It is a common saying that health is wealth. It is also true that to manage one’s health, a significant portion of their earnings have to be invested. But healthcare is not like other basic needs of a man like food, clothing, and shelter which can be carefully planned on a budget. Sickness comes without notice and has the potential to disrupt one’s entire financial plan. This is why it’s important to have health insurance coverage to cater to such eventualities. This article will delve into Nigeria’s health insurance system with the aim of appraising some salient issues that have the potential to reshape the health ecosystem in the country.
Background to Nigeria’s Health Insurance Policy
Nigeria is the most populous black nation on earth, boasting well over 200 million persons. The country has a statutory body responsible for the health insurance of the citizenry named the National Health Insurance Authority (NHIA). The authority was first signed into law in 1999 as National Health Insurance Scheme (NHIS) and was in 2022 renamed NHIA through a legislative act that gives it the mandate to cover all Nigerians.
It has been more than twenty years now since the launch of this scheme but only 5% of Nigerians have been covered according to the country’s ministry of health. Most of whom are civil servants.
There are health insurance companies that provide insurance services at a higher cost than the government authority but due to the prevalence of poverty in the country, they have not been able to make key inroads into the market.
In 2020, the authority as a response to this low coverage created an insurance program called the Group, Individual, and Family Social Health Insurance Programme (GIFSHIP). The aim is to capture the informal sector of the country, which are in the majority.
What is Group, Individual, and Family Social Health Insurance Programme GIFSHIP?
The GIFSHIP is a specially designed program to capture uninsured Nigerians. It seeks to ensure that no Nigerian is left behind in the quest to achieve universal health coverage.
With it, the farmers and traders who were hitherto not captured can register and enjoy the benefits of health insurance that does not discriminate.
At what cost? An individual can register to the GIFSHIP for the sum of N45,000 Naira ($100) for the health insurance coverage per annum. That is not all, the N45,000 can cover one person and two additional persons. In essence, each person is enjoying health insurance for a year at the cost of N15,000 ($35). Families and groups can also register as many persons as possible all at the cost of N15,000 per person.
The cost seems fairly cheap and affordable. Readers may wonder if the insurance coverage is full or partial. The good news is, the coverage is full for primary and secondary health cases, only tertiary cases are split in 50:50 between the patient and the health authority.
Primary Health Cases
For better understanding, primary health cases are those that can be treated by primary health care centers. Secondary cases are those that can be treated by general and specialist hospitals while tertiary cases are those that can only be treated by teaching or specialized hospitals.
This hierarchical access to healthcare is achieved through the referral system. If a patient is enrolled in a primary health center (PHC) as his primary health care provider and is suffering from an ailment that is beyond the scope of the PHC, he can easily be referred to a higher hospital where his ailment can be treated at zero or low cost.
The system uses designated health management officers (HMOs) to which each patient is assigned. The HMO keeps track of the patient’s health bills and pays the bills to the hospital at which the patient was treated accordingly.
A patient has the right to select from any of the thousands of hospitals that are accredited by NHIA in any part of Nigeria. Virtually all publicly owned hospitals and clinics are selectable and a number of private hospitals and clinics are accredited by NHIA as well.
Limitations of the Group, Individual, and Family Social Health Insurance Programme
Delay Before Surgery
Under this program, in order to protect the interest of the authority, it is decided that a new enroller can only be eligible for major surgeries and other tertiary treatments, six months after enrollment. This is counterproductive as it defeats the purpose of helping poor Nigerians to have quick access to affordable health care.
Long Waiting Period for Health Insurance
There is a waiting period of 90 days after registration before a patient begins having access to the insurance service. It will be better for Nigerians if this administrative policy is relaxed.
Unavailability of Drugs
Although a patient is required to pay only 10% of the cost of his drugs under the insurance program, it turns out that the expensive drugs are mostly unavailable at the dispensaries. This situation forces patients to buy drugs outside the hospital at high prices without enjoying the subsidized rates.
Laboratory Investigations
The insurance scheme does not cover all laboratory investigations. Investigations such as DNA tests and the like are not covered. In some cases, most hospitals do not have equipment for certain investigations and the private laboratories that offer such investigations are not accredited by the NHIA. This leaves patients with certain rare ailments at the mercy of private laboratories.
