NHIS And The Quest For Universal Health Coverage

The Nigeria’s National Health Act, (NH Act) 2014, stipulates that 50 per cent from federal government grant; grants by international donor partners and funds from any other source shall be given to the National Health Insurance Scheme (NHIS) for the provision of Universal Health Coverage (UHC) for all citizens. ODIRI UCHENUNU writes on the structure NHIS has put in place to achieve this.

The Nigeria’s National Health Act, (NH Act), 2014 is without doubt one singular instrument required to unlock economy and the greatest transformation for the Health Sector.

The act establishes a Basic Health Care Provision Fund (BHCPF) to be financed from Federal Government Annual Grant of not less than one per cent of its Consolidated Revenue Fund; grants by international donor partners and funds from any other source.

Out of the fund, the Act states that 50 per cent shall be used for the provision of basic minimum package of health services to citizens, in eligible primary and secondary health care facilities through the National Health Insurance Scheme (NHIS); 20 per cent shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities; 15 per cent shall be used for the provision and maintenance of facilities, equipment and transport for eligible primary healthcare facilities; 10 per cent shall be used for the development of Human Resources for primary health care and 5 per cent of the fund shall be used for emergency medical treatment to be administered by a committee appointed by the National Council on Health.

According to analysts, the Act was set up to achieve the Universal Health Coverage (UHC) and meet the Millennium Development Goal (MDGs) target.

The UHC implies ensured access to and use of high-quality healthcare services by all citizens and protection for all individuals from catastrophic financial effect of ill health. It can be a major determinant to improved health outcomes for all citizens, especially the poorest.

The UHC can also help to reduce maternal and infant mortality rate as pregnant women will now have access to free delivery services while their children are assured of standard paediatric services in the nation’s health facilities.

Nigeria is eager to expand access to health insurance, as it can play an important part of an overall strategy to achieve UHC and since its launch in 1999; NHIS has been the major initiative to expand health insurance in Nigeria.

The President, Nigerian Medical Association (NMA), Dr Kayode Obembe, said the Act which seeks to protect, promote and fulfil the rights of the people of Nigeria to have access to health services has provided a proper template for the take-off of the UHC.

Obembe said if 50 per cent of the fund is judiciously expended for primary health care through the NHIS, the appalling health indices of Nigeria would seriously improve by leaps.

He said, “It is alright to say that 50 per cent of the basic health fund is committed through NHIS. But for the funds to get to rural areas, the community has to provide counterpart fund equivalent to 25 per cent of the fund for disbursement.”

How are they going to muster the 25 per cent requested as counterpart funding? Would the states pay up regularly? How can UHC be achieved? These are some of the questions that are begging for answers.

The assistant general manager, NHIS, Dr Christopher Okoh, while speaking with Leadership correspondent said state governments can muster the 25 per cent if they are able to pursue way of innovation and by using the accruable sum from the save one million lives to set up health insurance agencies.

Okoh said, “We are thinking that if the federal government is able to operationalized the national health act and state governments are able to pursue way of innovation by using the accruable sum from the save one million lives to set up health insurance agencies, we will be able to work together to ensure all Nigerians are enrolled into the health insurance scheme.”

He said NHIS is working ways that can help to decentralized health insurance scheme where all the state will have their health insurance agencies. He said, “NHIS is going to leverage on other fund resources, outside the 50 per cent. We are going to meet the state governments through their health insurance agencies, which have already been established in some of the states in Nigeria, and with these health insurance agencies, money will be disburse to the NHIS.”

The assistant general manager said NHIS is working already with the national primary healthcare development agency, to develop minimum healthcare packages and with that, NHIS expects the state to adopt it or to make increase based on their capacities to fund.

Speaking on how the money will be disbursed, Okoh said, “NHIS will be disbursing money to those states based on the vulnerable. We will be doing what is called equalization from the centre. What this means is that NHIS will not be keeping all the monies in the polls. We will be resident at the state health insurance agencies and will disburse money based on equalization from the funds that will be accruing to it from the national health act and other funding sources to facilitate coverage of the vulnerable at the state level.”

Speaking on how UHC can be achieved, he said the only way to achieve UHC is through universal health insurance and social health insurance. He urged Nigerians to accept and buy into health insurance so that the UHC will be a reality in no distance time.

He said NHIS, as at April last year, enrolled all its enrolees to get treatments from all tertiary diseases in any federal hospitals in Nigeria. He said, “This is a means to give back to our enrolees that are suffering from conditions from tertiary diseases like cancer, oncology etc. So what we did was to write to identified centre of excellences that can provide this service and also wrote to Health Maintenance organisations (HMOs) and told them to refer patients that have been identified to having these conditions.

“It has been on in areas of oncology and we have a lot of patients in national hospitals and other centres of excellence taking treatment from our funds. We have done a lot of successful cardiac surgeries in Garki hospital in Abuja, we have done a lot in Enugu at its centre of excellence for cardiovascular surgery. We have done a lot on neurosurgery, hip replacement and knee replacement. We have also done successfully renal transplant in Ife,” said Okoh.

He said one of the major reasons for the tertiary disease intervention was to make Nigeria a tourist destination for medical excellence, so as to reduce the capital flight and to tell Nigerians that these surgeries that they go to India to do can be done successfully in Nigeria.

“We want to change the perception of Nigerians that NHIS is not only covering malaria, but also covering those things that are outside its formal sector benefit package. We are also working with some NGOs in the country, by funding some surgeries even though they are not in NHIS scheme,” he added.

Speaking on how one can be enrolled into the NHIS scheme, he said, “Are you a civil servant at the state level or federal level? Are you a market woman? We have programmes for both the formal sector and the informal sector. For artisans, we have the urban self-employed skill where the artisans can come together as a group and access healthcare.