Is your health digging an unhealthy hole in your pocket?….


The provision of private health care in Nigeria is changing. This change is most profound among staff and dependants of the public and organised private sector.

Previously …this was the deal. A company would have a “retainership” with one or more private hospitals. The hospital would bill the company for services provided at the end of every month. The “catch” is that staff had to sign off the item on the bill as it relates to them. Thus creating an ideal opportunity for mutually beneficial “deals”. Therefore a simple formular emerged…patient agrees with doctor to receive N10000 worth of treatment. Dr takes N5000, patient takes N5000 company looses N10000. Great for doctor, great for patient (until he really gets ill) …terrible for company.

No surprise that most have embraced the principle of managed care, where a health care service provider agrees to provide a pre-defined package of care for employees at a fixed amount, irrespective of if the employees access care or not. The public service part of this is managed by the Nigerian Health Insurance Scheme. This is the principle on which most of the medical care in the USA is provided. similar schemes are at different levels of incubation in Ghana, and Uganda
It has been a hard sell in Nigeria, and many have greeted it with scepticism but it is finally catching steam

The Punch newspaper of 01/08/07 reports that an estimated 2 million Nigerians (2% of the organised sector) are enrolled. The NHIS has 27 HMOs and about 5000 providers.

Monthly premiums are about N1000 ($4) /per month.

Recently… the Pharmaceutical Society of Nigeria kicked up a big fuss…describing the scheme as “yet to ensure harmony among providers”. In a thinly veiled attack on the physician dominated schemes…They claim that in the scheme “prescribers” are also the “dispensers”…..They seem not pleased at being sidelined. Not pleased at all….

The greatest challenge facing the NHIS is how to improve access to the scheme and get members of the unorganised private sector on the scheme. TWhat is the strategy and logistics for covering a sizable proportion of our 140 million Nigerians. Yet, we must not wait until we get it all perfect to start. This in principle is a good scheme…the challenge as in many programmes is scaling up. It is obviously not-yet-Uhuru but we seem to be on the way. Some of the of the big players among HMOs are Multishield and Hygeia

Beyond all this is the need for a parallel scheme to provide some succour to the poor, the elderly, children those in the rural areas that cannot pay any premium…..or do we just let our poor die?

How will things evolve??? Watch this space…

Find below some interesting advertising in the popular press…

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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