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Tag: The National Health Insurance Authority (NHIA)

  • Cancer: NHIA, Roche expand oncology cost-sharing initiative at UCTH Calabar

    Cancer: NHIA, Roche expand oncology cost-sharing initiative at UCTH Calabar

    The National Health Insurance Authority (NHIA) and global healthcare company Roche have formalised their partnership through the signing of a Memorandum of Understanding (MoU) to expand and implement the Oncology Cost Sharing Initiative at the University of Calabar Teaching Hospital (UCTH), one of the designated centres of excellence for cancer care under the initiative in Nigeria.

    The MoU, signed during a ceremony held in Calabar, marked a significant step in the Federal government’s collaborative journey to transform cancer care across Nigeria.

    With cancer cases on the rise and treatment costs spiralling beyond the reach of many households, the NHIA–Roche partnership stands as a model for what can be achieved when government agencies, global innovators, and health institutions unite with a shared sense of purpose, the stakeholders noted.

    The NHIA–Roche Oncology Cost Sharing Initiative aims to address one of the most pressing dilemmas in cancer care, the unbearable economic burden placed on patients and their families.

    By pooling public and private resources, the initiative seeks to reduce out-of-pocket costs, ensure continuity of treatment, and prevent patients from having to make choices between their health and their livelihoods.

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    The NHIA Coordinator for Cross River State, Stanley Effah, underscored the dual burden cancer places on individuals and health systems.

    “Cancer is not only a formidable medical challenge but also a profound economic one, affecting patients, families, health systems, and society at large.

    “The financial burden of cancer treatment can be as devastating as the disease itself,” he said

    Effah pointed out that health insurance gaps, high out-of-pocket expenses, and co-payments often result in delayed care, medical debt, or abandonment of therapy altogether.

    “No one should have to choose between their health and their livelihood, yet this is the reality for many,” he added.

    In response to these challenges, he explained that the NHIA–Roche partnership represents more than just a technical implementation model.

    “This initiative is not only a strategic tool; it is a moral imperative and a beacon of equity and innovation, if and only if all stakeholders continue to work together and keep the NHIA enrolees, the patients, at the centre,” Effah emphasised.

    The UCTH, now a major beneficiary of the expanded rollout, was lauded for its dedication to improving cancer outcomes in the region.

    Effah commended the Chief Medical Director and hospital management for their unwavering commitment to delivering specialised care and aligning with the initiative’s core values of equity, innovation, and compassion.

    He called on all actors in the Cross River State health insurance ecosystem, including government officials, providers, and community leaders, to intensify support for the programme.

    “Let us make equitable, affordable, and high-quality cancer care not just an aspiration, but a reality,” he urged.

    The expanded implementation at UCTH signals a broader national commitment to reduce disparities in access to oncology care. 

  • Health insurance: NHIA retrieves ₦4.3 million for 54 enrollees, sanctions 47 HMOs

    Health insurance: NHIA retrieves ₦4.3 million for 54 enrollees, sanctions 47 HMOs

    The National Health Insurance Authority (NHIA) sanctioned 96 healthcare entities in 2024, including 49 healthcare facilities and 47 health maintenance organizations (HMOs), for various service delivery breaches under the national and State health insurance schemes, it has emerged.

    Based on the findings from the investigations, the NHIA issued 84 formal warnings to healthcare facilities and facilitated the refund of ₦4,375,500 to 54 enrollees by 39 facilities, it revealed, adding that four facilities were suspended and six were delisted.

    Among the HMOs, 35 received warning letters with directives to implement corrective measures, while 12 were compelled to refund ₦748,200 to 15 enrollees.

    The action followed investigations into thousands of complaints lodged by enrollees and was taken per the NHIA’s operational guidelines and the NHIA Act 17 of 2022, the agency’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, said in a statement on Sunday.

    According to him, the sanctions ranged from formal warnings and enrollee refunds to suspensions and the delisting of non-compliant providers.

    He further explained that the enforcement measures are part of its renewed focus on ensuring quality care and accountability in Nigeria’s health insurance ecosystem.

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    According to him, the agency’s 2024 Annual Complaints Report, compiled by the Enforcement Department under Acting Director Dr. Abdulhamid Habib Abdullahi, revealed that a total of 3,507 complaints were received during the year.