Group, Individual, and Family Social Health Insurance Programme and Women
According to Dataphyte, of the 5 percent of Nigerians with any meaningful health insurance coverage, only 43.3% are women. This data is telling and worrisome especially when viewed through the prism of Nigeria’s maternal mortality rate.
UNICEF in 2021 observed that although Nigeria contributes only 2.4% of the world population, it sadly contributes to 10% of global death for pregnant women. This situation has a direct relation to Nigerian women’s poor access to good health insurance and facilities.
This data is not surprising to many Nigerians especially those with knowledge of how women in rural areas give birth at home with little to no professional support.
There are also stories of husbands who abandon their wives at the hospital bed due to fear of the expenses likely to be incurred.
It is precise because of the above gory situation that GIFSHIP stands to change the fortune of rural and low-income women in terms of health insurance coverage.
Health Policy, Infrastructure, and Personnel
Nigeria’s health insurance policy is very socialist in nature as the cost of enrolling is fairly low and affordable and it has great prospects of impacting the lives of Nigerians. But a good health insurance policy is only one side of the coin. Health systems need facilities, infrastructure, and good personnel to operate.
In the area of nationwide spread of health facilities, Nigeria is seriously wanting as the country, according to the Nigerian Health Facility Registry boasts of only 39,116 operational health facilities to serve its 200 million population.
Additionally, the number of registered doctors in Nigeria is put at 24,600 in 2019 by Statista. A number that’s grossly inadequate to serve the country’s huge population. As if to make matters worse, the few registered doctors in Nigeria are finding their way out of the country almost on a daily basis to countries where their services are better remunerated.
In essence, Nigeria’s health sector can be said to be a tripod with only one functional leg, that is the policy. The infrastructure and personnel call for some great improvements.
Ways to Utilize Nigeria’s Health Insurance Policy
As it has been earlier established, Nigeria’s health insurance policy has the potential to impact Nigerians in a positive manner. Below is a list of ways through which Individuals, Communities, and Philanthropists can best utilize the policy:
- Non-governmental and community organizations specializing in women can leverage the GIFSHIP to provide healthcare access to rural women, divorcees, widows, and orphans.
- To address the problem of husbands who abandon their wives on the hospital beds due to fear of bills, mosques, and churches can as a precautionary measure advise intending couples to enroll into the insurance scheme before marriage.
- Communities can organize ways to raise funds to insure their most vulnerable members or those with known ailments that require special health insurance.
- Philanthropists and politicians can enroll low-income earners under the GIFSHIP at a low cost instead of the peanuts they offer them as aid from time to time.
- Religious leaders can mobilize members of their congregations to enroll in the GIFSHIP. Mosques and churches in Nigeria are places where aid for health challenges are mostly sought.
- Schools, especially boarding or private universities can enroll their students. This will enable students to have access to healthcare beyond the school’s sick bay through the NHIA referral network.
Nigeria’s Health Market
The low coverage of Nigeria’s health insurance means many people pay for health services out of their own pockets. 95% of Nigerians fall under this category and according to Dataphyte, in 2018, their expenditure amounted to 77.6% of the country’s total spending on health care.
Many Nigerians explore the option of medical tourism to countries such as India, Egypt, Germany, the UK, and the US. The patronizers of this option include the country’s leaders, business persons, and the middle class.
The choice of Nigerians that explore medical tourism is clearly not the lack of good insurance policy but the decay in health infrastructure and low personnel.
This situation makes Nigeria a ripe market for investment in health facilities. Investors and business-minded persons should keep an eye on the 77.6% of monies spent outside the insurance system.
The country’s nearly 40,000 hospitals are a clear indication of the addition required to augment the shortage. In a market of over 200 million people, only 58 HMOs are currently operating as insurance companies with the NHIA. The room for investment is as wide as it can get.
To increase the number of registered doctors in Nigeria, investment in medical schools is needed to produce doctors that can fill the wide gap currently available. In this regard, a number of private universities have sprung up in the country over the past decade and more of them need to be seen.
Conclusion
For Nigeria to achieve stability and progress in its healthcare ecosystem, its policy on insurance needs to be widely accepted and subscribed to by all Nigerians with close support from improved health facilities and more qualified health professionals.
The prospects of Nigeria to be a leader in healthcare are enormous despite the burgeoning challenges. The country’s health insurance policy might be the leap the other two stands need for the tripod to be complete.
