By Kemi Olatunde

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To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria’s leading vehicle for achieving universal health coverage.

In Nigeria, health insurance is becoming mandatory for all residents and citizens.

In addition to improving the quality of care and expanding infrastructure, the Nigerian government is also looking to reduce barriers to insurance coverage which was introduced in 1999. The Nigeria’s National Health Insurance Scheme (NHIS) targeted universal coverage, yet penetration remained persistently low. Less than 5 percent of the population was enrolled in the NHIS, and an estimated 120 million Nigerians did not have health insurance coverage.

In May 2022, President Muhammadu Buhari signed into law, the recently passed National Health Insurance Authority (NHIA) Bill 2022, repealing the National Health Insurance Scheme Act. The new law will ensure coverage of 83 million poor Nigerians who cannot afford to pay premiums as recommended by the Lancet Nigeria Commission. Payment for treatment is largely out-of-pocket for most of the population. One major impediment to increasing participation rates is the non-mandatory nature of health insurance in Nigeria, according to the NHIS. While most employees in the federal civil service are currently subscribed to the programme, the NHIS is yet to capture most citizens, especially those individuals working in the country’s large informal sector.

A 2018 survey found that 97percent of Nigerians lack health insurance, and 70percent make out-of-pocket payments for health. Out-of-pocket payments can lead to catastrophic health expenditure, especially in rural areas.

The majority (70percent) of Nigerians make out-of-pocket payments for health. A 2018 Nigeria Demographic and Health Survey indicated that about 97percent of Nigerians lack any form of health insurance thus NHIA brings hope to over 83 million Nigerians living in poverty.

In 2018, Ondo state joined her counterparts across the country to institute a global culture of contributory healthcare or health insurance as a complementary tool to public funding of healthcare by the passing of a bill for the establishment of Ondo State Contributory Health Commission (ODCHC) and a social scheme to be known as the Ondo State Contributory Health Scheme (ODCHS) into law by the House of Assembly.

Late Governor Oluwarotimi Akeredolu, SAN,  signed the law on the February 6, 2018 while there was an official commissioning of an office complex in June, 2019 to kick-start the operations of the ODCHC with a mandate to ensure that all residents of the Sunshine state have health insurance cover.

Participants laud NHIS operations, highlight room for improvement

Some Nigerians who spoke with The Hope stated their dispositions towards health insurance.

 According to a 52-year old civil servant in the state, Mr. Alex Benjamin, the health insurance in the state for public servants; Orange Health Insurance Scheme (ORANGHIS) is commendable, noting that it has assisted beneficiaries eradicate out of pocket payment in accessing health care.

“I can say that I am moderately satisfied with the scheme, but believe it could be improved. It is still at the baby state but I suggest that those in charge should work towards reducing the long waiting hours of beneficiaries in health facilities. The economy is very harsh now and the health insurance has helped a lot of us. Nobody prays to fall ill but no matter the sickness, we are covered financially. We have all it takes to source for the money we need for other things because government has helped us by putting in place the health insurance,” he said.

A nurse in one of the private health facilities in the state, Mrs Bisi Ajiboye noted that “I enjoy the NHIS because it makes it possible for me and my household to enjoy affordable health care and free access to medical care. It is a better way of paying for health services than out-of-pocket payment.”

A federal civil servant, Mr Adeola Anjorin identified out-of-stock syndrome for most drugs as a challenge for health insurance while accessing services, adding that other challenge include provision of poor quality medicines and services.

“l believe that whatever comes freely may not be standard. It is good that government has put this in place but most times, the drugs are not there and when they are there, they are of less quality. The scheme I am not sure gives expensive drug to patients. Although, government may have done its part but those in charge in the various health facilities may wish to divert or hoard it for their personal use. This is wrong. We must learn to be responsible citizens. We must all play our role well in having an improved system for things to work in Nigeria.”

X-raying Ondo efforts on ensuring health for all

Permanent Secretary, Ministry of Health, Dr. Adeniran Ikuomola, stated that the provision and availability of financial resources to cater for health have been sorted out with health insurance, urging all to key into the various packages in the state to eradicate the financial burden of accessing health care.

He explained that health care financing is key to the health system of any country, which, according to him, cannot be ignored.

State Coordinator, National Health Insurance Agency (NHIA), Dr. Adebiyi during an event recently stated that the state has done well in its drive towards achieving universal health coverage (UHC), adding that the organization will continue to support the state in achieving the goal of guaranteeing all citizens of Nigeria access qualitative health care.