    The report also showed that, of these 2,929 cases, approximately 84 percent were fully resolved.

    The breakdown showed that 2,273 complaints were filed against healthcare facilities, while 1,232 were directed at HMOs.

    Only two complaints were lodged against enrollees, the report also showed.

    The agency also revealed that the most common issues raised against healthcare facilities included the unavailability of essential medicines, denial of entitled services, out-of-pocket payments for services covered under the scheme, and non-disclosure of payment details.

    For HMOs, it said, complaints focused on delays or outright denials of referral authorisation codes, prolonged settlement of reconciled claims, and failure to monitor the quality of care provided by their affiliated facilities.

    The report also highlighted that all complaints requiring investigation were addressed within the standard timeframe of 10 to 25 days, with an average resolution time of 15 days.

    The agency also stressed that in cases where delays occurred, complainants were informed of the reasons and the ongoing resolution efforts.

    Complaints reached the NHIA through various channels, including in-person visits, official letters, emails, phone calls, and the NHIA call centre.

    To further streamline the complaint resolution process, the NHIA introduced a new policy mandating that referral authorization codes must be issued by HMOs within one hour.

    Should an HMO fail to respond within this window, healthcare providers are authorised to proceed with treatment, in line with an established emergency protocol.

    Commenting on the development, NHIA Director General Dr. Kelechi Ohiri described the sanctions not as punitive but as part of broader efforts to enforce accountability, raise service standards, and rebuild public trust in the health insurance system.

    Noting that the efforts are crucial to driving enrollment and improving the patient experience, the Executive Secretary said, “Enrollees deserve the best care, and we are committed to ensuring that happens.

    “These sanctions send a clear message that substandard care will not be tolerated. At the same time, we commend providers who continue to deliver excellent services”.

    He added that with the recent adjustment of capitation and fee-for-service payments marking the first such revision in twelve years, healthcare providers now have greater capacity to offer quality, timely services.

    Ohiri reaffirmed that NHIA’s complaint and grievance management process reflects its commitment to transparency, continuous service improvement, and equity in healthcare delivery.

    These efforts, he noted, are in line with President Bola Ahmed Tinubu’s agenda to achieve Universal Health Coverage (UHC) for all Nigerians.

  • Fed Govt injects N32.8 binto basic healthcare

    Fed Govt injects N32.8 binto basic healthcare

    The Federal Government has said it approved the disbursement of N32.8 billion from the Basic Health Care Provision Fund (BHCPF) to support primary healthcare programmes in the first quarter of the 2025 fiscal year.

    The funds will be shared through the National Health Insurance Authority (NHIA), the National Primary Health Care Development Agency (NPHCDA), the Nigeria Centre for Disease Control and Prevention (NCDC), and the National Emergency Medical Services and Ambulance System (NEMSAS). 

    This comes as the Federal Government prepares to approve a new set of governance guidelines for the BHCPF.

    The Coordinating Minister of Health and Social Welfare, Prof. Ali Pate, announced this yesterday in Abuja at the 10th BHCPF Ministerial Oversight Committee (MOC) meeting.

    The minister reaffirmed the government’s commitment to strengthening the nation’s healthcare system. 

    Members of the committee, chaired by the coordinating minister, included the Chairman of the Nigeria Health Commissioners’ Forum and Ekiti State Commissioner of Health and Human Services, Oyebanji Filani; heads of the NHIA, the NCDC, NPHCDA, and the World Health Organisation’s (WHO) representative, among others.

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    Pate said N32.8 billion had been allocated to strengthen over 8,000 primary healthcare centres nationwide.

    The minister promised that the funds would support the expansion of primary healthcare services, the Vulnerable Groups Fund, emergency medical treatment and ambulance services, and the NCDC’s disease outbreak prevention and response efforts.

    He said: “We have to ensure health security by preventing outbreaks, detecting them, and being able to respond to them. That is the approval.

    “The second approval was that of the revised guideline for the BHCPF, which is provided for by law.

