Nigerians and the NHIS challenge

The Executive Secretary of National Health Insurance Scheme, (NHIS), Prof. Usman Yusuf, at a recent event said only about three percent of Nigerians have access to healthcare coverage. He said there was an urgent need for the scheme to reach out and extend coverage to more Nigerians, especially in the grassroots. Daily Trust visited the […]

The Executive Secretary of National Health Insurance Scheme, (NHIS), Prof. Usman Yusuf, at a recent event said only about three percent of Nigerians have access to healthcare coverage. He said there was an urgent need for the scheme to reach out and extend coverage to more Nigerians, especially in the grassroots.

Daily Trust visited the Utako Market and also had a chat with mechanics at the Jabi Motor Park, Abuja, to sample their opinion on what they understood by NHIS and their thoughts on subscribing to it.

The general response was “I don’t need it. I don’t take ill and even when I do, it is small, small, sicknesses like catarrh, cough and malaria [sic]. And for these ones I can drink agbo (mixture of herbs in water or alcohol) and if it doesn’t go, I can go to chemist and buy medicine. All the money I will spend will not be up to what NHIS will be collecting monthly from me.”  [sic]

The general belief is that people in the informal sector are the ones not registered under the NHIS. But Daily Trust found out that there are many in the formal sector who are also not registered and for some of those who are registered, it is for status reasons as a result of the hospitals they now have access to. Our reporter spoke to two of such people.

Ladi Umar, 36, a lawyer, was pregnant with her seventh child when she decided to enrol for the NHIS. She did it for two reasons – it would be her third caesarean section and she didn’t want to have to dole out over N350, 000 for medical bills. Her other reason was because she wanted it done in one of Abuja’s top clinics that she ordinarily would not have been able to afford.

Daula Sale, 41, a sales representative, said he was simply not interested in the scheme because he considers it a scam. “In any case, I’m not obliged by my employers to register,” he said.

The question this provoked was does this category of Nigerians understand what the Scheme is about?

What is health insurance?

A Research Fellow/Abuja Liaison with the Health Policy Research Group, Felix Abrahams Obi, explained: “Health insurance is aimed at providing access to healthcare in a way that eliminates financial barriers and protecting people from catastrophic expenditure.”

With some organisations giving people the option to be or not to be a part of it, Obi said; “Making health insurance optional has many demerits. Considering that no one can predict when they can take ill, or what the probable cost will be, and other such unforeseen situations.

“If made compulsory, the benefit is that everyone will be insured and the risk pool large enough to provide a robust benefit package. If made optional, it could introduce the challenge of moral hazards.”

Why should people bother to register for healthcare?

Obi said: “Health insurance comes with a ‘benefit package’ which often covers the major prevailing diseases that people suffer- from preventive, primitive, curative and rehabilitative services.

According to him, the present NHIS benefit package (the formal sector social insurance programme and the voluntary contributory social insurance program) have a robust benefit package. “Enrolees have the advantage of receiving a bouquet of services free of charge and when they have to pay for medications, treatments or surgeries, they only make a co-payment of 10% of the entire bill unlike uninsured citizens,” he said.

The challenges

According to a Public Health physician, Dr. Seye Abimbola, the main challenge is that the scheme only covers people in the federal civil service for the most part. Ultimately NHIS covers people in the formal sector and the people enrolled are federal civil servants.

Abimbola, a research fellow at National Primary Health Care Development Agency, (NPHCDA), who focuses on health policy, in response to the reason civil servants are the bulk of people registered, also said: “It’s because they are the ones with dependable income that can be deducted at source. It is the same for people in the private sector – they are formally employed.”

Role of public health specialists

Speaking on the role of public health specialists in the matter, he said they should help create awareness about the benefits of health insurance so the general public will not be wary of its benefits.

“For instance, the voluntary scheme run by NHIS only costs N15, 000 premium per annum and the enrolees have same benefits as those provided to federal civil servants and their families by NHIS,” Obi said.

In the same light, Obi said: “PH specialists need to be advocates of universal health coverage since they understand the imperative for citizens to have health insurance coverage, in order to easily access needed health services without having to face financial barriers, which prevents most people from going to hospitals to access care, hence are constrained to look for cheap alternatives like going to quacks with its attendant consequences; or they may delay seeking of treatment until complications set in.”

Way forward

On his propositions for what Nigeria should do to ensure more people – especially those in the informal sector – are covered under the scheme, Abimbola cited examples of what other countries with similar challenge like Nigeria have done to succeed.

“In other countries with a similar scheme as Nigeria’s, the government subsidises or completely pays the premium on behalf of citizens in the informal sector. In some other places, they try community-based health insurance where people make contributions at the community level.”

Although this has achieved some measure of success, there are still challenges with it because: “it is difficult to get people to pay premiums voluntarily, especially given that most people at that level are poor.”

However, “in places where it works, the government heavily subsidises such schemes. Thailand and Rwanda are good examples.”

Abimbola also said: “We need to enrol all state and local government employees. We can do this by creating state level pools or geopolitical zone level pools because state level pools may not be large enough. But we need sub-national pools connected to the national pool which can all be run by NHIS or each state could have its own version of NHIS that are then linked to or run by the national NHIS.

“Then for those not in the formal sector, we can think about government subsidised community-based health insurance. We can think of pools, linked to occupational groups such as market women, NURTW and the others which will be connected to either the state or geopolitical zone pool.”