The National Insurance Scheme(NHIS) has, since inception, worked assiduously to ensure that Nigerians access affordable healthcare at service points. ANDREW ESSIEN interracted with the Ag. Executive Secretary/CEO, NHIS, Dr Femi Akingbade discussing how far the scheme has gone.
The NHIS has been greeted with positive response but as it is, not many people know about it except the elite in the public sector. Why was the Scheme conceived?
The NHIS was actually promulgated by Decree 32 of 1999 and the idea is for the Nigerian government to be able to provide easy, affordable health care for its citizens. However, just like you’ve mentioned, it is still not known by the larger populace is because since we took off in 2005, the focus has been on the formal sector which are principally federal government employees and the reason being that health is on the concurrent list does not allow everybody to key into the programme because of the non-mandatory nature of the law that brought NHIS into being and because it is not mandatory, you find out that a lot of people are not aware of what health insurance is all about and that is one of the things the new NHIS is poised to work on, going forward.
Why do you think it is important for every Nigerian to be covered by Health Insurance?
First and foremost, it is geared towards reducing out-of-pocket expenditure. You find out that a lot of people, at the time they need health care, pay a lot of money at service delivery points and this is one of the things health insurance is trying to take care of so that you can actually equate the risk and payment. Some people can afford to pay; some may not be able to. The whole idea therefore, is to be able to pool this whole risk together and also be able to pool the funds together so that it can be used to take care of every Nigerian when they need health care so that people will not need to pay at the point of service and that is the whole essence of health insurance in Nigeria.
What are the reasons for the low penetration of health insurance in Nigeria even with the level of awareness?
Like I said earlier, the non-mandatory nature of the scheme. Health insurance is not mandatory, the act establishing it left a little bit of caveat which does not make it compulsory for everybody to key into the programme and as you may be aware, health being on the concurrent list means that the federal government can actually legislate on health but states are not compelled to do it, so you actually find out that a lot of states have not keyed into health insurance because it is not mandatory and that is one of the things we are poised to work on.
The NHIS has penetrated the formal sector just as you mentioned earlier, what are you doing to incorporate the informal sector into it?
One of the key things we are trying to do is to get the corporation of the states. We have tried severally in the past to launch community-based insurance programmes but you find out that it is not as fast in terms of numbers generation and it is quite expensive because if you have to go from community to community to gather people, you will need to spend so much. We are looking at targeted groups now to be able to bring them into the scheme.
The second thing we are trying to do is to make the states realize that they need to come under this insurance cover and that is why we have started the State Insurance Programme where we are trying to decentralize health insurance in to the state which means that the states can actually create their own agencies and contribute their funds into it and we will engage in counterpart funding with them and help them technically to setup their own insurance scheme but they must make it mandatory for their citizens and residents to key into the programme and this will help in generating the needed numbers we are talking about.
If the NHIS does not coordinate the state programme, what then is the relationship between you and the states?
That is exactly what we are trying to cement now. Like I said, health being on the concurrent list does not allow the federal government to control anybody, hence, each state is running different programmes that are running parallel to what NHIS is doing in terms of some states saying that they are offering free health services to their citizens which does not make it optimal. If we have a large pool of funds that can be depended on, it can actually go a longer way. A lot of the free health services offered by the states oftentimes do not outlive the government of the day.
Once that government leave, the new government is not compelled to follow it. Therefore, one of the things we are trying to do is to institutionalise health insurance so that even if a governor leaves, the next government will know that it is a critical factor of success for him in the state.
One of the programmes embarked upon by NHIS has been the mobile health scheme, what is the position of that at the moment?
We are as a matter of fact still on it, it is a programme that is still ongoing. The national mobile health insurance programme was designed to leverage on the teledensity of the country in terms of administration. We found out that with the mobile penetration in the country, we can use that to get people registered easily because a lot of people have phones and access to telecommunications and also to be able to make payments which was a fantastic idea. Recently, we realized that alot of charges go into administering this process and this is one of the things we are trying to review, trying to cut down on what should have gone into administering health care.
We are into discussions with the Mobile Network Operators and other regulatory bodies that are concerned with the mobile network operations like the NCC and some other organisations to bring down this charges so that more money can go for this health care. We are in the process of reviewing all these things and I am sure we will come back repackaged for the national mobile health. It is actually the way to go because of the teledensity of the country.
Some Health Maintenance Organizations (HMOs) do delay in the payment of arrears which affects their operations. What is your take on this?
I will not tell you that I have not heard of this before, but I can assure you that by the beginning of the next quarter starting in October, you will see NHIS coming out harder on some of this erring HMOs because we have gotten reports on some of these HMOs owing monies as far back as a year or even more. We have actually compiled all these and we are in touch with the Healthcare Management of Nigeria which is the parent body of the HMOs. We have reported some of these erring HMOs even though it is not all of them that are engaged in the shady practice, we are going to sanction them from this quarter, I can assure you of that.
What is your take on the development of the health sector in the coming years?
The health sector in the country actually transcends NHIS. There are so many players in the sector under the guidance of the Federal Ministry of Health, there are alot of initiatives that the Ministry is bringing up. The paramount thing for everybody under that body is universal health coverage. All the agencies under the Federal Ministry of Health have our hands on deck, we are actually forming alliances instead of duplicating efforts, we want to harmonise what we are doing to be able to provide health care not only under one roof but inside one basket and the Ministry is coordinating all of that. Yes, the indices has improved a bit based on the Millennium Development Goal 4 and 5, if you look at the maternal mortality rate as at the figure of 1990, you will find out that in every 100000 births, we lose about 1200, if you look at infant mortality as at 1990, for every 1000 we loose about 170.
The same thing with children under five, you will discover that some die before they turn five not from accidental deaths but from things that can be prevented. You can see that these indices are going down. Also with evolving Sustainable Development Goal that is coming on now, we will sustain what we have started and within a year when more people would have been covered with health insurance, you will see that this indices will drastically reduce. For now, the country is not doing so well compared with countries around Africa or the global sphere in general but am sure that in a very short time we would have forged partnerships that will help reduce the indices.
Do you think this is responsible for the medical tourism people engage in and how much do you think Nigeria loses for this enterprise?
Well, there is so much figure out there. But first of all, medical tourism is because one of the nature of Nigerians, the confidence of people on the healthcare system in the country is almost eroded, so for those that can afford it, they prefer to go to where the system seems stable but sometimes it is not true. We have seen situations where people go to India or Germany and yet they still die, it is not sacrosanct that they live. We have also tried to ameliorate that by setting up special tertiary intervention that can actually promote hospitals in Nigeria that can equally perform this tertiary interventions that people run abroad for.
Since last year we started that, we have done alot of heart transplants, kidney replacement and so many other things in the tertiary sphere and it has been very successful. Medical tourism will be eroded once the health system is stabilised. Alot of monies like you have pointed out go out of this country, people say as much as 250bn is going out.
These are resources that are out -of-pocket that can be used to develop the health sector of the country. I am sure we will get there and medical tourism will be a thing of the past. I am optimistic that by the time we setup what we are planning, lots of people will even be coming to Nigeria and we will attract more gains to the economy. This is the time for change and I am totally committed to it.