Repositioning Wellness Insurance Inwards Nigeria: Prospects As Well As Challenges

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Repositioning Health Insurance inward Nigeria: Prospects as well as Challenges


At independence inward 1960, Nigeria, similar most other developing countries adopted diverse measures aimed at fulfilling high standards of living for her citizens. Many evolution plans were formulated as well as implemented upward till the early on 1980s.

 However, the desired objectives of these measures were non realised
optimally due to the instability inward the national polity.
The intermittent incursions of the state of war machine into governance ensured the perversion of the people’s wish to alive a goodness life. The menses thus witnessed economical mismanagement as well as authoritarian governance (Ajakaiye, Taiwo as well as Chete, 2002). The mismanagement meant abject poverty as well as depression economical status of the citizenry leading to the emasculation of the bulk of the people as well as thus widening the gap betwixt the rich as well as the poor. Under the Human Development Index (HDI) of the United Nations Development Programme (UNDP), Nigeria has consistently ranked as i of the to the lowest degree inward the mensuration of character of life of the people. By the early on 1990s, according to Agbakoba (1996), virtually all the social infrastructures had deteriorated. One expanse of the economic scheme that suffered greatly is the wellness sector.

 The World Bank (1999) reports that inward the early on 1990s the per capita wellness spending of Nigeria was non alone depression simply was of depression quality. Health expenditure of US$9 per soul past times Nigeria was much lower than inward another African countries such as Republic of Ghana (US$14) as well as Republic of Kenya (US$16). The internet effect of this was that inward 1990, babe mortality was 11.4 per cent inward Nigeria compared to 7.4 per cent inward Republic of Ghana as well as 5.7 per cent inward Kenya. Thousands of Nigerian children were malnourished, as well as inward the absence of adequate immunisation, were prey to the killer diseases, that is, measles, polio, whooping coughing as well as diphtheria (Ehusani, 1996). The miserable painting exhibit of Nigeria’s wellness sector was revealed past times the World Health Organisation which noted that the country’s overall wellness scheme performance inward twelvemonth 2000 was ranked 187th amid the 191 fellow member province of the organisation (WHO, 2001). The number of this was high babe under-five as well as maternal mortality as well as the prevalence of diseases, many of which were of epidemic proportions. Malnutrition, iodine deficiency, stunting as well as depression nascency weight prevailed. Life expectancy roughshod to 48 years as well as the dream of health-for-all past times the twelvemonth 2000 became a mirage.

The province of affairs inward the sector was so critical that to Dr Agan,  the Chief Medical Director, University of Calabar Teaching Hospital, Calabar, who noted that wellness aid delivery inward Nigeria was dead (Vanguard, May, 17, 2012). Nigeria parades i of the lowest wellness practitioner-to-patient ratio inward Sub-Saharan Africa: 0.3 Physicians per G persons, 1.7 infirmary beds per G persons, 1.7 Nurses, 0.02 Dentists, 0.05 Pharmacists, 0.91 Community Health Workers as well as 1.7 Midwives, per G persons respectively (WHO,2006; Ogbolu 2007).

Interestingly, many of these skilled personnel receive got migrated to Europe, America as well as the Middle-East to practise as well as thereby constituting a encephalon drain costing much coin as well as also a provide gap inward the province (Kelland, 2012).
The province of Nigeria wellness services as currently organised, especially, exhibit major defects which include, (Akindutire, 2008):

a.       Inadequate coverage: Many Nigerians even so receive got no access to modern wellness aid services. Rural communities as well as the urban poor are also non good served;
b.       The orientation of the services is inappropriate amongst the disproportionately high investment on curative services to the detriment of preventive services;
c.       The direction of the services frequently shows major weakness resulting inward waste materials as well as inefficient targets as well as goals;
d.       The lack of basic statistics is a major constraint at all stages of planning, monitoring as well as evaluation of wellness services;
e.       The fiscal resources allocated to the wellness services, particularly to about priority areas, are inadequate to permit them to component subdivision effectively; and
f.       The basic infrastructure as well as logistic supports are frequently defective owing to inadequate maintenance of buildings, medical equipment as well as vehicles, unreliable provide of H2O as well as electricity, as well as the poor direction of drugs, vaccines as well as supplies system.

