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Social health insurance: “Amended NHIS Act ‘ll make participation compulsory”

By Sola Ogundipe
THE dream of every Nigerian to have full access to comprehensive healthcare services through a realistic social health insurance scheme is set to be realised as soon as the amended Act of the National Health Insurance Scheme (NHIS) is approved.

Executive Secretary of the NHIS, Malam Waziri Dogo-Mohammed  told Good Health Weekly  that one of the recommendations of the newly amended Act is to make participation in the NHIS compulsory.

There are currently about 300, 000 beneficiaries of the maternal and child health project of the NHIS  in six states of the Federation. More people are set to benefit once the amended NHIS Act is approved.
There are currently about 300, 000 beneficiaries of the maternal and child health project of the NHIS in six states of the Federation. More people are set to benefit once the amended NHIS Act is approved.

“The Act establishing  the NHIS makes social insurance optional, but our experience shows that a number of important participants are not participating. The only way we can make it mandatory is to amend the Act. In the amended Act, NHIS is going to be made compulsory. The name of the scheme will change. We just realised that the Act gave the scheme a very difficult name. Actually a scheme is just like a programme made to achieve a certain goal for a specific population.”

According to him: “We have gone a long way to actualize this. But by the time this Act is done with, we’ll be happy it has taken this long to fine tune it and get a better Act that will address most of the perculiarities of the NHIS. The Federal Executive Council has looked at it and made a lot of input. Final touches are being made and already, there is a team working on it.

On the 25th of this month (November), the final draft of the amended Act will be presented. It will then go back to the Health Minister who will take it to the Federal Executive Council who will look at it before approval and passage to the National Assembly before it is presented to the President.”

He noted that while there could be a  scheme for a group of students, or the vulnerable groups, or the indigent, the NHIS started as a scheme and it started with the formal sector – the Federal employees, but the Act is for social health insurance, and  we also have private sector insurance which the NHIS cannot cover  unless the Act is changed.

“We are prepared for the States to log on but since 2007 only Cross River and Bauchi States have logged on. We have done a lot of advocacy at different levels but because participation is  not mandatory, the States are not doing anything.”

Further, Dogo-Mohammed remarked that the NHIS has however undergone a lot of changes in recent times as well as tendencies to try to change it holistically, but he regretted that it has been very difficult to change things.

“Vulnerable groups are not covered. We have the formal and informal insurance, but by the time you come and say you want to do the social health insurance, contribution is important. Somebody has to pay something. So for us to look at it as a mandatory exercise, if we  want NHIS to regulate, it cannot be just a scheme. It has to be like an agency that is going to be more or less like an authority so that it can be able to monitor the various schemes in the country and it is the Act that is going to make it mandatory.”

On how many Nigerians are on the scheme

“The figure is dynamic because as people get registered some are exiting either through death or retirement and new projects are coming up, but on the register we are hitting five million under the formal sector, but this does not include the maternal and child health project which now has recorded over 300,000 women and children.”

On the maternal and child health project

“The NHIS courtesy of the acceptance it is getting from some of our partners, the office of the President looked of the operation of the NHIS and saw that it is possible to be able to take the modus operandis and change the health indices of the country as regards to maternal and child health. This is because generally all States claim they are giving free maternal and child healthm yet the indices are not changing, hence we must act differently It was discovered that if some money is given NHIS and there is assurance of the identity of those who enjoy and compare with ose who benefit, and verufy this, we will get money

Last year six States were selected – one per geo-political zone. We started with Gombe in the North East, Sokoto in the North West, Jigawa in North Central, Oyo in South West, Bayelsa  South South and Imo in South East. Since it is a new project and it to be piloted, we just started.

Nigerians are tired of the high maternal and child mortality, so we have a road map in engaging the States, but it has not been easy getting the political acceptability. Some of the governors will not listen and think that since the project is for three years and they are expected to abstain while the MDGs downscale, some are talking of the benefit package being too comprehensive for their liking.

We are now working toward getting a benefit package that will be more accepotable to the States.

On relationship with HMOs

We are interfacing with the HMOs. When it comes to registration, it is very difficult to get the beneficiaries is difficult. They also give their staff targets. To them it is the numbers and not the genuiness of the registration that is more important, but we find that they register over-aged or under-aged people, but when you work the data. So many are not qualified. There is problem with registration and processing of the data. The general belief is that all monies allocated, must be spent, but that is not so.  We are trying to fast track the processing of the data by establishing  zonal offices so that you do not have to keep bringing  forms to Abuja.

There is often mutual suspicion about free things in Nigeria. We started registering at facility level but now we are going to meet the people in their houses. But even that is causing another problem. When you keep trying, people become suspicious.  These are some of the problems with the maternal and child project.

Our target for the maternal and child helth project is 600, 000 lives and we are now half way. Each State was given 100,000 lives, we know it is not possible to get all the women at once. You do not actually capture these women because they do not come out. There is need for more sensitisation.

“If you want people to join, you have to bombard them wit a lot of information. The formal sector is about 25 per cent of the population. You want the organised private sector where. The Act is talking of social health insurance, but we do not know what is  Until they change the Act, we cannot know what is going on in the private health insurance.

On the organised private sector

Now we are gaining confidence of the organised private sector. Many companies are now voluntarily applying to the NHIS, we are also factoring in going to do advocacy to the companies.

On capitation

“Capitation is the quantum of money sent every month on behalf of every registered person wether or not the person visits the health facility. Currently it is N550 for the primary level of care. But because in a pool, only 5-10 per cent will go to seek care and the pool of money will ensure access to care. This is the principle of the social health insurance.

When it started it was just called capitation, but by the time I came to the NHIS it was called global capitation.  It is based on the provider, not the professional.

Our providers are classified. A primary provider is a facility that will give about 70 per cent of available services and there should be a team of medical facilities. So  NHIS capitation goes to the provider. By the time you start breaking the money there’ll be a problem. No Nigerian patient will like to go to a mere consulting clinic. Nigerians want the best consultation and attention. So anybody asking to be given their own share of the capitation for drugs is just not being realistic.

This is why accreditation with the NHIS is voluntary. No facility was coerced to register. Every facility under the scheme applied and we sent teams to  check if they have reached the benchmark checklist before approval as a provider and they willingly sign to participate with the HMOs.”


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