Nigeria as a nation was plagued by abysmal health indices: a 53 years life expectancy, a 42 years Healthy Life Expectancy, a 10 percent of global maternal mortality figures, 59,000 annual pregnancy/childbirth-related deaths, long-term disabilities ,and 1 in 18 women at risk of dying from childbirth.
This gives an obviously gloomy picture. Little wonder that Sustainable Development Goals were highly welcomed, especially SDG 3, which addressed universal health coverage. At the root of SDG 3, was the desire to make health accessible to everyone of every age whenever and wherever they needed it without robbing the bank.
To actualize SDG 3, it was imperative to talk about funding since somebody needed to pay for the health care services. The way out was to institute a health insurance scheme as applicable in the developed world, so the National Health Insurance scheme in Nigeria was a child of necessity and it was welcomed with great enthusiasm.
Unfortunately, and as the poor level of coverage suggests, there are inadequacies, including:
Inadequate legal framework: The enabling 1999 act failed to define the targeted coverage population, resulting in leaving out the informal sector—the largest sector of the Nigerian population. Making the scheme voluntary for the informal sector is also perceived by many as a serious undoing. The legal framework also did not outline funding mechanisms for the under-privileged.
Inadequate implementation: The beautiful strategies haven’t been met with commensurate implementation. Nothing attests more to this than the current 3-5 percent coverage.
Inadequate government funding: Judging by the current spending per GFP devoted to healthcare funding, Nigeria falls short of global recommendations for universal health coverage. Poor funding of health, especially as it affects rural areas and the large informal sector, is probably the greatest inadequacy of the Nigerian health insurance scheme.
Inadequate enrollment due to optional enrollment policy
The optional enrollment policy adopted for the Nigerian health insurance scheme might be well-intentioned, but the low coverage achieved so far shows the inadequacy of this policy. Scholars and stakeholders have criticized even the response of the scheme to tackle low informal sector enrolment for not involving the grassroots.
Inappropriate regulation: Sharp practices by health maintenance organizations coupled with inadequate regulation by relevant agencies make up a twin challenge affecting the Nigerian health insurance scheme. Providers at all levels are part of the rot while the consumer suffers!
Inadequate motivation to make the scheme work: “Political will” as identified in the Nigerian context refers to the lethargy and lip service paid to the achievement of universal health coverage through health insurance. Such lip service by definition is devoid of “the will to act” and so no action. Aside from inadequate action, other instances arising from the practice of assuming the health needs of communities without involving them in decisions that affect their wellbeing.
In summary, to optimize the benefits of a national insurance scheme, the government must increase funding for healthcare and sensitize and involve the grassroots in these critical health decisions.
Take-home message: Since the informal sector is too large to be neglected, operators of the Nigerian health insurance scheme must adopt the cradle to the grave approach, where everyone contributes for everyone to benefit.
