NHIS: Your health according to your pocket
The government of former President Olusegun Obasanjo came with the National Health Insurance Scheme (NHIS), like previous health programmes, it was greeted with sceptic. But with time, Many Nigerians embraced it more so that it was made compulsory. According to many Nigerians, the NHIS is actually not what it was meant to be due to […]
The government of former President Olusegun Obasanjo came with the National Health Insurance Scheme (NHIS), like previous health programmes, it was greeted with sceptic. But with time, Many Nigerians embraced it more so that it was made compulsory.
According to many Nigerians, the NHIS is actually not what it was meant to be due to the categorisations in the scheme. Going to hospitals is considered a nightmare for most Nigerians because they end up not getting value for their money. Or worse, they are being segregated by the categorisation of the supposed NHIS that is meant to bring succour to the average Nigerian who cannot afford medical treatment for various ailments.
Yusuf, a young man, thought he had no problem finding a solution to his medical problem since he was registered under the NHIS, but his condition was made worse in a hospital in Kaduna by a nurse who said he should be treated according to his status on the NHIS scheme. At the end of the day, he was given just Paracetamol, multivitamins and malaria treatment when he was actually suffering from kidney failure.
Because he was in the bronze category, he was not given the necessary test to determine what was actually wrong with him and the doctor simply went ahead to treat him for malaria. Many other people have had cause to complain about the kind of treatment they get from some NHIS providers as they feel that they can equally get this kind of treatment in other hospitals.
“We have not really felt the impact of the NHIS because there are still instances when we go to the hospital and we are charged for some tests and medication. Even when we are given medication, we are told that we are not entitled to that medication because it is above what our status in the NHIS category i, so healthcare delivery through NHIS can never be achieved, because they have succeeded in segregating people in the whole system. We are not even talking about the money they deduct from our salary towards the funding of the scheme. To me, I see it failing the same way the National Housing Fund started and failed,” Mr. Andrew Akinbola, a civil servant with one of the ministries in Abuja, said.
On the overall, however, the NHIS is expected to provide the Nigerian citizen with the opportunity to have reliable and affordable healthcare delivery system, with every segment of Nigeria’s population in mind irrespective of who you are and what social group or class you belong to. The NHIS is aimed at mobilising resources in a sustainable manner for the provision of accessible, quality healthcare for all irrespective of social status.
The health scheme was incorporated to accommodate workers in the public and organised private sectors and is mandatory for any organisation having ten or more employees. The cost of the healthcare service is spread equitably. Contributors chip in five percent of their basic salary while employers pay ten per cent to the common pool. This entitles a contributor, a spouse and four children to full health benefits of the scheme which many are yet to see.
“On many occasions, I have been to the hospital and was told that my NHIS status does not cover my medication, so I have to fund it myself. When I demanded for an explanation, I was told that since it was a baby I had, the services we were enjoying were secured by the scheme for the first six weeks and after that I have to pay for the immunisation of my child which ranges from N4,000, N8,000 depending on the kind of immunisation you are taking and so many other things that they claim do not cover my NHIS status,” says Mrs Mercy Akpan, whose NHIS service provider is a private hospital in Abuja. Another supposed beneficiary of the health scheme had something not too pleasing to say about the whole scheme. “In the hospital I am registered, we are first asked if we are private or under NHIS and once you are confirmed to be a NHIS beneficiary, you are not allowed to see the specialist or consultant, your file is taken to the outpatient doctor for examination and prescription,” says Maryam Bello.
A few months ago, stakeholders in the health sector held a workshop in Lafia, Nasarawa State and said the various challenges militating against the provision of qualitative and affordable healthcare services to Nigerians through the National Health Insurance Scheme were surmountable,
Another great challenge facing the NHIS’s effectiveness is the reluctance of government to pay for treatment given to patients who have gotten treatment under the scheme. “It is a great challenge that we are facing here because even after attending to these patients that have registered under the NHIS programme and have picked our recommended hospitals as their service providers, we still have problems getting the money we have spent on drugs and treatment from the government. Government’s nonchalant attitude to the payment of treatment for patients is one of the hindrances that will make the whole scheme a failure,” says Dr. Obinna Michael, with a private hospital in Abuja.
He said “with this development of us having to face a lot of hurdles before we are paid for the services we render to patients under us and the stress associated with it and even the patients not understanding the policy or status category on which they belong expecting to get the services of the silver policy or category when they actually belong to the bronze category, the whole scenario is just not working. And with things not getting any better, we have on several occasions decided to opt out of the scheme and continue with just being a hospital that renders services on a cash-and-carry basis,” he said.
If what Obinna says is anything to go by, it means very soon, Nigerians will go back to having the cash-and-carry system of health service delivery and the intended healthcare delivery for all will be a mirage. The health insurance policy is also alleged to be focused in urban areas alone as people in rural areas hardly have access to it.
The Executive Secretary of NHIS, Dr Muhammad Bello Waziri Dogo-Muhammad sometime back said the scheme was based on social security, adding that about 70 percent of Nigerians who might not contribute to the scheme would be catered for. “All Nigerians shall be covered whether you contribute or not because it is a social insurance scheme,” he said.
But the big question is how possible is it even as those who are registered and aware are not enjoying the benefits of the scheme? Many Nigerians are not aware of the health policy scheme and even those who are aware have started losing faith. “From the inception of the health policy scheme, I saw it as a white elephant project. To me, the NHIS is just another avenue to siphon money; tell me where the funds are for the National Social Insurance Trust Fund (NSITF) and the National Housing Fund (NHF). Despite the fact that the houses have been turned to owner-occupier and we have paid for them, there are still deductions made from our salaries and where are and what have happened to the previous contributions we made? I knew it would be a waste of time and energy as dubious minds are using it as the opportunity to make illegal claims and money,” says Mr. Paul Oche, a civil servant.
The story does not only end with people who are already registered but those who have registered and still cannot access the benefits. “I registered and up till now, the story I have been getting is that my card is not ready. Since then, I have been using any hospital I like. It just does not make sense to me, because in the long run, I pay at the hospital and ironically my money is still being deducted from my salary, so where is the justification in this?” Mr Bayo Bidemi asks.
Speaking a few months ago, the Managing Director of Oasis Insurance Plc, Mr Tunde Oshadiya, identified the challenges Health Management Organisations (HMOs) face in trying to meet the aims of the NHIS. “As long as the hospitals and participating HMOs are not paid in line with the agreements reached at the inception of the programme, it may be difficult to sustain the success recorded under the programme on a long-term basis.
Most of the HMOs complain about not getting prompt payment from the NHIS for treatments given to Nigerians under the scheme. Therefore, NHIS cannot be successfully implemented without the support of hospitals. Another threat is the fact that Nigerian workers have for long been used to drawing their medical allowance as part of their monthly salary,” he said.
There is also the suspicion that some of these hospitals that are accredited are officials of this health policy scheme as it is believed that some of the management staff of the scheme have interest in some of the hospitals. “If you take a good look at the whole thing, you will find out that some hospitals have more enrolees than others. While some have in thousands and can even hardly accommodate all their patients, some have in tens and hundreds. So tell me what justification is that if not that they are using it as a means to do illegal business and gains?” laments Hassan Hakeem, a medical practitioner.
What about the people the scheme is supposed to serve? Are they getting maximum benefit from it? There are series of people who have complained bitterly about the services rendered to them when they visit their health policy providers. Some have complained that the drugs prescribed to them are substandard and different from those they give to other people.