidency to make the scheme work for all Nigerians. Decrying the irregularities of some HMOs and widespread ill-treatment of enrolees, he made it emphatically clear that the HMOs had not done well in the past and pledged to purge the scheme of endemic corruption and inefficiency.
While we commend the new NHIS boss for his bold admission that the NHIS needs urgent repositioning, we must equally state that mere diagnosis is not enough to strengthen and stabilise the ailing scheme; what it needs are well-articulated strategies, backed by the required political will to effect changes. We urge the NHIS boss and his team to begin to walk the talk, or risk having the fresh presidential mandate given to him end up as a pipe dream, just as other targets of past administrations.
To begin with, we recommend that Prof. Yusuf spearhead a holistic review of the scheme’s operation and, if necessary, reassess the enabling statutes in order to effect necessary amendments that will guarantee the scheme’s overall efficiency. For instance, the legal instrument that created the NHIS posits that health insurance is voluntary, instead of mandatory. Issues like this have to be revisited before vigorously pushing for the expansion of the scheme to more Nigerians through the universal coverage drive. Countries that have made huge success of the health insurance concept have all had mandatory schemes.
It is also important to engage state and local governments in order to fast-track the expansion of the NHIS to every part of the country, including the rural areas. In addition, the new leadership of the scheme must extend its focus to the largely untapped informal sector. This, however, will require making more concerted efforts to accredit more HMOs to take care of this group as the numbers of HMOs operating in the country presently is inadequate to cater for the huge population.
More importantly, it is essential to ensure that all health professionals operating under the scheme are fairly treated and adequately compensated. Except this is done, patients may not get the quality care they deserve. A neglected caregiver cannot be expected to give the best attention to a desperate patient.
Beyond this, vigorous attempts must be made to enlighten and persuade Nigerians to embrace the scheme. Despite the fact that the NHIS has been in operation for eleven years, millions of Nigerians, especially in the informal sector, know little or nothing about it. Therefore, the new NHIS leadership must see it as a priority to create awareness about the scheme, using every available media channel.
We have no doubt that the NHIS, if strategically repositioned, can deliver on its mandate to help safeguard and fortify all Nigerians, regardless of social or economic status, against the daunting exigencies of ill-health.