The National Health Insurance Scheme (NHIS) had the foresight of putting paid to health anomaly in Nigeria. Bounded by countless circumstances, VICTOR OGUNYINKA examines the ills and potentials of the programme.
The strength of good governance is reflected in the efficiency of its programmes and polity. In ensuring that Nigerians get access to qualitative health care, a lot of policies and structures have been introduced to better the lot of the citizenry, but midway through, the efficiency of such structure is put to test via management and policy implementation. The results, in most cases, have been anything but successful.
The National Health Insurance Scheme (NHIS) is one of the programmes introduced in 1999 by the ex-president, Olusegun Obasanjo, not only to improve qualitative healthcare service and delivery, but to ensure that every class of Nigerians access the programme direct or indirectly.
Having survived four different administrations and recorded quite a handful of achievements, the NHIS programme, has still unarguably, provided the perfect domain for a successful health scheme compared to what obtains in developed countries.
The Southwest (excluding Lagos) Zonal Coordinator of NHIS, Mrs Olajoke Balogun, explained that the scheme has been working since it was introduced in 1999, and by June 6, 2005, after the administrative imbalance was sorted out, NHIS launched a formal sector programme, which involved any employee of the Federal Government to access qualitative and affordable healthcare services.
To ensure that NHIS goes beyond the borders of serving Federal Government workers, Mrs Balogun revealed that a programme called voluntary contributors’ social health insurance was launched in November 2011. According to her, “the programme is designed for non-government workers or people that don’t belong to private organisation that has up to 10 work strength.
“That (voluntary contributors’ social health insurance) is a scheme that is for the layman on the street or for any individual that wants to get registered independently. It costs just N15, 000 per annum and one could register at one’s preferred hospital or facility. Any ailment could be attended to except severe terminal diseases,” she said.
While speaking on the initiative and achievement of NHIS, Mr Taiwo Fagbemigun, a Senior Research Officer, Federal Institute of Industrial Research Oshodi, Lagos, explained that compared to what obtains in developed countries, where the scheme is adopted from, the NHIS programme has not lived up to its billing, owing to its lack of implementation and awareness as well as its ineffectiveness.
“The first problem here is lack of awareness. Many people still don’t know how the system operates, what it covers and their entitlement under the scheme. That’s why despite the monthly deduction from salaries of civil servants, many of them still found themselves paying for healthcare services that ought to have been covered by the scheme. The Ministry of Health and NHIS office need to do more in that regard.
“Government’s insincerity is another shortcoming. The excuses been tabled by many private healthcare centres is that government is very insincere particularly with remitting the meagre monthly allocations to hospitals. Many a time, they don’t get paid for three to four months. Herein lies corruption.”
While reacting to issues bordering on deduction from salary, Mrs Balogun said: “A police officer once challenged me that we take their money without rendering services, I told him categorically that no Nigerian is paying yet to access healthcare. At the beginning, it was agreed that the government will subsidise the payment for individuals by some percentage, but till this moment, it is only the Federal Government that has been paying.
“This is because the labour union has not agreed to what workers should be paying. What NHIS is making use of now is what the Federal Government is paying the employees. Out of the Federal ministries, parastatals and agencies, it is only National Health Insurance Scheme that has been paying. For instance, I pay for my contribution to match what my employer; the Federal Government is paying on my behalf.”
Furthermore, another setback bedevilling the smooth running of the programme is the fact that the mandate that established the programme is guilty of oversight of compulsion for all and sundry to participate in the programme.
The former Minister for Health that kick started the scheme; Professor Eyitayo Lambo had a mandate of ensuring that by 2015, all Nigerians are covered and registered under the programme. Even in 2016, the coverage is a far cry from its initial proposition.
Mrs Balogun included that one of the challenges of the programme is that so many states and local governments’ workers are not on the scheme. She said: “We’re trying to make it compulsory for all government workers.
“We are trying to see that they all get involved by saying that all states can form their health insurance agency and implement their own programme for their own people. For instance, in Oyo State, the bill is at the House of Assembly and it has passed the first reading. We’re working along with the members of the house to ensure that the bill is passed and to make sure that all Oyo indigenes and residents can start accessing quality health care services.
Also, Mr Fagbemigun added that NHIS is a contributory scheme, which is supposed to provide a pool of fund for provision of healthcare. “With this fund, government is expected to improve the standard of our hospitals. If an individual fails to visit a hospital for a year, it doesn’t matter. He or she must pay. You are paying for another friend who needs it. That’s how it’s been done all over the world. It should be mandatory.
“… I had my contract terminated in Germany because I chose not to subscribe for two months of health insurance. Healthcare service is expensive everywhere around the world. From Germany, to United States, India etc, medical services are expensive and world class. With the present configuration of NHIS, we cannot achieve anything tangible.”
Whatever benefit is embedded in the NHIS programme would be oblivious to end users if adequate awareness and education is not apt.
Mrs Balogun retorted, when asked if the organisation is doing enough in reaching out to the interior parts of the country. “You may say that the awareness hasn’t gotten to the hooks and crannies of the country but that is not to say that a lot of people don’t know about it. You know Nigeria is a very vast country. The programme has been in existence and people have been subscribing to it.
“We do routine education and awareness everywhere possible. We have sensitisation write-ups in newspapers, flyers in different language, organise workshops for students in tertiary institutions, and also take out messages to trade fair centres in the country just to herald what NHIS is all about.”
In the same vein, Mr Fagbemigun stated that government needs to invest hugely in the health sector to bring it up to standard.
“Government needs to subsidise health care services for its populace and set aside, large pool of fund to reinvent the NHIS and the health sector as a whole. It also need to give opportunities to people to choose different packages as they so desire, which covers light ailment like headache, malaria etc to standard to premium packages.
“For instance, if I am paying N2,000 monthly, I shouldn’t expect attention when I have terminal diseases. A premium package holder should expect that because he or she will be paying more monthly. Government workers should be allowed to freely choose their health insurer. They should be allowed to decide who they will want to work with be it, be it private insurer or government,” he concluded.