The National Health Insurance Scheme (NHIS), in 2004 got a presidential mandate to ensure a nationwide coverage of the social health system by 2015.
The scheme commenced operation in 2005 with the formal sector otherwise called the government employees. This category of workers is a mere fraction compared with the population of Nigerians working in the private sector.
As a result, presently, over 75 per cent of the country’s population is not included in the National Health Insurance Scheme (NHIS). These groups of Nigerians who are from the private or informal sector have the responsibility of bearing the financial burden of their health needs whenever they arise.
Although, it would be a welcome development to expand the scheme to accommodate all Nigerian, government however, must address some of the challenges which have to do with capturing an accurate data of the enrollees of the scheme.
The expansion of the scheme across the country would go a long way to reduce he difficulty many Nigerians face in getting medical attention. Accessing quality healthcare facilities has been a major problem for many low income earning Nigerians thereby leading to the high mortality rate in the country. This exercise, apart from deepening democracy will create a corresponding active citizenship.
To actualize this, the management of NHIS sent a team of researchers to India to understudy their community-based healthcare. They considered the similarities both countries have with in terms of population.
The Executive Secretary of NHIS, Mr. Dogo Waziri who spoke recently on the planned expansion said, “We are partnering with Micro Insurance Academy in India and our Indian counterparts, the Indian National Insurance to execute this.
With all these experiences, the Federal Executive Council, FEC, has already approved that we should put the final touches in place and then hope that in the next few weeks we should be able to get the President to flag off our community health insurance.
“when the formal sector came in 2005, there was no much sensitization on how it was going to operate and that was why it was met with a lot of resistance. We should not forget that the formal sector is for people who have some economic muscle to participate, talk-less of an informal sector that is largely unorganized in terms of organization and even economic empowerment.
“We will sensitise both the givers of service and receivers alike on their roles. This community sensitization programme is very important and goes along with the community health Insurance scheme which is a voluntary contributory programme”.
Some of the stakeholders, who spoke with LEADERSHIPSUNDAY, however expressed fear that the expansion of the programme to cover the informal sector’s employees, if successfully implemented would transform the country, adding that “with the current act setting up NHIS, it will be another government white elephant project”.
According to the enrollees, this is because the act establishing National Health Insurance Scheme (NHIS) is weak thereby making the scheme look like business as usual since it
cannot sanction any defaulter.
Speaking also on the planned expansion, FCT, chairperson of Trade Union Congress (TUC) comrade Aliyu Abdul said extending the scheme to informal sector without reviewing the current act establishing NHIS would be going back to the dark days where some Health Maintenance Organisation (HMO)s appear to be more powerful than the NHIS.
Comrade Aliyu however lamented that some of these HMOs because they are represented on the council; they make laws that only suit themselves and not the generality of Nigerians.
According to the Unionist, the organised Labour has made their point clear that the scheme will not work effectively unless certain challenges are address.
He said the scheme may seem to be successful in the formal sector, stressing that this was a result of the organized nature of the sector compared to the informal sector.
“The expansion is a welcome development and is long overdue because following the success of the program in the formal sector; other Nigerians in the informal sector have been yearning for the scheme since the formal sector which the scheme is covering presently is a fraction of the Nigeria population.
“This is truly the right time to do this because, the formal sector had recorded a lot of success because earlier Nigerians are skeptical about the scheme, at a point they were even comparing the programme with the failed National Housing Fund (NHF), however today what we are witnessing today is that the enrollees in the formal sector has created a lot of awareness about the programme, the demand is high and in fact, a lot of dependents have been added to the scheme apart from the normal four persons plus the spouse which now made the number five. So I think that has attracted other persons in the informal sector to the programme.
“labour was contacted to come and give its input and we did, so we believe the scheme would be of great benefit to the generality of Nigerians because they need it due to the high cost of health services at that level, which made the coming of the programme a welcome development. Now medical attention is at their door steps of the rural dwellers”.
He added that , “the scheme has a lot of packages, and when I talk about the success of the programme, I mean the entrance of the scheme into the formal sector which has to do with Federal civil servants, even though a lot of state government are yet to key into the scheme, Labour on its part has been trying to talk to this governors on this because there is so much to be done, so the federal level as far this scheme is concerned, has recorded a huge success and we are glad they are taking it to the informal sector.
“We are hoping that as they started going round talking to all the stakeholders in various communities, it will be continuous process so that as they go into the new sector, maybe because of the robust nature of the scheme they will face some challenges.
“When you have a robust stakeholder’s relationship some of these issues could be managed at that level by all the stakeholders involved and it would lead to better services for everybody”. He said.
Commenting on the challenges ahead of the management of NHIS, Comrade Aliyu disclosed that “Some of the challenges have to do with the registration that was done at the initial stage, According to him, lot of people did not do the right thing while some took it for granted and could not be registered. So when the scheme started running, there is much correction to be done.
“Another challenge is the notorious nature of the Health Maintenance Organisation (HMOs). Some of the HMOs have been very funny because there are situations where some employees will go to the hospital but the health care provider will tell them that the HMOs have not paid the capitation.
“When we do our investigation, we discovered that the capitation was even paid three months ahead of your visiting the hospital, so there is no basis for the HMOs not to hold on to that payment and informing the health care provider that the money had not been received.
“Another thing is that the act establishing NHIS was not strong because the scheme is supposed to be a regulatory body like PENCOM and others, but the act itself does not give NHIS the powers to sanction erring operators like the HMOs, and I think that is one of the reasons the act was taken to the National Assembly for review, Labour is looking for that amendment because, we are saying that give NHIS more powers to clampdown on any erring HMOs because what the present act is saying is that one can take them to court and you know how court cases are being delayed in Nigeria today.
They should be given more power to sanction immediately, and I also advice strongly that the over bearing influence of the HMOs at the council level should be checkmated because I don’t know why they should be at the council of NHIS.
They will sit there and make laws that suit themselves, and to me, that is unacceptable. What you hear today when you go out is that NHIS does not regulate the HMOs.
“ I also think Federal Government can check the information and communication technology (ICT), because most times if our members go to the hospital, they are told their names are yet to be forwarded as enrollees to the hospital, so data base management of NHIS must take their job very seriously”.