Eight years after it was inaugurated, only six million out of 160 million Nigerians have been enrolled under it.
This coverage includes only those in the formal sector as the private sector is not visible under the scheme.
Stakeholders who spoke with our correspondent have attributed the uninspiring coverage to poor health indices recorded every year in the country. They also noted that countries that have achieved total health insurance coverage have the best health indices.
In the global report on Health Insurance in 2011, Switzerland, which topped the list of countries with the best health indices, has achieved 99.9 per cent health insurance coverage.
Others are Denmark, Finland and Sweden, all of which have more than 80 per cent health insurance coverage for their citizens.
In Africa, many countries that began their health insurance scheme after Nigeria have gone ahead to attain 60 per cent coverage, while the ‘giant of Africa’ remains at the bottom with less than five per cent.
But the Minister of Health, Prof. Onyebuchi Chukwu, who spoke at a briefing in Lagos, said for government to drive the scheme, and for Nigeria to achieve universal health insurance coverage, the NHIS must be mandatory for all.
According to him, currently, only those at the federal level have been able to benefit from this scheme, as many states were yet to enroll under the NHIS.
He said to achieve universal coverage, the NHIS Scheme should be given the same mandatory status as the pension scheme.
Chukwu said, “It is not the Federal Government that will enroll all Nigerians. States and local governments should also be compelled by law to enroll their formal workforce in to the scheme. Until the pension scheme became compulsory, it was not a success. And the National Health Scheme is more important than the pension scheme.
“You must even be alive and healthy before you can live up to the age that you will be accessing your pensions. This is the way we can improve from the present level we are in.”
He also blamed poor compliance to some policies under the scheme by the informal and private sector for the poor implementation and enforcement of the scheme.
According to the minister, under the scheme, any employer with more than six members of staff must enroll for health insurance. But Chukwu alleged that many employers were violating this clause.
However, the National President, Nigeria Medical Association, Dr. Osahon Enabulele, who spoke in Lagos on, argued that it was the responsibility of government to ensure that Nigerians had access to basic health care needs by making the scheme mandatory. Doing otherwise, he argued, would defeat the purpose of the scheme.
Enabulele also blamed government for the poor implementation of the provisions in the scheme.
He said, “The NHIS coverage is grossly inadequate, Nigeria cannot even currently boast 20 per cent coverage. If anything at all, it is less than 10 per cent. That is a serious indictment on our government. About 90 per cent of Nigerians do not have any form of health care plan; they pay for health services from their meagre resources.
“A situation whereby a woman in labour, who needs surgery, is not treated until she coughs out N100,000 for a Caesarean section, which would save her life, is deadly. Right now, it is Nigerians that are responsible for 70 per cent of the total health expenditure in the country. It is not right.
“Rwanda today has 80 per cent health insurance coverage while Ghana, which started four years after Nigeria, has about 60 per cent and it has not made it compulsory for Ghanaians,” he said.
Worst hit is the informal sector in the country, which are not even given serious consideration in the health insurance scheme.
The NMA boss highlighted poor funding on the part of government and poor logistics and planning from the health insurance scheme managers for the low coverage.
Enabulele noted that state and local governments should be made to commit resources to the scheme and thus increase access to the scheme at the grassroots.
“We cannot say because we want to drive health scheme, we should impinge on the fundamental rights of Nigerians. Every human being has a right to procure health services the way they want it. Government has the uttermost responsibility to provide social health services for its people.
“As it has made it possible for the formal sector to enrol without compulsion, it should fathom a way for the informal sector, the market woman and artisans to access it without compulsion. If we begin to make it mandatory, it means Nigerians who should constitutionally not be denied health care will be turned down because they do not have a health insurance card,” he added
Enabulele also charged government to provide more health care facilities to encourage more Nigerians to buy into the scheme.
He said, “Nigerians have lost faith in the health care system of the country. Why would I enroll in a scheme, when there are no hospitals around me? When I know that the health centre in my area has no doctor or nurse. What is the benefit for me, really? Government should provide more functional health facilities. That is when you can demand that it should be compulsory.”
He also stated that poor management and leadership at the NHIS was a major factor why it had yet to achieve any meaningful impact of the health of Nigerians.
Enabulele said, “If there is no head at an institution, they will be doing routine. For more than a year, the NHIS has just an acting head. We have submitted over three nominations to the Presidency, but are yet to act on it. Everybody is playing the waiting game. Nobody wants to do anything to upset the substantive director. Government must speedily address that. Let us set a target for the head of NHIS, that in one year, we want the coverage to be 50 per cent. If there is no leadership it will drag back the full expression inherent in the health insurance scheme.”
However, those enrolled under the health insurance scheme are also not happy. A public servant with one of the federal institutions, who spoke with our correspondent in Lagos, said the scheme was exploitative in its implementation.
The patient, Mr. Sunny Philips, said major health challenges were not covered under the scheme, though they were stated otherwise.
He said, “It is almost humiliating for me when I go to the hospital and they are reluctant to treat us because some minor cases are not covered by the scheme. In fact, they will rather attend to the patient who is paying in cash to them.
“But when I rushed my daughter, who was very sick, to the hospital last month, the doctor eventually bailed me out. He told me that government had not settled the bills of the patients under NHIS in the last six months; hence, he would not be able to treat her for now and advised me to look for cash. I had to go back home to get my ATM for money before they treated my daughter.”
Another pharmacist, who spoke under the condition of anonymity, said she was yet to be paid for the drugs she had dispensed to patients under the scheme in her pharmacy in the last one year.
She said, “I do not think government wants it to work because they are frustrating the stakeholders. You cannot operate health care the way you operate a ministry. If you do not pay me for the drugs I have dispensed, I cannot keep giving drugs out for free. There are a lot of politics going on behind the scene.”
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