Viewpoint - February 8, 2021

NHIS: Reshaping Nigeria’s health insurance landscape

By Emmanuel Ononokpono
The World Bank says by the year 2022, about 92.6million Nigerians will sink into poverty. It is a notorious fact that poverty opens the door to ill-health, which in turn worsens poverty. It is a chicken and egg situation.
It’s proven that poverty is a major obstacle to accessing healthcare. Against this backdrop, deliberate steps must be taken to arrest the forecast of the Bretton Wood institution.
By mandate, the National Health Insurance Scheme (NHIS) is strategically positioned to stem the tide of poverty by ensuring that all Nigerians avoid making out-of-pocket payment for healthcare.
The chief objective is to evolve a system where all Nigerians will have access to preventive, promotive, rehabilitative and curative health services without financial hardship. This idea is better known as Universal Health Coverage (UHC).
The Concept of Universal Health Coverage (UHC) is a goal which NHIS is committed to achieving by 2030 in line with the Sustainable Development Goals (SDG) of the United Nations.
By that timeline, the prospects are that 90% of Nigerians would have access to a form of pre-payment and risk-pooling healthcare schemes.
Also, that 100% of vulnerable Nigerians shall have been covered by social assistance and safety net.
Ultimately, the projection is that out-of-pocket expenditure will not exceed 30% of total health expenditure.
Nonetheless, the gaps in the quest to attain UH- are duly acknowledged by NHIS and its stakeholders. To that end, concerted efforts are being made to tackle extant issues.
The Executive Secretary of the National Health Insurance Scheme (NHIS), Prof. Mohammed Nasir Sambo, at various fora, has drawn the attention of stakeholders to these pertinent challenges facing the UHC target.
Moreover, the Chief Executive of the foremost health financing institution has expressed the Scheme’s commitment to midwife a system that will give provide financial access to quality healthcare for all Nigerians.
The questions the Prof. Sambo-led health insurance sector is taking aim at are germane and fundamental.
How many Nigerians are currently covered by health insurance? Which population segment have not been included so far? What strategies can be adopted to cover these population segments especially the vulnerable, and most importantly, what methods should be adopted to rapidly scale up population coverage?
At the heart of these challenges has been the imperative of reviewing the NHIS Act to include the provision of making health insurance compulsory for all Nigerians.
The Executive Secretary, knowing the strategic importance of removing the voluntary clause, engaged critical political figures in the national assembly to secure their cooperation towards the all-important end of amending the legal framework.
That effort has resulted in the passage of the NHIS Act as amended by both chambers of the legislature, now awaiting presidential assent.
Clearly, the question of how many Nigerians is covered will be permanently resolved because no Nigerian will be left behind.
Moving away from early efforts that did not consider specific roles for states in the implementation of health insurance, the new and different approach to intensifying the drive towards UHC is the decentralization policy.
Building on the resolution of the 58th Emergency National Council on Health where decentralization was adopted as a major reform initiative, NHIS is driving the establishment of mandatory health insurance at State levels.
More than a dozen States, including the FCT, have established their State Social Health Insurance Agencies with NHIS providing relevant technical assistance and leadership.
Moreover, the passage of the National Health Act which established the Basic Health Care Provision Fund (BHCPF) is another giant stride in the overall effort.
NHIS being one of the implementing agencies is overseeing the funding and purchase of healthcare at the level of primary health centres across the country.
This development holds the prospect of revamping healthcare infrastructure in underserved rural areas of the country.
The planned recruitment and deployment of Community Health Extension Workers (CHEW) as part of the implementation of the BHCPF will ensure availability of health personnel.
Furthermore, Prof. Sambo’s leadership of NHIS which is driven by the triad engine of a 3-point agenda has unfolded series of initiatives, strategies and activities that are yielding earmarked results.
For instance, the Catastrophic Fund for Cancer, coverage of members of the National Youth Service Corps (NYSC), National Coverage of the Elderly and Retirees plans are at an advance stage for the implementation of the following programme the Group, Individual and Friend Social Health Insurance Programme (GIFSHIP) these has been successfully launched and is fairing being vigorously pursued initiatives retain the promise of bringing all segments of Nigerians under health care coverage.
Worthy of note is the fact that GIFSHIP is designed for small-scale enterprises with less than 10 staff, non-cohesive groups of persons outside the organized private sector, self-employed individuals, families, retirees and their various associations, diaspora groups and foreigners living in Nigeria.
Essentially, all Nigerians who in terms are not under the formal sector coverage.
The GIFSHIP service platform gives beneficiaries access from primary to tertiary levels of care in their selected health care provides at affordable premiums of awareness creation.
A result-oriented NHIS inspired by the Prof. Sambo administration is guaranteed to speedily move in the path of attainment of the Universal Health Coverage by 2030.
Taken together, the health insurance landscape is steadily taking the shape fitting for the country, in a manner that will ultimately guarantee the inclusion of all Nigerians and drive down the incident of poverty.

Mr. Ononokpono is the Deputy General Manager/Head, Media & Public Relations Division, NHIS

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