THE task of implementing the National Health Insurance scheme (NHIS) nationwide has been a very daunting one for the government, but in the past few years, Nigeria has continued to make efforts at expanding the number of people who have access to quality healthcare especially in the Millennium Development Goals (MDGs) related targets.Presently, about 75 per cent of the population still pay for their health needs from out-of-pocket which means that a large percentage of Nigerians still pay for their health needs when critically ill and need urgent medical attention.Part of the steps to widen the access to quality healthcare was the introduction of the formal sector social health insurance programme for employees of the Federal Government in 2005. Yet, the coverage has been among the civil service, students of some tertiary institutions and the military. Suffice to say, therefore, that the coverage is still a far cry from the ideal.In a country where most of the people either live in the rural areas or are operating in the informal economic sector, which is still largely unorganized, this poses a challenge to a health insurance scheme that is formed around organized groups.Executing a health insurance that is supposed to pool resources together to readily provide health needs of the people, even before they need it, certainly requires a wider scope that is well beyond operating within the formal sector.In 2005, the National Health Insurance Scheme (NHIS) was given the presidential mandate to ensure universal coverage by 2015. To achieve this mandate, the NHIS has since swung into action developing various programmes to suit the many social-economic groups in the country. It also developed operational guidelines to ensure effective implementation of the various programmes. The guidelines spelt out payment mechanisms, accreditation procedures and requirement and quality assurance process among others.While it could be argued that the informal sector is unorganized, it does not translate to the fact that they cannot be organized for specific purpose through associations, guilds and unions. For example, there are communities of artisans such as vulcanizers, carpenters, bricklayers, drivers etc that can come together to pursue matters that can be beneficial to members. Indeed, the National Union of Road Transport Workers (NURTW) is one group that has emerged as a formidable and organized group that is championing the interest of its members.It is these groups that seem to be providing an in-road for the NHIS to latch onto in its effort at further widening access to quality healthcare facilities by Nigerians.The Executive Secretary NHIS, Dr. Waziri Muhammad-Dogo, said that the Scheme has made substantial progress since coming on board in 2005 and it is now poised to explore the latent informal sector.He added that considering the vast size of the informal sector in the country, the scheme has developed blueprint for the implementation of community based social health insurance programme.He said: 'We have come a long way since the blueprint for community health insurance was approved by the Federal Government. After the approval, we have developed operational manuals and the different models because the term 'community' means different things under different circumstances. A community could be an economic community like cooperative group such as the road transport workers or groups of artisans. These are different groups that come together to promote an economic interest or interests. Indeed there are many of this type of communities in the country today. There are also villages and towns that are living together within a given geographical location. The first one is more dynamic because membership goes beyond physical boundary.'The NHIS boss hinted that survey had been carried out to know all the existing communities in the country.'We now have a survey of all the cooperative societies in the country, all microfinance groups, and all groups that are union-oriented with some activities. These are economic groups that can serve as entry points by the time we start community health insurance scheme,' he explained.However, he was quick to add that the community health insurance scheme will cohabit with the existing scheme.The NHIS helmsman revealed that the Scheme has received the final report in preparation for the flag off of the community health insurance scheme by President Goodluck Jonathan.He explained that a team from the NHIS was recently in India to examine how the country is executing its own community health programme. Waziri added that India has some similarities to Nigeria in terms of population figures and dynamics.He added: 'Also as part of the preparation, we had to go and compare notes with our Indian counterparts who had been executing community health insurance scheme for some time and have also recorded a high success rate. India has a community health insurance for the poor that is heavily backed by the government. The three tiers of government teamed up to provide health care to the poor that are living below the poverty line and they run into millions because of the high population of India, which has hit about 1.2 billion. The Federal Government, together with the state governments decided to give care to these people who are excluded from the conventional health care programme. These two tiers of government decided to have a sharing formula. The Federal Government pays 75 per cent while the states pay 25 per cent. We went to see how they were able to capture these people who are not organized unlike the formal sector that has a register of its working class and other data. In the informal sector, it is an all-comers affair.'In India, he explained, the responsibility of collating who is really poor was given to the state governments.He explained: 'Of course we know that quite a number of people who are not all that poor will also want to be a part of this kind of initiative which also presents the challenges of detecting who is not eligible. Therefore, the state governments were given the opportunity to identify, down to the remotest villages, those that qualify to benefit from the package. They were subsequently registered after they were given identity cards that have their personal identity number. The states now handed over this information to the Federal Government with their own counterpart funding. The Federal Government then added its own 75 per cent and then outsourced actual registration given the beneficiaries smart cards and number per family.'With this innovation, India has now expanded access to health care facilities with about 40 million people covered under the programme.The NHIS Chief said the scheme has developed its own Information Technology to ensure robustness and user-friendliness.Waziri also hinted that the NHIS is partnering with a micro insurance academy in India in the execution of the programme in Nigeria.'We are partnering with a Micro Insurance Academy in India and our Indian counterparts, the Indian National Health Insurance for the Poor to execute this. With all these experiences, the Federal Executive Council has already approved that we should put the final touches in place and then hope that in the next few weeks we should be able to get Mr. President to flag off our community health insurance in Nigeria,' he stressed.He highlighted that NHIS will embark on massive sensitization of stakeholders on specific roles of all the medical teams to forestall misunderstanding of roles.He explained: 'We have to do a lot of sensitization. When the formal sector came in 2005, there was no much sensitization on how it is going to operate and that was why it was met with a lot of resistance. We should not forget that the formal sector is for people who have some economic muscles to participate talk-less of an informal sector that is largely unorganized in terms of organization and even economic empowerment. We will sensitize both the givers of service and receivers alike on their roles. This community sensitization programme is very important and along with the community health insurance scheme is voluntary contributory programme.'Waziri stressed that there is no discrimination of packages saying, 'In this, there is no difference from what a government employee or worker in the private sector is enjoying that will not be applicable to the people in the voluntary contributors package.'He maintained that the packages would not be uniform across the country, as it will take a range of issues on board in deciding what will constitute the packages.The NHIS boss said: 'In the community health insurance, members of a community will have to decide what they want covered in the package because it is not going to be uniform throughout the country. When one moves from one state to the other or from one local government area to the other, there are diseases that are more common than the others. In some cases it could be job hazards, like members of the road transport workers who are more likely to be prone to road accidents, will likely prefer accident related packages.
Click here to read full news..
