Nigeria: Why Nigeria Cannot Achieve Universal Health Coverage Now - NHIs Executive Secretary

Nigeria cannot achieve Universal Health Coverage (UHC) until the National Health Insurance Scheme (NHIS) is made compulsory for all Nigerians, the executive secretary of the scheme, Mohammed Sambo, has said.

"We have a presidential mandate to achieve UHC but if NHIS is not made compulsory we cannot achieve that," Mr Sambo said Monday at the opening ceremony of the ongoing NHIS management retreat holding in Kaduna.

His comment reiterated concerns raised by several players in the health sector on the need for an amendment of the NHIS Act with to make the scheme compulsory for all.

A bill to repeal and replace the NHIS Act was passed by the 8th National Assembly in April and forwarded to President Muhammadu Buhari but he has neither signed it nor declined assent.

Speaking to journalists during a tea break at the event, Mr Sambo stressed the importance of the NHIS Bill.

Advocacy for NHIS Bill

Mr Sambo, a professor, said plans are underway to ensure high-level advocacy to convince the president to sign the bill so that "everybody, the states, organised private and informal sector will join the scheme."

He said NHIS under his leadership mapped out strategies to get the bill signed "because the amended bill has been widely acknowledged by every stakeholders as a very good bill that will help us achieve UHC".

"We have a plan to have a round table discussion with the senate and the house of reps so that we can look at the law and develop a high powered committee that will undertake advocacy for the purpose of signing that bill.

"If we get that, we will have a very good pool in our coffers to provide care for the vulnerable population," the NHIS boss said.

NHIS Conundrum

Despite billions spent on the NHIS since 2005 when it took off, millions of Nigerians still lack access to quality healthcare.

This is mainly because they cannot afford quality care since health insurance has largely been ineffective.

About 70 per cent of Nigerians pay out-of-pocket for health while the few enrolled into the scheme complain of inadequate service delivery.

Observers say the scheme only covers between five and 10 per cent of the Nigerian population.

But Mr Sambo said such figures are "wrong, fictitious and unjustifiable" because "there are no denominators for the total population the scheme is expected to cover."

Fictitious NHIS coverage Percentage

"I have looked at the scheme and I cannot see the denominator that will make you arrive at that 10 or 5 per cent coverage. The percentage is fictitious and has no basis," the NHIS boss said.

The professor said the only way to determine the accurate level of coverage - especially since NHIS is yet to be made mandatory - is by establishing the total population the scheme is meant to cover which he calls the denominator.

He said the scheme took off with a mandate to cover the formal sector, mostly federal government employees, but yet, does not have accurate data of their total figure.

"We don't know the total population of the employees in Ministries, Departments and Agencies (MDAs). There are no answers to the total number of employees in the federal government.

"If you cannot answer to that, then you cannot be talking of the proportion of coverage. You can only say for instance that about 100,000 people are covered," the professor explained.

Rebranding Agenda

Mr Sambo said his rebranding agenda will engender evidence-based information to establish the total population NHIS should cater for through accountability and transparency. This, he said would help in the calculation of the total coverage.

"We will ensure that we put out very good denominator on what we are to cover. In the reform agenda, we will calculate how many MDAs we have at federal level and the total population of federal employees then we will now go back and see how many MDAs is subscribed to NHIS because as an employee of the FG, this is supposed to happen at the point of getting employed.

"We will design strategies to meet with MDAs who are yet to subscribe and tell them to do so in line with the presidential mandate of attaining Universal Health Coverage (UHC) through the scheme. If they don't join, they will slow us down."

He said with the release of the Basic Health Care Provision Fund (BHCPF), the poor and vulnerable will now be properly covered.

The NHIS boss also said the ongoing workshop is the first step to a "purposeful strategy that will reorient the organisation into having a value system that will bring peace between staff and management".

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