Government has responded to the infrastructural decay inward all sectors of the economic scheme past times adopting a reform agenda embedded inward the New Economic Empowerment as well as Development Strategy (NEEDS), (National Planning Commission, 2004). The wellness sector reform is component subdivision of the evolution strategy aimed at improving the measure of wellness aid for all Nigerians. Influenza A virus subtype H5N1 veritable component subdivision of the wellness sector is the wellness insurance scheme which, as a wellness financing machinery protects people against high terms of wellness aid through a pre-payment method. It is against this backdrop that this newspaper appraises the wellness insurance scheme instituted past times the Nigerian regime inward line amongst its policy objectives.

1. The Concept of Health Insurance

Health insurance is a social safety machinery that guarantees the provision of needed wellness services to persons on the payment of about total at regular intervals. It is designed to pay the costs associated amongst wellness aid past times paying the bills as well as thus to protect people against high terms of wellness aid past times making payment inward advance of falling ill. The scheme thus protects people from fiscal hardships occasioned past times large or unexpected medical bills.
It saves coin on the brusk run as well as protects the poor from medical weather condition that tin Pb to greater loss of coin on the long run (Nigerian Tribune, 24, May, 2010). It involves pooling of resources from persons of dissimilar illness-risk profiles as well as the terms of the take a opportunity of illness amid those who are sick as well as those who are healthy, are shared. It has 3 original characteristics- prepayment, resources pooling as well as cost-burden sharing. Pre-payments nether the scheme are fixed either as a proportion of the pay-roll, or as apartment rates contributed past times the participants. This way that payment is non proportional to the take a opportunity of illness of private beneficiaries.

Many advantages accrue from participation inward social wellness insurance. According to Nielson (2009), they include:

-        broadening the sources of wellness aid financing;
-        reducing the dependence as well as line per unit of measurement area on regime budget;
-        increasing the fiscal resources as well as ensuring stable rootage of revenue for  healthcare;
-        ensuring visible current of funds to the sector;
-        assisting inward establishing patients’ rights as customers;
-        combines take a opportunity pooling amongst actual back upward past times allocating services according to postulate as well as distributing fiscal burden according to might to pay;
-        solves equity as well as affordability occupation inward providing as well as financing wellness services; and,
-improves as well as harnesses private sector participation inward the provision of wellness services.

Social wellness insurance schemes also enable experts to reasonably predict the healthcare terms of a large group. By lowering the personal costs of services, wellness insurance schemes receive individuals to seek wellness maintenance services to a greater extent than regularly than they otherwise would thereby preventing potentially serious illness.

2.  Evolution of Health Insurance Scheme inward Nigeria

 The scheme is government’s reply to the decay inward the wellness aid scheme inward Nigeria. This manifests inward government’s acknowledgement of the poor province of the wellness aid delivery scheme (FGN, 2000). According to Dogo-Muhammed (2007), all these receive got a combined effect on the wellness aid delivery scheme leading to the inability to “deliver the optimum bundle of character wellness care, including routine immunisation, emergency care, preventive as well as direction of communicable as well as infectious diseases, particularly malaria, tuberculosis as well as HIV/AIDS’’ .
This ultimately led to facial expression of dissatisfaction inward the character of wellness aid services past times the public. The poor province of the wellness sector prompted the Federal regime to initiate an all-embracing reform policy presented as “a broad-based purposeful as well as sustainable key modify inward the function, construction as well as performance of wellness scheme inward social club to deliver efficient, qualitative, affordable, effective as well as equitable wellness aid services to the public as well as ultimately improve the wellness status of the people’’ (FMOH, 2005). The original thrust of the wellness policy therefore, is to provide a key shift of government’s perception of health, manner of delivering the services as well as the roles as well as responsibilities of each tier of regime inward providing amend wellness aid for Nigerians.

