The federal government’s target of having all Nigerians covered by the National Health Insurance Scheme (NHIS) by 2030, less than 10 years from now, looks plausible enough even if ambitious. NHIS Executive Secretary, Professor Nasir Sambo said the scheme was poised to achieve the target. “Our aim is that by the year 2030, all Nigerians will have had the opportunity to get into the social health insurance system as a principle of solidarity, as a mechanism for cross subsidization and effective healthcare financing”.
With a widening income inequality, wrenching unemployment and poverty, most Nigerians are indeed desirous of affordable health care financing which only a workable health insurance scheme can offer. The NHIS was established to improve the health of all Nigerians at an affordable cost by providing social health insurance where health care services of contributors are paid from the common pool of funds contributed by the participants.
Essentially a pre-payment plan, health insurance offers participants the opportunity to pay a fixed regular amount that is then pooled allowing the Health Maintenance Organisations (HMOs) to pay for those needing medical attention. Indeed, as a risk sharing arrangement, the scheme aims to advance resource mobilisation and equity. Perceptibly, it is the most widely used form of health care financing all over the world.
As should be expected, because of its importance, the introduction of NHIS in 2004 was greeted with euphoria as most Nigerians viewed it as a veritable platform to cushion the effect of the unusually high cost of accessing health care. However, years after it was established, the scheme was able to cover less than 15 million Nigerians, most of whom are public sector workers.
In July 2020, when the NHIS chief visited this newspaper, he noted that the scheme covered only about 12 million people most of whom are formal/public sector workers. Sambo said the scheme operates under a 2004 law, which focuses on the formal sector.
Besides covering just a negligible fraction of the country’s population, the NHIS has, until recently, been weighed down by leadership challenges that was exacerbated by widespread allegations of graft that dogged its operations especially the HMOs.
Leadership problem is part of the Scheme’s challenges this newspaper notes, rather worrisomely, that in the 20 years of the NHIS’ existence, it has had 12 Executive Secretaries. Good enough, the current leadership under Professor Sambo has been able to ensure stability in the scheme. Should the pace with which the current leadership is championing the scheme be sustained, in the years ahead, achieving the target of covering all Nigerians in the next ten years will be a given.
Then of course, to achieve this, in our considered opinion, there is the need to entrench transparency and accountability in the entire operations of the scheme as well as accelerate the attainment of universal coverage. Even as the nation struggles to have all its citizens covered by the NHIS, we are wont to ask about the state of implementation of universal health coverage.
How best can the nation ensure access to health care for all Nigerians, especially the hapless poor who, on a daily basis, are faced with choosing between health care and other daily expenses like food, clothing and even a home?
NHIS comprises formal and informal sector social health insurance schemes with the formal sector, flagged off on June 6, 2005, largely to improve funding and achieve Universal Health Coverage in 2015. Clearly, the NHIS is Nigeria’s main mechanism for achieving universal health coverage.
There is no contesting the fact that universal health coverage holds the key to unlocking the door for equitable, qualitative, and universally accessible health care for all Nigerians without suffering financial hardship. While the World Health Organisation (WHO) expects over 90 percent of a country’s population to be covered by pre-payment and risk-pooling schemes, Nigeria only has less than 15 percent of her population currently covered.
This is composed largely of employees in the public sector, some subscriptions in the organized private sector, and some community-based social health insurance schemes. As things stand, the majority of Nigerians still bear the direct cost of health-care services with private health expenditure still accounting for a high percentage of the total health expenditure.
It is from this standpoint that we believe the plan to cover all Nigerians in the next ten years is commendable and a matter that ought to be pursued with vigour. Beyond the target, the government must come up with a clearly defined strategy to achieve this.
If in its 20 years of existence, the scheme was able to cover less than fifteen million Nigerians, having all the citizens covered in ten years looks like an over-ambitious target. Still, we are convinced that it is doable with the right political will and commitment on the part of all.
NHIS Flags Of Social Insurance Programme For Group, Individual, Family (Opens in a new browser tab)