Health Insurance in Nigeria: NHIS and Alternatives

Amaka is five years old. A pretty little girl with zest for life and love for people, she lives with her parents and siblings in the Asaba, Delta State, Nigeria.

Amaka’s family isn’t the upper crust type. Her mother sells tomatoes and pepper in a local market in Asaba. And her father is a tailor — one that only mends torn clothes.

Although the family’s total monthly income never exceeds N70,000, they’re able to make do with that and still live comfortably.

Things went on fine until Amaka recently fell sick and was diagnosed of renal failure. For her to survive, she needed a kidney transplant that would cost a staggering N4 million.

Because Amaka’s parents would never be able to gather that much in decades, they resorted to traditional medicine, which didn’t improve her condition in the least. We would rather not continue with Amaka’s sad story.

The above is the sad reality for many Nigerians. Too many lives are lost because people cannot afford expensive healthcare costs. Medical bills running into hundreds of thousands and millions of Naira will force most to consider alternatives. And this has led to the untimely death of many Nigerians.

The National Health Insurance Scheme to the rescue?

The Nigerian National Health Insurance Scheme (NHIS) was created by President Olusegun Obasanjo in 2005 with the very first community-based scheme launched in Kwara State by Professor Lambo Eyitayo, the then Minister of Health.

However, up to five years after the first health insurance scheme was kicked off in Kwara State and nine years after the promises of nation-wide access to quality health services by 2015, a paltry 10% of the Nigerian population actually have access to this health service.

Up to 90% of Nigerians still shell out healthcare expenses from their own pockets, while others like Amaka and her family depend on traditional healers and swindlers for help in such delicate conditions.

According to the information on the NHIS website, Nigerians have access to the following rights under the scheme:

  • The right to choose any primary health care provider (PHCP) of his/her choice.
  • A registered enrollee would be empowered with NHIS identity card/patient card for easy access to his/her PHCP.
  • A subscribed enrollee has the right to present a card at the chosen HCP when they fall sick.
  • A subscribed enrollee has the right to qualitative health care providers without making any payment except 10% co-payment at the point of collection of drugs.
  • A subscribed enrollee is entitled to referral services from their PHCP and also from a secondary HCP to a Tertiary HCP as contained in th NHIS benefit package.
  • A subscribed enrollee has the right to change provider to another PHCP of his/her choice after six(6) months
  • A subscribed enrollee who is dissatisfied with services rendered to him/her HCP has the right to make formal complaint to his/her HMO/NHIS
  • A subscribed enrollee who falls ill outside his station has the right to access care from any NHIS accredited provider in that location upon presentation of NHIS identity card. The HMO covering that subscribed enrollee would later reimburse the HCP.
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The NHIS has programmes for employees in the public sector and voluntary contributors for individuals who are neither employees in corporate establishments or members of communities. There are also programmes for students in Tertiary Institutions, public primary schools and communities.

However till late 2014, at least two-thirds of the income generated in the Nigerian healthcare system is acquired from pockets of individuals or other private expenditure.

A sad fact is that of these stated numbers, almost 86% is made straight out of the pockets on individuals and a tiny 3% paid out of the prepayment plans with private health insurance companies. These could be employees of multinational companies who are covered by private health insurance as part of work place benefits.

These statistics simply reinforce into what has been earlier stated: too many people pay for health treatment out of their own pockets as against those covered by the scheme (NHIS) and those covered by work place health insurance plans.

So what exactly should be the hallmark of a good health insurance plan?

A solid and effective health insurance system should be equitable and considerably lower the financial expensive of paying for one’s health to be shared by the populace regardless of status or class if not completely free.

A health system where a large percentage of the populace shell out money for health care is undeniably inequitable and this will mostly be suffered by the poor.

Good news! Y’ello Health to the REAL rescue!

In answer to this critical call for sustainable and equitable health insurance, the Nigerian National Health Insurance Scheme (NHIS), Einstein MTS (a mobile insurance services generator) and the telecomm giant MTN have designed a health insurance service called Y’ello Health. This is the first of its kind in Nigeria and so far, it looks quite promising.

This service is aimed at the provision of affordable health insurance for all Nigerians through a pre-paid mobile based system of subscription for the service. With most Nigerians owing mobile phones, this approach certainly simplifies the ease with which Nigerians can subscribe for health insurance.

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There are over 6000 registered partners across Nigeria that registered Nigerians can select from. Subscribers are able to select pre-defined treatment types as well. The best part is Nigerians registered under this scheme will have access to medical treatment unlimited number of times for only 250 naira weekly!

With 1000 naira per month and 12,000 naira  yearly, Nigerians (mobile subscribers) can have easy access to this newly developed scheme by simply dialing *616# on their MTN lines. Before long, other network providers will be involved in the Scheme as well to widen the reach.

Another great feature of this new system is the fact that people can opt to pay for other people who are less privileged and cannot afford the premium. This is a welcome development; a nationwide platform that actually promotes being our brother’s keeper.

The scheme although in its early pilot stage already boasts of covering up to 5 million Nigerians and seeks to reach 48 million Nigerians (about 30 percent of the population) by the end of 2015.

There are also plans to begin mandatory registration of public school pupils from September of 2015. This plan targets to have at least 24 million children registered nationwide. Funding is to be provided jointly by the Federal Government and the State Governments of the country.

The Nigeria Health Bill of 2014 (once operational) does give free cover to pregnant women and all Nigerian children under five years of age; a most welcome development for the less privileged. The digitalisation of health insurance in Nigeria is a giant step forward for Nigeria and Nigerians. There is also a programme being designed to monitor the quality of the treatment process; a sort of quality control system to ensure the effectiveness of the Scheme.

Affordable premiums, unlimited treatment opportunities, over 6,000 qualified health facilities (up to 10,000 by the end of the year), and automatic subscriber detectors at health facilities…what’s not to love?

For the incremental development of Nigeria, it is important that this Scheme prospers and grows into everything it has been designed to be. Truly, only time and national health indicators will tell.

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