…97% of Nigerian men, women not covered – NDHS

By Chioma Obinna

The idea behind the introduction of a health insurance scheme anywhere in the world is simply to improve the health of citizens at an affordable cost.

This also justified the kick-starting of the National Health Insurance Scheme, NHIS, in 2005 by the Olusegun Obasanjo administration for the attainment of Universal Health Coverage, UHC. 15 years after, however, and with a population of over 200 million, less than 5 per cent of Nigerians, mostly in the Federal Civil Service, are covered under the scheme.

Although experts say health insurance remains a pedestal for achieving UHC, only 3 per cent of Nigerians have health insurance, according to the 2019 National Demographic Health Survey, NDHS. Sunday Vanguard reports:

When in 2019, Mr & Mrs Jonathan Izuogu had their second child, their joy knew no bounds. Not only because the child appeared healthy at birth, lively, and cute, the sex of the child was a dream come to true as they had planned to have just two children, a boy and a girl. Their first child was a boy and now having a girl as their second child was a kind of fulfilment.

However, just two months later, the child’s health was failing. She was rapidly losing weight. She cried inconsolably. At this point, the couple decided to take her to a hospital where an echocardiogram revealed that she had congenital heart defects and needed urgent open-heart surgery.

Although the couple were both employed, their savings could not pay for their daughter’s surgery.

And they had no health insurance. Several months after, they lost the child because they could not afford the money for heart surgery.

Their child was among one in every eight children that die before their fifth birthday.

The Izuogus are not alone. There are many others who ran into troubled waters before the lack of health insurance.

Joe, eight, has just finished four sessions of chemotherapy treatment but needs further treatment as medical doctors handling his case say the chemotherapy has no effect on his cancer. The boy has already lost one of his eyes and on the verge of losing the second. His parents have also lost everything, including their home, spending money trying to find out what is making him so sick. They are currently going from pillar to post trying to raise money for his treatment. They have no health insurance and his father recently lost his job and the mother, a petty trader, cannot do much for the family.

Joe is waiting for a messiah that may never come. But the case of Ade Ogunlewe is different. For months, his parents worked so hard to find the cause of his illness until Ade was diagnosed of an extreme case of inflammatory bowel disease. He had lost some weight.

Ade’s treatment was not that difficult the moment the diagnosis was made as his parents had private health insurance. With treatment, he gained back around half of the weight he lost.

Thousands of Nigerians are facing catastrophic health emergencies on a daily basis. The cause of these health challenges is preventable and ailments treatable if these Nigerians have money and access to health care.

Investigation shows that many never get the help they need. Consequently, year-after-year, Nigeria has continued to parade unenviable poor health indices. Nigerian women still die at childbirth, malnutrition among children continues to rise, malaria kills in hundreds while diarrhoea and pneumonia are on the rampage in communities across the country.

For instance, the 2018 National Demographic Health Survey shows that one in every eight children die before their fifth birthday and 132 per 1,000 live births. Again, 54 per cent of Nigerians (98 million) are poor living below 1.9 dollars per day.

Across the world, health insurance improves access to health care, thus promoting good health.

Experts say reasonable access to health care encourages individuals to seek health maintenance services more regularly than they otherwise would, thereby preventing potentially serious illnesses.

According to a UNICEF Monitoring and Evaluation Specialist, Maureen Zubie-Okolo, health insurance protects individuals from financial hardships that may result from large or unexpected medical bills.

In Nigeria, health insurance can be obtained from private organisations or government agencies. The Act of Parliament that came into force in October 2014 envisages a health care system that will cover all strata of society in all urban and rural communities.

However, coverage is limited to public and large private organisations.

Today, despite the fact that many states have initiated health insurance schemes, not many Nigerians have health insurance and the awareness is still very low.

According to medical experts, with an innovation health insurance plan, Nigerians will have access to high-quality, affordable and convenient care. No wonder the United Nations harped on health care financing as a tool in achieving one of its goals – Universal Health Coverage, UHC – in the Sustainable Development Goals, SDGs, by 2030.