 The wellness insurance scheme, as a wellness financing machinery is located inside the context of the wellness reform. The National Health Insurance Scheme (NHIS) was established nether the National Assembly Act No. 35, 1999, past times the Federal Government of Nigeria to improve the wellness status of Nigerians at an affordable cost. It must endure noted that the thought of   wellness insurance inward Nigeria was start mooted in1962 when the so Minister of Health, Dr Majekodunmi, presented a mouth on it to the Parliament inward Lagos. The mouth did non move past times through on the declaration that the province did non receive got plenty providers of character wellness aid services (Ana, 2010). However inward 1988, the so Minister of Health, Professor OlikoyeRansomeKuti laid upward a commission on the institution of a wellness insurance scheme, the outcome of which was eventually approved past times the Federal Executive Council inward 1989 which directed the Federal Ministry of Health to start the scheme inward 1993 (Adesina, 2009).

In establishing the scheme, regime adduced the next reasons:

-        The province of the nation’s wellness aid services was to a greater extent than frequently than non poor;
-        There was excessive dependence on government-provided wellness facilities;
-        There was as good much line per unit of measurement area on government-owned wellness aid facilities;
-        There was dwindling funding of wellness aid inward the human face upward of rising costs;
-        There was poor integration of private wellness facilities inward the nation’s wellness aid delivery scheme (NHIS, 2011).

Consequently, the next objectives were laid for the scheme to achieve:

-        To ensure that every Nigerian has access to goodness wellness aid services;
-        To protect families from the fiscal hardship of huge medical bills;
-        To bound the ascent inward the terms of wellness aid services;
-        To ensure equitable distribution of wellness aid costs amid dissimilar income groups;
-        To ensure high standards of wellness aid services delivery to Nigerians;
-        To ensure efficiency inward wellness aid services;
-        To improve as well as harness private sector participation inward the provision of wellness aid services;
-        To ensure appropriate patronage of all levels of wellness care; and
-        To ensure the availability of funds to the wellness sector for improved services (NHIS, 2011).

The scheme has fully as well as effectively taken off, starting amongst the formal sector of the economic scheme which is a social wellness safety scheme inward which the wellness aid of workers inward the formal sector of the economic scheme is paid for from funds crated past times pooling the contributions of both the employees as well as employers. As defined past times the enabling law, the formal sector comprises:

a.       Public Sector;
b.       Organised private sector;
c.       Armed Forces, Police as well as Allied Services;
d.       Students of Tertiary Institutions; as well as
e.       Voluntary contributions.

3.  Operational Framework of NHIS

3.1 Membership/Registration
It is mandatory for organisations inward both the public as well as private sectors employing upward to 10 (10) people to participate inward the scheme. An employer is expected to register itself as well as its employees amongst the scheme. Thereafter the employer volition affiliate itself amongst an NHIS approved Healthcare Maintenance Organisation (HMO), which is a limited liability fellowship established for the sole purpose of participating inward the scheme. The HMOs component subdivision thus:

•        Receive/collect contributions from eligible employers as well as employees;
•        Collect contributions from voluntary contributors; • Pay wellness aid providers for services rendered; and
•        Maintain character assurance inward the programme.

3.2.  Contributions as well as Scope of Coverage

Contributions are earnings-related. The employer pays 10 per cent piece the employee pays 5 per cent, representing xv per cent of the employee’s basic salary. However, the employer may determine to pay the entire contribution. Furthermore, an employer, inward accordance amongst existing contractual understanding betwixt employers as well as employees, may undertake extra contributions for additional encompass to the do goodness package. The contributions paid encompass wellness aid benefits for the employee, a husband as well as 4 biological children below the historic menses of xviii years. More dependants or a kid higher upward the historic menses of xviii years would endure covered on the payment of additional contributions from the principal beneficiary. Under this programme, a beneficiary is entitled to out-patient care, pharmaceutical care, diagnosis tests, motherhood aid for upward to 4 (4) alive births, preventive care, amid several others. According to the records of the NHIS, over 6 1000000 Nigerians inward the public sector are currently accessing the programme. They are mostly workers inward the Federal public service as well as those of 2 states –Bauchi as well as Cross River (Nigerian Tribune, 6, September, 2010, P.17; The Guardian, 5, September, 2012. P.28).

