SIR: May represents a landmark month in the healthcare delivery history of Nigeria as the National Health Insurance Scheme (2004) was repealed by the National Health Insurance Authority (NHIA) Act. The golden provision in the new legislation is that health insurance coverage has been made compulsory for all Nigerians and the country’s legal inhabitants. It is a laudable provision as it has provided a legal foundation for large scale uptake of health insurance coverage in Nigeria – a step toward the attainment of Universal Health Coverage (UHC).
It connotes a situation where everyone has access to the health care services they need, when and where they need them without any financial difficulty. The National Health Insurance Scheme Strategic Plan (2020-2030) stated that only about 4.2% of Nigerians are covered under the Social Health Insurance. This translates to about 8.4 million persons out of an estimated population of 210 million Nigerians underscoring the level of effort that is required from all relevant stakeholders in the health care delivery space in the journey towards the actualization of this global health care goal (UHC).
On health care provision for the indigent and the poor, the new NHIA Act provides for a Vulnerable Group Fund that is to cater for the health care coverage for vulnerable persons and payment of their insurance premiums. The Vulnerable Group Fund is to be funded from sources such as Basic Health Care Provision Fund; Health Insurance Levy; special intervention by the government; earnings on investment of the authority’s idle funds by the Governing Council; grants, donations and other gifts.
In most states Health Insurance Scheme Laws, these categories of persons are clearly defined to include: pregnant women, children under-five, people with special needs (PWDs), the elderly and the poor. In the new NHIA Act however, the persons that constitute the vulnerable is left for the Governing Council of the authority to determine, raising a clarity question.
There is also a funding concern to be addressed at the subnational level. The Equity Fund in most states’ Health Insurance Agencies Laws, which is the equivalent of the Vulnerable Group Fund in the NHIA Act, is bedevilled with funding challenges. The fund is yet to commence in some states as the funding from the various stipulated sources such as: the take-off grant from the state government, 1% of the States and Local Governments Consolidated Revenue Funds, formal sector and informal employees’ contributions, pubic officials contributions (as in some states laws), grants, donations, etc. have yet to start flowing in.
Key attributable reason cited by some experts is insufficient political will on the part of stakeholders (e.g. the executive arm of government) to drive the process.
To sum up, for Universal Health Coverage to be attained within the SDGs timeframe of 2030, a lot more effort and commitment is required of the various stakeholders within the health care delivery space. Walking the talk would entail committing stipulated funds for the provision of health care coverage for all and sundry. The Health Care Insurance Agencies both at the federal and the states, and indeed the entire civil society body in Nigeria, have a lot of sensitization of the public to do for an increased uptake of health insurance as it is a veritable tool to achieving Universal Health Coverage.
- Fidelis Toochukwu Onyejegbu,
Centre for Social Justice, Abuja.