    “While we’re waiting for a legal opinion from the Attorney General of the Federation, the MOC agreed with the thrust of the changes that were made in the guidelines, and those are very good steps forward, which has brought in the lens of equity and has also increased the resources going to primary health care centres. “

  • NHIA unveils plan to achieve universal health coverage by 2030

    NHIA unveils plan to achieve universal health coverage by 2030

    The National Health Insurance Authority (NHIA) has reiterated its commitment to achieving Universal Health Coverage (UHC) in Nigeria by 2030. This ambitious goal was emphasised by Dr. Kelechi Ohiri, the Director-General of NHIA, during the Gatefield Health Summit 2024, with the theme: “Beyond65.” The summit convened influential global health leaders and advocates to address the rising crisis of non-communicable diseases (NCDs) in Nigeria and sub-Saharan Africa, a region where NCDs account for over 37 per cent of deaths—more than one in three fatalities.

    In a presentation delivered by Mr. Olufemi Adeoye, the Deputy Director of NHIA, key strategies were outlined to ensure that every Nigerian has access to affordable and quality healthcare services. One of the focal points was the ongoing expansion of health insurance coverage, particularly targeting the informal sector and rural communities, which are often underserved. “The informal sector constitutes a significant portion of our population, and we cannot achieve UHC without bringing these individuals into the insurance fold,” Adeoye stated, emphasising the need for inclusive healthcare solutions. This initiative is crucial as a large part of Nigeria’s workforce operates outside formal employment, leaving many without access to health insurance and essential medical services.

    To bolster these efforts, the NHIA is introducing new financing models, including the NHIA Digital Platform. This tech-driven initiative aims to streamline enrolment and claims processing for health insurance beneficiaries, enhancing the efficiency and transparency of the healthcare system. According to Adeoye, this platform will not only improve access to healthcare but also strengthen the overall resilience of the healthcare infrastructure. “We are moving towards a more inclusive and transparent system that prioritises the health needs of all Nigerians,” he noted. “This will not only ensure that no one is left behind but also fortify the resilience of our healthcare system.”

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    The NHIA, operating under the administration of President Bola Tinubu, has also intensified partnerships with state governments and private insurers to create customised insurance packages tailored to meet the unique health needs of various regions. Adeoye highlighted that these collaborations are essential for sustaining the health insurance scheme and building a more robust healthcare financing structure. As part of its mandate, the NHIA is actively engaging with key policymakers to secure ongoing funding for health insurance programmes. Adeoye expressed optimism that legislative support for NHIA initiatives will provide the necessary framework for achieving UHC in alignment with global health agendas. “Achieving UHC is a collective effort, and we need the active participation of all stakeholders to make this a reality by 2030,” he asserted, calling for increased collaboration from the private sector and civil society organisations.

    The NHIA, which evolved from the former National Health Insurance Scheme (NHIS), has expanded its mandate to encompass broader health coverage across Nigeria. Adeoye emphasised that the agency is intensifying its focus on addressing the healthcare needs of the most vulnerable populations in the country, ensuring that no one is excluded from essential health services.

    Earlier in the summit, Mr. Adewunmi Emoruwa, Lead Strategist at Gatefield, highlighted that discussions were led by global health leaders who underscored the critical role of fiscal health policies in combating NCDs. Emoruwa pointed out the growing obesity epidemic and the burden of care for individuals living with NCDs, as well as the pivotal role of primary healthcare systems in preventing and controlling these diseases. He also stressed the importance of addressing environmental factors, such as air quality, that significantly impact public health. “We need to acknowledge the interplay between environmental health and the rising rates of non-communicable diseases,” he stated, advocating for comprehensive strategies that encompass both healthcare and environmental policies.

    Building on last year’s success, where a Presidential commitment was made to allocate 10 per cent of the national budget to healthcare, Emoruwa expressed hope that this year’s summit would further rally support to address the silent epidemic of NCDs. He emphasised that effective policy implementation is essential for making meaningful progress in the fight against these diseases.

    The summit served as a platform for stakeholders to brainstorm and share innovative solutions to the pressing healthcare challenges facing Nigeria. As discussions unfolded, it became evident that a multi-faceted approach, integrating health, economic, and environmental strategies, is essential for achieving the ambitious goal of Universal Health Coverage by 2030. As the NHIA and its partners continue to forge ahead with their initiatives, there is a palpable sense of optimism surrounding Nigeria’s healthcare landscape. With commitment, collaboration, and innovative solutions, the dream of UHC—where every citizen has access to quality and affordable healthcare—appears increasingly attainable.