Acting Executive Secretary of the National Health Insurance Scheme (NHIS) Mr. Attahiru Ibrahim, has stated that health insurance should be made compulsory for Nigerians if the country must achieve universal health coverage.
Ibrahim who was briefing reporters last week in Abuja on the activities of the scheme appealed for the amendment of the section that made enrollment optional in the Act establishing the scheme.
“The current act establishing NHIS made it optional but anywhere in the world that health insurance is in practice, it is compulsory. For us to achieve universal health coverage it must be made compulsory”, he said.
Mr. Ibrahim said the scheme was working closely with state governments to establish state health insurance schemes.
“We are encouraging the states to come up with agencies of their own and also not to make the mistake made in our Act by making it optional. We are urging the states to make it compulsory; I think those are the areas that need amendment.”
Nigeria introduced the National Health Insurance Scheme (NHIS) in 2005, the same year Ghana launched its own. However, while the Ghana scheme has covered well over 50 per cent of its population, the Nigeria NHIS seems stuck at coverage of about four per cent of the population, leaving a major chunk of the citizens, especially the poor, to pay for healthcare from their pockets, an approach that has not only made them poorer but has increased mortality rate.
Little wonder statistics have shown that 12 years after the establishment of the scheme, the level of out of pocket expenditure as a share of total health expenditure is still placed at 72 per cent the highest on the continent and one of the highest in the world. Even poorer countries in sub-Sahara Africa such as Kenya (26 per cent), Gabon (22 per cent) etc are doing better.
Information also shows that countries afflicted with conflict and post-conflict problems like South Sudan (54 per cent) and Sierra Leone (61 per cent) are still better than Nigeria, leaving stakeholders in the healthcare industry to ponder on the model used by the government to run the scheme.
The slow growth of the scheme however prompted the Health in Africa Initiative of the International Finance Corporation of the World Bank Group to conduct a study on the NHIS where it identified some constraints affecting the expansion of the coverage.
Issues identified include the voluntary nature of participation of the scheme, the lack of buy-in by state governments, the lack of a robust ICT platform to implement the scheme, and the lack of clarity on the regulatory functions of NHIS, for instance, its implementation of a public sponsored scheme.
Following the acceptance of the report by the management of the NHIS in 2013 the agency proceeded to implement some of the recommendations which included the recognition of state governments to set up their State Supported Health Insurance Schemes (SSHIS) through a National Council of Health memo approved in March 2014 by the federal government.
The memo, which contained features of what a typical SSHIS should look like, listed the legal basis of the SSHIS approved by the State House of Assembly and signed by the governor of the state.
It also highlighted how states should increase the share of total health spending by committing compulsory sources of funding to health with priority focus on interventions by funding a basic minimum package of services.
As at today, states that have passed laws establishing SSHIS are Lagos , Abia, Kwara, Delta, Ekiti, Kano and Bauchi, while Ogun, Enugu , Anambra and Ebonyi are at advanced stages with their laws being passed.
Delta State is already taking the lead as the first state in the country to implement a mandatory health insurance scheme, garnering over 112,169 registered enrollees within few months of starting the scheme, a result signaling that right health insurance models can achieve results.
Due to several allegations of sharp practices and alleged rot in the system, the House of Representatives had rejected the 2017 budget proposals of the NHIS.
The Minister of Health, Prof. Isaac Adewole, later suspended Usman Yusuf, the substantive Executive Secretary of NHIS over corruption allegations, one of which was the procurement of a N58 million SUV without due process. Mr. Ibrahim was therefore appointed to serve in acting capacity.
The suspension came weeks after the Senate had launched investigations into Mr. Yusuf’s activities as the NHIS chief.
Worried by the furore over the scheme, the House of Representatives a few months ago held a public hearing on the implementation of the NHIS.
On the ongoing probe of the scheme, Mr. Ibrahim said there are various agencies handling it and that he could not say anything until he has been properly briefed.
“There is an administrative committee constituted by the ministry and I don’t want to say anything until I see the report, I have not seen the report.
“All these agencies are doing their beat and until their report is submitted officially to me, I will not be able to say anything on that.”
He, however, cautioned against any attempt to smear the corporate image of the scheme as hub of corruption, saying this was unacceptable.
Mr. Ibrahim assured that anyone within or outside the scheme against whom impropriety was established, would be handed over to the agencies of government with appropriate mandate to bring such people to justice.
“Those who have been abusing their privileges around the scheme should be made to face the consequences of their actions in full measure,’’ Mr. Ibrahim cautioned, arguing however that the scheme had not done badly in the implementation of its mandate 12 years after its establishment.