The evolution of the National Health Insurance Scheme dates back to 1962, when the need for health insurance for Nigerian citizens was first recognised. This political will was manifested when, on June 6, 2005, the Federal Government flagged off the Formal Sector Social Health Insurance Programme for its employees. The Scheme was thereafter given a presidential mandate to ensure universal coverage of Nigerians by 2015 through Social Health Insurance. This implied the provision of sufficient financial risk protection to all Nigerians through easy access to adequate healthcare at an affordable price.
Health Insurance is a social security system that guarantees the provision of needed health services to persons upon payment of a token contribution at regular intervals.
The National Health Insurance Scheme (NHIS) was established under Act 35 of 1999 by the Federal Government to improve the health of all Nigerians, and at an affordable cost.
To achieve this mandate, the NHIS designed many programmes to suit the various socio-economic groups in the country. It similarly 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.
Within six years of the official flag off, the NHIS has given cover to 95% of federal government employees. Also, over 1.6 million pregnant women and children under the age of five were covered under the NHIS/MDG Maternal and Child Health (MCH) Project in twelve states of the federation. While additional twelve states are currently being processed for the same project.
The Tertiary Students Social Health Insurance programme has further resulted in providing financial protection and health cover to more than two hundred and fifty thousand students in tertiary institutions in the country. The various private health plans for the Organised Private Sector have been providing cover for those in the sector with their respective families. Other programmes at the verge of being rolled out include cover for NYSC members, prison inmates and retirees.
With a very large informal sector in the country, the presidential mandate of universal coverage cannot be achieved without the introduction of an effective and efficient community based social health insurance system in place. The NHIS had, within its initial years, introduced direct Community Health Insurance in the six geopolitical zones in the country.
The programme collapsed with the stoppage of the huge subsidy being granted by the Scheme. NHIS then embarked on full analysis of the factors that would facilitate sustainable Community Health Insurance in the country. This involved study tours to countries that have “gotten it right” and extensive desk research. Series of consultations were also held with various interest groups and community leaders on factors that could facilitate its implementation in the country.
Also an all inclusive stakeholder summit was held to further fine tune the implementation blueprint, which was finally developed and presented to federal government for approval. The blue print recognised three modalities for the implementation of Community Based Health Insurance, taking the peculiarities of the country into consideration. It was built on the experience of the NHIS in implementing the NHIS/MDG maternal and child health project which was recently awarded a certificate of merit as a good practice initiative by the International Social Security Association at its African Regional Forum in Arusha Tanzania.
The approach adopted by the NHIS in the implementation of the Community Based Social Health Insurance (CBSHI) initiative took cognisance of community ownership, social solidarity inherent in the Nigerian people and cultures and the various socio-economic groupings in the country. It further recognised the role of the community in actively mobilising, collecting, pooling and allocating resources for health care. Each community is to also adopt a benefit package for its members while the NHIS will give the required technical assistance in costing the package and actuarial determination of contributions.
Noting the peculiarities in the country, NHIS plans to run a pilot CBSHI in each state of the federation for three years. The pilot communities were selected based on critical success factors identified in them during a comprehensive inventory of community groupings and associations in the country. The Scheme subsequently identified Isanlu community in Yagba-East Local Government Area of Kogi state.
The stewardship role and support of government have been identified as crucial to the successful implementation of CBSHI in all countries of the world. The NHIS, as an agency of government, and with the approval of its immediate past governing council and the Honourable Minister of Health will subsidise the CBSHI programme in each of the pilot locations through the payment of contributions for all registered pregnant women and children under 5 for the duration of the pilot.
Community Based Health Insurance, though a necessary tool for universal coverage cannot on its own lead to the attainment of that objective. Most countries supplement it with private health insurance as a strategy to cover all citizens.
Noting this global trend, the NHIS consequently flagged off its Voluntary Contributor Social Health Insurance Programme, designed for those who are in informal employment (or firms with less than 10 staff) and who can afford to pay the required contribution of fifteen thousand naira per annum. This will give the contributor a health cover similar to the formal sector benefit package.
The contributor will in addition not only select his or her health care facility but also his/her Health Maintenance Organisation (HMO). To ease the administration of the programme and make it attractive to potential subscribers, the entire process will be conducted online and be available 24/7. Like most pre-payment schemes, there will be a waiting period of one month between affiliation and access to care. The programme would be totally IT driven and marketed and implemented by HMOs under the regulation of the NHIS.
With public acceptance of the Scheme and its programmes which has now led to increased demand for its scaling up, the flag-off the Community Based Social Health Insurance and Voluntary Contributor Social Health Insurance Programmes will create the opportunity and platform for reaching the unreached!
The Scheme is also working assiduously to address the vulnerable groups in society. These are those who don’t have the financial ability to contribute to any pre-payment plans. The creation of a vulnerable group fund will certainly be the solution to provision of cover to this group. The fund could be financed either directly by the three tiers of government through the proposed Health Bill.
The NHIS has proposed the possibility of mobile phones airtime utilisation to raise adequate resources for health. This has been tagged “the one kobo per second” initiative. This is certainly in tandem with the federal government resolve to drive human capital development and economic growth.
Dr. Dogo- Muhammad is the Executive Secretary of NHIS