Seven years after the establishment of National Health Insurance Scheme, NHIS, in the country, many challenges have been identified both by enrollees and the healthcare providers. The National President, Healthcare Providers’ Association of Nigeria, HCPAN, Dr. Adenike Olaniba, spoke with Vanguard Healthy&Living on these challenges, the need for a subsidy and the way forward towards achieving a universal coverage by 2015. Excerpts: WHAT is the NHIS all about?
National Health Insurance Scheme is a scheme that was introduced to achieve universal coverage, qualitative healthcare at affordable cost to all Nigerians. However, we have discovered that since the scheme was launched seven years ago, only about 5 per cent of the population has been covered.
It is only the government workers and parastatals that have been enjoying the largesse of the NHIS. If NHIS is to penetrate the informal sector, that is to go down to the grass roots, we believe there must be subsidy. No matter how much members of the community pay to the primary care provider if there is no sustainability of the programme, then the programme will collapse.
How can the scheme benefit the common man?
Experiments carried outside in Nigeria have shown that when the programme starts along the line, after a year or two, there was no regular funding for the programme it will collapse. We are now asking as healthcare providers’ association that if the government wants this programme to go down to the grass roots, that is the community-based social health insurance that is being proposed then, there must be a group of people that can bridge the gap because a gap is always created in the community social health insurance.
Never mind that Board of trustees are put in place but it has been observed that the masses do not pay their premium regularly. They may pay their premium for the first six months, thereafter; the premium will not be forthcoming. How then, do we maintain or sustain the programme, if nobody will bridge the gap?
Other challenges that we have found is that we discovered are that many enrollees are based in the general hospitals and tertiary institutions. The healthcare providers are now saying that there must be distribution of these enrollees. We believe that not enough public enlightenment was carried out before these enrollees chose the general hospitals and the tertiary institutions.
The diseases that are being treated at these institutions can be very well managed at the primary healthcare level and at the private providers’ level. Throughout the world the first point of call of any patient is always primary care providers. So there is need for enrollees to go back to their communities to take health services from their primary care providers.
If this is done many of the providers that are complaining of not having enough enrollees will be able to have enrollees and will be able to offer quality services because whatever capitation they get from these enrollees they would use it to upgrade their facilities.
How then do you address the issue of choice?
The issue of choice is there. We are not forcing anybody to go back. But the issue is that if the government adopts the policy for people to choose facilities that are nearer to their homes, we believe that primary healthcare can also be provided by private practitioners around you. It is a matter of education, sensitisation and making people aware that what they can get at the tertiary hospital can also be provided by their private practitioners.
How many percentage of taxation do you think government should devote to NHIS?
I will not advocate through taxation in Nigeria because statistics have shown that an average Nigerian do not pay tax as such. Yet, we are all talking about ideal situation that is happening in the UK where National services is being run on general tax. But don’t forget that in the UK almost everybody pay tax even those on government benefit are also made to pay tax.
So taxing Nigerians to pay for health may be a mirage. We need to look at other sources. There have been some suggestion like a percentage from the VAT that everybody pay whenever they buy goods because whether you are working in government or private sector, you will still have to pay VAT on anything you purchase. That may be an area where we can get that subsidy from.
Another area they have use in Ghana is through the telecoms. By the time you buy the recharge cards a percentage of what you are buying will be sent to cover health insurance. These are areas the providers are thinking about. But our major concern is that out there in the informal sector, majority of the people are poor and cannot afford health insurance.