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Health insurance for all
By Sun News Publishing
Wednesday, March 9, 2011
Federal Government’s plan to extend its social health insurance
scheme to the neglected rural populace is worthy. But the plan deserves
serious commitment and sincerity of purpose so it does not go the
way of past schemes that did not profit the people after huge sums
had been invested in them.
The National Health Insurance Scheme (NHIS) says it is planning
to inaugurate a community-based health insurance programme, so that
the about 70 percent Nigerians in the informal sector of the economy
and in the rural areas may begin to access affordable healthcare
from April this year.
Also planned for launching is the Tertiary Institutions Social Health
Insurance Programme (VCSHIP); Retirees Health Insurance Programme;
and Voluntary Contributors Social Health Insurance Programme. The
NHIS Secretary, Dr. Waziri Dogo-Mohammad, said at the inauguration
of the planning committee in Abuja, that extending the social health
scheme from the formal public sector to the informal sector has
been a major challenge to government in the past 45 years, when
the NHIS was first conceived. It is still seriously challenging
the NHIS authorities till date. Said the NHIS chief executive: “The
2015 presidential timeline for universal coverage remains rhetoric
until cover is provided for a substantial part of the informal sector.”
What’s the social health insurance policy all about? It is
a federal government policy to provide easy and cheap access to
quality healthcare to Nigerians, starting with a pilot programme
with federal civil servants. It was later extended to the private
sector. Public and private employers of labour were expected, under
the scheme, to contribute 10 percent of estimated minimum health
bill of an employee, who contributes five percent of monthly salary
to a fund subsidized by the Federal Government.
The spouse and four children have free access to an accredited public
or private Health Maintenance Organisation or Health Care Provider
in their choice area. Beneficiaries should get medical care without
the stress of paying on demand for service rendered.
In 45 years of operation, the NHIS has been able to cover largely
federal civil servants, while about 21 states of the 36 in the federation
have indicated willingness to take care of their own employees with
counterpart funding. The 774 local government council areas of the
federation are still to key in their employees. The Organised Private
Sector (OPS) is still negotiating participation.
Public doubt of the scheme is connected with the suspicion of fraud
that envelopes general insurance policies, perceived largely as
a casino rip-off by smart crooks who renege on performance. Even
today, the NHIS is yet to fully overcome the challenge of accredited
health providers using their illicit connection to collect fees
for clients they did not provide service for.
In effect, much as bureaucrats have a good record of designing beautiful
programmes and projects on paper, effective implementation has been
a major challenge. If the NHIS has so much difficulty in providing
social health service to a well organised urban population in 45
years, what is the assurance it can make a success of coverage for
70 percent informal and largely unorganised, illiterate rural population?
What plan has been put in place to achieve the objective in the
less than one month before April 2011? There is need for periodic
evaluation of the NHIS programme to identify areas of strength and
weaknesses for correction. Plunging into coverage of the informal
sector without adequate preparation and research may mean money
down the drain.
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