Stakeholders must ensure implementation of the law to accelerate universal health coverage
The recent signing of the National Health Insurance Authority (NHIA) Bill by President Muhammadu Buhari has now made it compulsory for every Nigerian to be covered by a health insurance scheme. But while we welcome the improved program, the bulk of the work lies in implementing the law. The repealed NHIS could not expand the scheme beyond 5% of the country’s 220 million people due to a lack of implementation and political will. As a result, the country was losing hundreds of thousands of its citizens every year due to its inability to pay health care costs out of pocket.
We recognize that there can never be a one-size-fits-all model for delivering health insurance to society. But we believe that the defining problem for the NHIS at the time was the system-wide inequalities in its implementation, including the lack of cohesion between the federal system and those promoted by state governments, the private sector and health care providers.
Although many countries, including Rwanda and Ghana, have recorded successes in universal health coverage (UHC), it took Nigeria 18 years after the establishment of the National Health Insurance Scheme (NHIS) to have a document that now obliges every citizen to enroll in an insurance program for their future health needs. In signing the Bill, the President described it as a pathway towards providing universal health to at least 83 million poor Nigerians who cannot afford to pay a premium. He added that the NHIA will work with state government health insurance schemes to accredit primary and secondary healthcare facilities to ensure enrollment of Nigerians.
This time, the NHIA was created with a promise of delivery. Every stakeholder in the sector must ensure that it is implemented to the letter as the nation is behind on the 2030 goal for universal health coverage. The NHIA, in collaboration with state governments, the private sector, health care providers, among others, must put in place processes to ensure that Nigerians – from the formal sector to the informal sector, including unemployed – are enrolled in health insurance schemes. The actors must ensure, this time, a synergy between them. With universal health coverage as the goal, all levels of government, healthcare providers and different schemes must ensure that past disparities that limited the implementation of the NHIS are put aside as the NHIA promises to start again on a clean slate.
The effectiveness of a social health insurance in Nigeria would also be enhanced with the inclusion of the 36 states in the scheme and encouraging them to set up and operate their own insurance schemes in line with the provisions of the revised health scheme. States that have not yet launched their health programs should take models from those that are making progress. It should also trickle down to their local governments, communities, neighborhoods and families.
Ordinarily, the primary objective of the NHIS is to “facilitate the equitable financing of health care costs through the pooling and judicious use of financial resources to provide financial risk protection and burden sharing costs for people, against the high cost of health care, thanks to various prepayment systems”. programs before they get sick. But only a small proportion of Nigerians have prepaid healthcare. The advantages of a functioning health insurance plan in a country like ours are numerous. First, the idea of cashless treatment for the insured makes it imperative for them to get immediate treatment in the event of sudden illness, while the premium paid on health insurance is generally tax deductible. Until we can extend health insurance to all citizens, the country’s push for UHC will be a mirage.