Towards Universal Health Coverage In Nigeria

 By Fidelis Onyejegbu

May 2022 signifies a landmark in the healthcare delivery history of Nigeria as the National Health Insurance Scheme (2004) was repealed by the National Health Insurance Authority Act.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 in the country. The UHC connotes a situation where everyone has access to the health care services 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 per cent 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 required from all relevant stakeholders in the health care delivery space in the journey towards the actualisation of this global health care goal. To kick-start the implementation of the laudable provisions of this new legislation, and in keeping with its section 4, a governing council that would serve as the policy arm of the authority is to be constituted. 

They are to perform key roles such as the approval and registration of third party administrators (e.g. Health Management Organisations); lead the implementation of the policies and guidelines; regulate and supervise the various health insurance schemes under the Act; meet disciplinary actions against any erring HMOs, among others. In essence, without the board being constituted more than four months after the NHIA Bill became an Act, carrying out the full duties of the National Health Insurance Authority in driving the attainment of UHC in Nigeria is pending. It is, therefore, advocated to the Office of the President of the Federal Republic of Nigeria to set up the governing council for the NHIA to commence its full duty.

In some states, the health insurance scheme laws provide for the compulsory uptake of health insurance by all inhabitants of the states. For the health insurance agencies to operate optimally, its policy arm, being in place, is critical. The challenge is that the executive arm of government in some states is yet to set up the governing council/board for the state health insurance agencies, limiting their capacity to deliver on their mandate of effectively regulating the health insurance schemes, among other crucial roles. 

It is indeed an advocacy point to be taken forward by the Civil Society Organisations to the relevant stakeholders. 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 of vulnerable persons and payment of their insurance premiums.

The VGF 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 state Health Insurance Scheme Laws, these categories of persons are clearly defined to include: pregnant women, children under 5, people with special needs, the elderly and poor. 

However,  the new NHIA Act, which constitutes 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 sub-national level. The Equity Funding most states’ Health Insurance Agency Law, which is the equivalent of the VGF in the NHIA Act, is bedevilled by funding challenges.

The status is that is the Fund is yet to commence in some states as funding from the various stipulated sources such as: the take-off grant from the state government, 1 per cent of the states and local governments Consolidated Revenue Funds, formal sector and informal employees’ contributions, public officials contributions, grants, donations, etc. has yet to start flowing in. 

The 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 UHC to be attained within the Sustainable Development Goals time frame 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 sensitisation of the public to do for an increased uptake of health insurance as it is a veritable tool to achieve the UHC.

*Fidelis Onyejegbu is the Programme Manager, Centre for Social Justice