UNTIL a strong legal and institutional arrangement guiding the activities of the National Health Insurance Scheme (NHIS) is put in place, the scheme might not achieve the desired goal of providing efficient, equitable and qualitative healthcare services for all Nigerians.Stakeholders who met in Kano last week to brainstorm on the amendment of the law establishing the scheme, stressed that the entrenchment of an efficient and equitable health financing system is only achievable when deliberate efforts are made to define a well articulated legal framework that would not only provide a strong and instutionalised regulatory capacity but also make it possible for adequate health resource mobilisation, pooling and their efficient allocation.They submitted that the scheme as it is presently structured and worded may not be able to provide the leverage for the NHIS to achieve the desired result of universal coverage for all Nigerians.Essentially, social health insurance relies heavily on its pooling strength, which can only be achieved where it is made compulsory for all the population or a defined segment of the population.In 1999, the legal framework establishing the NHIS was signed into law with the purpose of providing social health protection for all Nigerians.In 2005, following six years of preparation, the formal sector programmed of the scheme was launched. The scheme, according to NHIS Executive Secretary, Dr. Dogo Mohammed, has implemented this programme for five years using the legal framework of the NHIS Act of 1999.'The NHIS formal sector programme is a social health insurance programme designed to cover Nigerians in the formal sector employment (Public and Private).'However, in its desire to extend coverage to other segments of the society, the scheme has also developed other programmes expected to cater for people outside the formal sector employment.But stakeholders are worried that the desired objectives could be a tall dream, as the law as presently constituted would serve as obstacle to the expansion plans of the scheme.Mohammed, puts it more succinctly: He said: 'The NHIS enabling law ACT 35 of 1999, establishing the scheme to provide social health protection for all Nigerians, has numerous deficiencies, which if not corrected will continue to serve as an obstacles to the expansion plans of the scheme.'He cited the section of the law that made it mandatory for all employers with ten and above employees to contribute in the scheme, insisting that section is a major flaw that needs to be corrected.Again, he pointed out the failure of the 1999 constitution to properly articulate health as creating a lacuna.'Our experience has shown that other tiers of government have not been as committed as the central government as it relates to the NHIS.'Also, providing coverage for the informal sector using Community Based Health Insurance (CBHI) to mobilize adequate resources for the healthcare of its participants is generally poor.'This is compounded by the prevalent levels of poverty among this group. Consequently, towards enhancing performance, targeted subsidy is required to finance gaps, pay for the vulnerable groups and the poorest of the poor in the society and provide stewardship for the inherent poor technical capacities in their management,' he said.Dr. Mohammed Isah of the Department of public law, Faculty of Law, Bayero University Kano, agreed with him. He pointed out that the three tiers of government operating under the federal system of government is a major obstacle to the realization of the goals of the scheme.He said: 'This informed why the scheme failed to extend to states and local governments employees except in few cases,'Isah also identified the use of nomenclature in relation to health insurance, limited regulatory powers of the council, which according to him, renders it incompetent to enforce the provisions of the law, poor status of Nigerians and lack of public awareness on the NHIS programme as major deficiencies of the law.
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