Can the NHIS be a vehicle to achieve UHC in Nigeria?

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Over the last few months, the NHIS leadership, function, and processes have come under a lot of scrutiny, creating a great deal of public discourse amidst controversy.

Much of the controversy had to do with what the NHIS and its stakeholders (including HMOs and service providers) have NOT done to ensure that every Nigerian is provided with basic health coverage.

A browse through the NHIS website will reveal an impressive array of programmes which ideally should help ensure that the majority of Nigerians have basic health coverage, however, this is not our current reality. The question we must ask is whether these programmes are functional and whether Nigerians are aware that they exist.

The average taxi driver in Abuja, the nation’s capital, is largely unaware that he can purchase health insurance for himself and his family at a reasonable cost. He is also uncertain of the quality of services he will get. Even where he is aware, for the most part health insurance conjures up thoughts of exorbitant costs and fears of fraudulent diversions of his hard-earned funds.

The NHIS website was recently redesigned, ideally to give better information to Nigerians about the existing programmes in the Scheme. While we applaud them for this effort, we know that more can be done to help Nigerians understand the importance of health insurance, and also the options available to them in choosing an insurance coverage plan for themselves and their families. If Nigerians knew more, they would demand more, and maybe health insurance would have a chance to grow in Nigeria.

In this week’s thought leadership series on health, we review the programmes offered by the NHIS, as listed on their website, with the hope that as Nigerians become more aware of these programmes, they will better utilize them, demand more and ensure that the NHIS is held accountable for the work it is meant to do.

The NHIS has programmes grouped under three different sectors; the formal, informal and the vulnerable sectors.

Photo Credit: Nigeria Health Watch

THE FORMAL SECTOR

The Formal Sector Social Health Insurance Programme is a social health security system in which the health care of employees in the Formal Sector is paid for from funds created by pooling the contributions of employees and employers. The contributions paid cover health care benefits for the employee, a spouse and four (4) biological children below the age of 18 years.

The National Mobile Health Insurance Programme ensures that legal residents above 18 years that have a registered GSM line from any of the Mobile Network Operators, enjoy social health insurance cover underwritten by accredited Health Management Organizations (HMOs) with services provided by NHIS accredited healthcare providers across the country. Subscribers can pay an annual contribution through daily, weekly or monthly instalments or else an annual upfront payment.

The Vital Contributor Social Health Insurance Programme is health insurance that is paid for by willing individuals or employers on behalf of employee in organizations with staff strength of less than ten. It is a programme designed for those who are not currently covered by any of the NHIS programmes and for those who may not have been satisfied with the existing health care services. Contribution rate is N15,000 (Fifteen Thousand Naira) only per person, payable once annually or at least one month in advance.

Photo Credit: Nigeria Health Watch

THE INFORMAL SECTOR

The Informal Sector Programmes are made to cater to groups such as students, communities, and people working in non-formal occupations. It includes two programmes.

The Tertiary Institution Social Health Insurance Programme provides health insurance to students in tertiary institutions (universities and colleges), paid for from funds pooled through the contributions of students. Its’ purpose is to cater for the health care needs of Nigerian students in tertiary institutions who due to their status as students cannot benefit under other health insurance programmes.

The Community Based Social Health Insurance Programme provides health insurance for cohesive groups of households/individuals or occupation-based groups. Membership is voluntary and open to all residents of the participating communities/occupation-based groups, including retirees. Contribution is determined at a flat rate fee per household/individual and paid in cash monthly or seasonally in advance.

Photo Credit: Nigeria Health Watch

THE VULNERABLE SECTOR

Vulnerable Group Social Health Insurance Programmes are designed to provide health care services to persons who due to their physical status, including age, cannot engage in any meaningful economic activity. Contributions for all programmes under the vulnerable sector is to come from advance payments from The Federal, States, Local Governments, Development Partners and Civil Society Organizations to the Vulnerable Group Fund.

They include the following:

Physically Challenged Persons Social Health Insurance Programme(PCPSHIP): a programme designed to provide health care services to those who are physically disabled or suffering from mental illness.

Prison Inmates Social Health Insurance Programme(PISHIP): designed to provide health care services to inmates of Nigeria Prisons and offending minors in Borstal Homes.

Children Under Five (5) Social Health Insurance Programme (CUFSHIP): a programme designed to cover the health needs of Children under the age of five (5) years across the country. Membership is open to children under the age of five (5) years especially those whose parents are participating in Community Based Social Health Insurance Programme (CBSHIP).

Other groups catered for under the vulnerable sector are pregnant women and the aged.

Each of these programmes seem laudable on their own merit. They however need vigorous community awareness campaigns for them to begin to permeate the consciousness of Nigerians and ultimately to change behaviour.

In the following interview, Dr. Ifeanyi Nsofor, Policy and Advocacy Director at Nigeria Health Watch, shared some strategies that he believes the NHIS must employ to increase functionality of its programmes.

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We believe that the varied programmes provided by the NHIS are a step in the right direction and if implemented with the right level of awareness, will lead Nigeria one step closer to #Health4AllNaija.

Have you had an experience with NHIS or one of the programmes listed above that you would like to share? Tweet at us @nighealthwatch and use the hashtag #Health4AllNaija to share your story.

Discussion1 Comment

  1. Good write up by Dr. Nsofor
    I am a Patient Advocate on viral hepatitis, a disease that has more morbidity and mortality rates than some of the much talked about diseases, yet there is very little response on the part of government and donors to save lives.
    Majority of people living with hepatitis cannot afford the cost of diagnostics and treatment in Nigeria, and sadly the NHIS is doing very little to cover the costs of chronic hepatitis diagnostics and treatment in Nigeria, where most health care delivery is out of pocket for patients.
    We are strongly advocating for full coverage (I am aware some aspects of the diagnostics, like LFT are covered) of ALL chronic hepatitis diagnostics, especially the viral load and cost of the treatment in Nigeria

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