THE Act establishing the National Health Insurance Scheme (NHIS) mandates it to operate a social security health insurance system that guarantees the provision of needed health services to persons, on the payment of token contributions at regular intervals.It was established to improve the health condition of all Nigerians at an affordable cost, while imposing on it the statutory authority for the scheme's benefits and programmes, as well as set the general rules and guidelines for the operation of the scheme.The journey to the establishment of the scheme started way back in 1962 with the recognition of the provision of health insurance in the healthcare to Nigerians after the earlier free healthcare system funded by earnings from oil exports and general tax revenue became unsustainable due to the global slum in oil prices in the 1980s.This lead to the introduction of several cost recovery measures, such as user charges and Drug Revolving Funds, which was were adversely affected by the introduction of the Structural Adjustment Programme (SAP) in 1986.Other factors, such as the general poor state of healthcare services, dependence and pressure on government-provided health facilities, dwindling funding of health care, amidst rising costs and poor integration of private health facilities in the country's health care delivery system also made the scheme inevitable.To ensure the access of good health care services by all Nigerians, the NHIS initiated various programmes to coverdifferent segments of society, including the formal sector social health Insurance; urban self-employed social health insurance; rural community social health insurance; children under-five social health insurance; permanently disabled persons social health insurance; prison inmates social health insurance; tertiary institutions and voluntary participants social health insurance; and the Armed Forces, Police and other uniformed services.NHIS is now ready, in the New Year, to launch another programme for students below 18, who are not qualified or gainfully employed to get cover under the present arrangement.NHIS Executive Secretary, Dr. Waziri Dogo-Mohammed, told journalists in Kano recently that the scheme was also developing a package for retirees, saying: 'It is when people get older that they get more diseases, like diabetes and hypertension.'We have done the national summit and are now doing thezonal summit to get the final input from all the groups, so that we will know how to finance the programmes, how the people are supposed to enjoy them and how they are to be covered.'He said the armed forces had had a meeting and those in service are entitled to a 100 per cent cover throughout life, so that even when they retire, they would continue to have cover.The NHIS boss said: 'Knowing that not all Nigerians are employed, we have developed so many programmes over the years, like the community health insurance programme, which was flagged off by President Goodluck Jonathan on December 17, together with the voluntary contribution, which we have tested and is working.NHIS undertook a national inventory of all micro-finance groups, cooperative societies and artisans in the country, which was outsourced to seven consultants, who after going to all parts of the country, identified these groups, based on which NHIS developed some parameters for selecting those likely to qualify by its own standard.'We selected 60 per geo-political zone and now we are going on verification to interact with them, to identify and find out if they have a hospital and whether they can act. While the work is being done, we are engaged in different communities,' he explained.As these are being done, there have been clamour and agitations from some stakeholders and NHIS for the amendment of the Act establishing the scheme, hence a Bill has been sent to the National Assembly to that effect.There have been stakeholders summit across the country to sensitise not only the stakeholders, but also the ordinary people on the import of the proposed amendment for effective operation.One of the summits was held in Kano on December 8 and 9. At the event, Governor Rabiu Kwankwaso said the agitation for the amendment could not have at a better time than now that his government was committed to improving the health status of the citizenry through the revival of viable programmes geared towards achieving the Millennium Development Goals (MDGs) targeted specifically at reducing child and maternal morbidity and mortality rates.Kwankwaso promised Kano's participation in the scheme in the context of community-based contributory health scheme, which he said is in line with the culture, tradition and values of the people.The governor stated: 'We will do everything possible within our financial capability to pay our counterpart fee for the programme to take off successfully in Kano.'This administration will ensure that the project is properly sustained for the benefit of a common man in the entire state.'I commend the efforts of the organisers of this summit, particularly members of the National Assembly and stakeholders in the health sector, in finding it necessary to amend this act.'Dogo-Mohammed, in his presentation, said since its establishment in 2005, the NHIS has implemented the programme using the legal framework of the 1999 Act, with valuable lessons learnt and many challenges exposed.He urged stakeholders to make a fresh attempt at confronting one of the main challenges facing the scheme- the NHIS Act- and amending it to accelerate Nigeria's goal of providing universal coverage of its citizens to have access to efficient, equitable and qualitative healthcare services.Dogo-Mohammed explained that the health system is judged by the healthcare coverage of the population and achieving such goal revolves around the financing options and legal framework the system chooses.The entrenchment of an efficient and equitable health financing system, he said, is only achievable when deliberate efforts are made to define a well-articulated legal framework that not only provides a strong and institutionalised regulatory capacity, but also makes it possible for adequate health resource mobilisation, pooling and their efficient allocation.The NHIS chief executive insisted that the Act, as it is currently structured and worded, may not be able to provide the leverage for the NHIS to achieve the desired result in its pursuit of universal coverage of Nigerians with social health protection.'From a technical standpoint, operating and sustenance of social health protection are dependent on the availability of strong legal and institutional arrangements. Social health insurance relies heavily on its pooling of strength, which can only be achieved where it is made compulsory for all the population or a defined segment of the population.
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