4.3 Rights of Enrolees

All participants inward the scheme taste certainly rights which are as follows:

-        Right to register as well as access medical aid listed inward the do goodness package;
-        Right to modify provider later on half-dozen months of the receipt of an identity card, if non satisfied;
-        Right to access aid inward whatever NHIS accredited provider inward the province on emergency;
-        Right to know the names of the drugs given to the beneficiary;
-        Right to asking as well as know the total terms of drugs (10 per cent);
-        Access to genuine as well as efficacious drugs;
-        Right to seat the speciality of treating personnel, and
-        Right to complain most poor services from wellness aid providers.

4.  Prospects as well as Challenges of Health Insurance

 Nigerians wish as well as deserve slowly access to qualitative wellness care. However this wish has non been met past times the Nigerian government. Consequently, the wellness province of affairs of the people of this province has remained unstable due to the attack of infectious diseases as well as poverty. According to Stephensen (1997), the mortality charge per unit of measurement is really high amongst the bulk of deaths arising from infectious diseases as well as complications of pregnancy as well as child-birth. Nigeria’s wellness aid scheme has been described as below average as well as plagued amongst huge challenges inward spite of increasing public wellness expenditures. Yet government’s per capita expenditure on wellness is less than US$5 –far below the US$34 per capita recommended past times the World Health Organisation (WHO), for developing countries (African Peer Review Commission (APRM) 2008).

 It is inward reply to this depression flat availability as well as accessibility to character wellness aid services past times Nigerians that serial of reform policies were late initiated as well as implemented inward the wellness sector. One of such reforms is the introduction of the wellness insurance scheme to heighten access to wellness care. According to its guiding principles, the scheme is to provide access to wellness aid to all citizens irrespective of socio-economic class, age, status as well as other considerations. The scheme is expected to endure funded through monthly contributions from employers as well as employees from both private as well as public sectors.

There is no dubiety that the wellness insurance scheme inward Nigeria since its inception, has to a large extent positively affected the lives of its enrolees. According to Dr Dogo-Mohammed, the Chief Executive Secretary of the agency, about of the achievements of the programme are:

a.       It has reduced the rising terms of wellness aid amid the participants;
b.       It has led to the fair distribution of contributions for health;
c.       It has ensured that socio-economic groupings do non constitute a barrier to somebody to access wellness aid where he wants; and
d.       It has restored confidence inward primary as well as secondary levels of wellness care.

Many participants inward the scheme receive got as corroborated the higher upward stated achievements. For example, Mr Bolanta, the so Commissioner of Police for Oyo State has acknowledged the goodness performance of the scheme. He notes that “the hassle experienced past times policemen inward the ascendence inward accessing qualitative medical aid had largely been removed amongst the introduction of the scheme”. He farther added that his officers as well as their dependants straight off had unfettered access to medical services without worrying most the bills (Nigerian Tribune, 3, December, 2010). It is thus appropriate to province that the scheme has the potentials to transform wellness aid delivery inward the country. However the scheme is beset amongst a lot of challenges which constitute obstacles to the attainment of its laudable objectives.Most of the challenges of the scheme are located inside the wider wellness sector of the economy. APRM (2008) identifies the challenges inward the wellness sector to include:

