By Sola Ogundipe
THE low level of participation in the National Health insurance Scheme (NHIS) in the country has been attributed to poor awareness among Nigerians.
This was the view of former Commissioner for Health in Lagos State, Dr. Segun Ogundimu, whoÂ recommended that government,Â and health management organisations (HMOs) as well as health care providers should propagate the scheme more to Nigerians in the rural and semi- urban areas.
Ogundimu, Managing Director, Clearline Health Management Organisation, said the need for this drive was necessary because: â€œA lot of poor indices we have in the country come from rural areas, Unless we carry the scheme to the rural areas, the indices will continue to be poor. The maternal and infant health is bad in Nigeria, but the bulk of it comes from the rural areas.â€™â€™
He advised against registration of more HMOs in urban areas. â€œAny HMO that is accredited now should be a community health insurance- based that will be willing to work in the rural areas.â€™â€™ Ogundinmu added that health care providers in rural areas should be motivated.
The former Commissioner said another big advantage the scheme will have is to stem the tide of overseas medical treatment. He wantsÂ HMOs tocome together and identify a particular centre of excellence in a particular ailment and develop it. â€œThey can go into partnership with such a hospital such that we can attract our sons and daughters outside Nigeria to come and work there, maybe every weekend.â€™â€™
The Managing Director stated that it would be difficult to make Nigerian medical experts abroad to come and settle down at home. â€œ A surgeon, who is established in America, cannot come home. After surgeries, he will need support services. We do not have skilled nurses to give him support services.â€™â€™
According to him, many Nigerians do not like going abroad for medical treatment but were compelled to do soÂ because of poor health services at home. Ogundinmu said that Nigeria had qualified man power in all areas of health sector.
â€œThere is a Bill before the National Assembly now. If that Bill can be passed and the NHIS is made compulsory for every Nigerian and all employers of labour, it will open the health sector. Investors will come from abroad and participate. They are coming gradually, but they are one leg in and one leg out because there is no infrastructural support. If the health sector is empowered by making the NHIS Â Â Â compulsory, every little kobo contributed will make a mighty ocean of money. We can then take care of the vulnerable group that cannot pay their bills.â€™â€™
Faulting the free health programmes of some state governments, he said, â€˜â€™in the western Region, where it was practised, 20 percent of budget was voted for health, while 30 per cent was earmarked for education. Which government can do that today? They cannot afford to do it because there are too many competing challenges. In those days, there was integrity. They would not divert drugs. There was political will. Those were the reasons Awolowo s free health programme succeeded. Governments of today should stop deceiving people. There is no free Christmas anywhere.â€™â€™
He also explained that most NHIS providers were running comprehensive centres because of the problem of logistics. Ogundinmu said he preferred a situation, where doctors would prescribe drugs to patients without dispensing them.
According to him, the scheme has solved the problem of commercial medical practice. He stated that in such a practice, a doctor could make patients to go for a test that they did not need because of the money he wanted to make.
He said, â€˜â€™the scheme is a clinical medical practise. The HMOs are like medical auditors. If someone does not needs an EC, why do you ask him to go for it? Just like any other professions, some doctors use the knowledge of their profession to extort money from Nigerians. Doctors are Nigerians too. They are not angels.â€™â€™
NHIS spends N50bn in 4 years
TOWARDS ensuring the sustenance of funding of healthcare services in the country, the National Health Insurance Scheme (NHIS) has so far injected N50 billion into the sector within the last four years. A total of N70 billion has been received from the Federal government over the same period.
Executive Secretary of the NHIS, Dr. Waziri Dogo-Muhammad, who disclosed these facts to CNBC Africa, opined that the National Health Bill, when passed wouldÂ further strengthen the financial capacity of the scheme to provide access to more Nigerians, insistingÂ there is the need to explore other viable options of funding healthcare as it is doneÂ in other countries.
Dogo-Mohammed told theÂ international news channel, that full implementation of the NHIS would eliminate 60-70 per cent of out-of-pocket expenditure spent on health. In an assessment, he said the initial scepticism that trailed the commencement of the Scheme has given way to enthusiasm.
He highlightedÂ major challenges confronting the Scheme as the absence of reliable health data and lopsided distribution of infrastructure, but assured that theÂ operation was tailored to address these problems and to attain universal coverage by 2015.
Efforts are onÂ to achieve Statesâ€™ buy-in of the various NHIS initiatives, emphasizingÂ the urgency and need to ensure other tiers of government enrol in the Scheme.