He stressed the need for stakeholders to create more awareness for the scheme.

A Lagos based civil servant, Mrs Ajike Bello who spoke with The Hope in a telephone interview stressed the need for government to tackle the challenges confronting health insurance in order for workers to get value for their contributions.

Chairman, Ondo State Hospitals’ Management Board (HMB), Dr. Taiwo Fasoranti described health insurance as the way to go noting that it saves one from financial embarrassment in accessing health care in Nigeria.

“I am an advocate of health insurance. Any government that don’t prioritize health insurance will fail. You can’t pay for health out of pocket and be financially buoyant. Some families have sold properties to keep their loved ones alive.

I give kudos to Governor Lucky Orimisan Aiyedatiwa for flagging off the Orange Health Insurance Scheme (ORANGHIS) for the informal sector recently, this will take away the burden of health care on the people. Health Care should not be a burden on the community. Health insurance is a must needed need.

“In the US where health care is mechanisms, you can’t pay a visit the hospital without health insurance. Government has encouraged people to get health insurance even in retirement. How many Nigerians can afford out of pocket health care? With it, burden on families, hospitals and government will be alleviated. Their is need for all to be insured as comprehensive healthcare is important. Health insurance enable people access preventive health care. Ondo State is on the right track in health insurance.

“I am happy that we have ORANGHIS for both public servants and informal sector. This has been helping the health care providers to thrive.”

He called on the Director-General, Ondo State Contributory Health Commission (ODCHC), Dr. Abiodun Oyeneyin to bring more residents of the state into the scheme while assuring of the board ‘support in getting more people enrolled for health insurance in the state.

Board member, HMB, Pharm. Taiwo Adefurin described it as a necessity for every Nigerian noting that it makes health care accessible and affordable to the people.

A trader, Bisi Ajayi who stated that she has not been enrolled under any insurance scheme noted that it is important that government enroll all Nigerians to cater for their health.

“I have a child in a foreign country and she has enlightened me on health insurance. It is a good thing and it will be my joy if government can enroll all Nigerians to ensure that they are well taken care of health wise as and when due. I lost a sister not quite long. Her children didn’t have enough money to give her proper treatment and it was already late before I got to know about her sickness. If she had been enrolled under a scheme, she wouldn’t have died untimely. Our Government should come to the aid of the needy. They should make it available to everyone irrespective of social status. They should let everyone have a sense of belonging.”

According to the Director-General, Ondo State Contributory Health Commission (ODCHC), Dr. Abiodun Oyeneyin the National Health Insurance Authority (NHIA) Act was signed into law on May 19, 2022 to replace the National Health Insurance Scheme (NHIS) Act 2004.

The law according to him, makes Health Insurance mandatory for all citizens and legal residents in Nigeria

Dwelling on health Insurance Coverage in Nigeria, he explained that the 36 States & FCT now have State Social Health Insurance Agencies which according to him, account for about 50 percent of current health insurance coverage in Nigeria.

Speaking extensively on some of the products of the Commission, he said;

“The Orange Health Insurance Scheme (ORANGHIS) was flagged-off in 2022. It is the scheme for those in the formal & informal sector.

“Till date, 101,684 public servants and their dependants have access to qualitative healthcare in both government and private hospitals.

 “We have the Abiyamo Maternal & Child Health Insurance Scheme for Pregnant Women & Children below the age of five (5) years which was flagged-off in 2019.

“The premium is fully paid by the State Government and covered services are provided at no cost to all beneficiaries.

“Till date over 47,000 enrollees (Pregnant Women and Children under 5) children have benefited from the Abiyamo Scheme.

“There is also the Basic Health Care Provision Fund Programme (Ilera-Loro Scheme) a product of he national Health Act of 2014.

“Under the scheme, 1 percent of the Consolidated revenue fund of Federal Government is set aside to provide Basic Minimum Package of Health Services to the Poor & Vulnerable.

“Till date 50,354 vulnerable persons across 203 wards within the state have access to care.”

He listed some of the challenges confronting health insurance to include high Disease Burden/Poor Health Indices, poor Infrastructure, poor Service Delivery, high cost of drugs and medications/out of stock syndrome, lack of adequate modern equipments (Brain Waste), exodus of health workers, low uptake of health insurance, low budgetary provision and performance and inadequate health care managers among others.

He added that the commission hope to cover at least 70percent of the population of the state by year 2027 adding that “we estimate to be among the top three states in Nigeria in terms of health insurance cover.”