       Poor implementation of programmes,
       Poor wellness facilities as well as lack of infrastructures such as goodness route network, H2O as well as electricity supply,
       Rural / Urban as well as flat differential inward access to character wellness care, the poor as well as rural population are less probable to access character wellness aid than the rich as well as urban dwellers, and
       Traditional as well as faith precluding many Nigerians from taking wages of wellness service delivery. Apart from the higher upward stated challenges facing the wellness sector inward general, the NHIS  specifically has the next as challenges/obstacles to its activities;
       Inadequate legislation: The law that laid upward the scheme appears inadequate particularly as it makes participation inward it optional, thereby restricting participation. This could line of piece of work concern human relationship for the participation of alone federal civil servants as well as those of alone 2 out of thirty-six (36) states at present,
       Practice of federalism: Nigeria operates a federal, as good as a 3 – tier scheme of government. This way that each of the tiers- Federal, State as well as Local regime – is relatively autonomous of each other as well as thus tin receive got independent decisions inside their domain. Hence the apparent reluctance of the province as well as local governments to purchase into the scheme,
       Problem of distribution as well as provision of medical facilities: Over xc per cent of the illness burdens are inward the rural areas, amongst a corresponding less than 10 per cent of the facilities. Moreover many of the wellness human resources are based inward the urban areas as well as are non ready to motility to the rural expanse to work.
       This is due to the dearth of infrastructures such as schools for the children, imbibe water, as well as electricity, amid others,
       Lack of public awareness: Some people do non wish to know or purchase into the scheme because they are dogmatic. Some people inquiry its contributory nature, believing that it is the responsibleness of regime to receive got aid of the wellness needs of its citizens,
       Labour resistance: Labour organizations across the province are fiercely opposed to the scheme. Ana (2010), reports that inward Cross River State, labour unions refused participation for fearfulness of failure of the scheme. According to him, they advert examples of previous schemes that failed as well as which made workers to lose their investments. Such schemes are the National Providence Fund (NPF) as well as the National Housing Scheme.  Efforts past times the Governor Oni’s management inward Ekiti State, for instance, to ensure the enrollment of public servants inward the State into the scheme was rebuffed past times the labour unions who insisted that regime should endure responsible for the total payment,
       Inadequate funding: It is apparent that regime resources are limited. In the instance of Nigeria, the revenue is dwindling, due to many factors, inward the human face upward of competing demands from diverse sectors of the economy. Funding the wellness insurance scheme past times regime lone is a daunting challenge.

5. Conclusion as well as Recommendations

The key challenge for Nigeria’s Health Sector is to accomplish the targets of the Millennium Development Goals (MDGs) as well as they include:

-        Reducing maternal mortality past times three-quarters past times 2015;
-        Halting past times 2015 as well as reversing the incidence of malaria as well as other major diseases;
-        Reducing the under-five mortality charge per unit of measurement past times two-thirds past times 2015; as well as - Halting past times 2015 as well as reversing the spread of HIV/AIDS. (NPC,2004).

It is obvious that Nigeria’s wellness aid scheme is really much challenged as well as constrained inward providing character wellness aid to all her citizens, most particularly the unemployed as well as the poor. Contrary to its stated objectives, the NHIS coverage is even so really limited as well as exclusive, as alone the wellness needs (partial) of Nigerians inward the formal sector are covered at present. Thus the vast bulk of Nigerians who are either unemployed or earn their living inward the informal sector are non included.

 The objective of regime inward providing for the wellness aid needs of the people is lauded. Yet its attainment is contingent upon the resolution of the challenges as listed above. The resolution of the challenges is located inward the institution as well as operations of the wellness insurance scheme which was inaugurated inward 2005. The objectives of the scheme are also commendable as well as achievable. However it is also challenged inward many fronts, amongst the possibility of diminishing its successful implementation. To address these challenges it is imperative that the next steps are taken:

       Intensify public awareness. More intensive public intensive awareness programmes should endure created to enlighten the people as well as relevant groups on the positive values of the scheme. The attributes of the scheme should endure good publicised past times translating it into the major Nigerian languages to enable the people to sympathise as well as appreciate its values as well as objectives.
       Diversify rootage of funding. It should endure noted that pay-roll contributions past times employers as well as employees are non the alone way possible to fund the provision of wellness for the people. People’s wellness aid tin also endure insured through special taxation contributions. For example, a wellness trust tin endure created to brace subsidy gaps. Such a fund tin endure derived from incomes that accrue from crude oil products as well as customs duties, etc. This volition take the occupation of funding on the component subdivision of regime as well as affordability past times would-be participants, which for straight off deny bulk of the public universal access to wellness care.
However until this is attained, governments should growth its funding of the scheme inward other to provide qualitative wellness services to the poor as well as fast-track the attainment of universal wellness inward the country.
       Increased coverage. The scheme should endure expanded to ensure that basic wellness needs of all citizens, irrespective of their social flat as well as status are met. There is thus the postulate for a legislation to brand the scheme compulsory for all Nigerians. In furtherance of this, a community wellness insurance scheme should endure seat inward house for implementation past times all the 3 tiers of government- Federal, State as well as Local governments, as good as Non-governmental organizations (NGOs) as well as Community-based organizations (CBOs).


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