But how many Nigerians have health insurance?

According to the 2018 NDHS, only three per cent of women and men, aged 15-49, have health insurance while 97 per cent don’t have.

The survey also revealed that the percentage of women who do not have any form of health insurance has decreased slightly since 2013, from 98 per cent to 97 per cent, while there has been no change in the percentage among men with 97 per cent in both 2013 NDHS and 2018.

Giving details of the survey at a two-day workshop organised by the Child Rights Information Bureau and the Federal Ministry of Information, in collaboration with UNICEF in Port Harcourt, Zubie-Okolo explained that the percentage of women with more than secondary education who have employer-based insurance increased from 0 per cent in 2008 to 11 per cent in 2018.

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“Among men with more than secondary education, the percentage increased from less than 1 per cent to 12 per cent. 11 per cent of women and 12 per cent of men with more than secondary education have employer-based insurance. Seven women and eight per cent of men in the highest wealth quantile are most likely to have employer-based insurance”, the UNICEF Monitoring and Evaluation Specialist said

She stated that from the survey, only four per cent of urban women and men are more likely than rural women and men to have employer-based insurance coverage and, in the rural areas, only one per cent is likely to have employer-based insurance coverage.

Calling for urgent needs for Nigerians to embrace health insurance in order to achieve universal health coverage by 2030, she said with health insurance, the poor health indices of Nigerians will be improved.

Also in a 2017 survey by NOIPolls, as many as 89 per cent of the Nigerian population paid for healthcare services out-of-pocket.

The poll also reveals low penetration of health insurance among the populace.

Commenting on the low coverage of health insurance in the country, immediate past President of the Healthcare Providers Association of Nigeria, HCPAN, Dr Umar Sanda, said the National Health Insurance Scheme was started on what he described as faulty ground.

According to him, health insurance is very important particularly now that the population of the country continues to increase and the fact that many people cannot pay out-of-pocket.

Noting that healthcare was becoming expensive, he stated that insurance is about keeping money for the future or saving money for eventuality.

“If you have health insurance and there is an issue which can cause you thousands or millions of money, your health insurance can carry it”, he said

“It is important that we must key into it but we need to change and review our methodology.

“Nigeria started on a faulty ground and the NHIS concentrated on the formal sector, the private sector, while the majority were not looked into.”

Continuing on the challenges against health insurance, he explained that health is on the concurrent list and that many states may not obey the Federal Government when it comes to health insurance but would want to fashion out their own scheme.

“So the way out is that states should have their own health insurance system. The private sector should also be made a major stakeholder and player in providing health insurance because the majority of our people are in the private sector.”

Calling for greater awareness of health insurance, Sanda said many Nigerians are frightened by the word ‘insurance’ due to their superstitious belief that something may happen to them.

“Some Nigerians feel that when you call it health insurance something will happen, but we need to educate our people. Maybe we should begin to call it health scheme to attract these Nigerians.”

On his part, an Independent Development Consultant, Dr. Davis Omotola, lamented that health insurance coverage for Nigerians was still abysmal and called for urgent attention.

“The law stipulates that when a company has a particular number of staff, they should buy into health insurance but many companies in Nigeria are defaulting”, he said.

“Companies are not buying into it and this is bad.

“If people take an insurance cover, it will improve maternal, child health and improve access to healthcare. More women will deliver in health facilities.”

To ensure that more Nigerians take up health insurance, experts are of the view that there is a need to amend the NHIS Act and enact other laws to make the scheme compulsory for all Nigerians as it would ensure proper monitoring, efficiency, proper utilization of health facilities and ultimately lead to a better health care delivery system in the country.

They believe that achieving health insurance cover for all Nigerians would help the nation achieve UHC in Nigeria in line with the United Nations SDG Goals by 2030.

It takes political will for countries to implement UHC and several African countries, including Botswana, Rwanda, and Ghana, are demonstrating that will.


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