Health insurance is the most efficient and sustainable means of ensuring access to healthcare
The recent improvement in two vital incentives for providers in the health insurance space by the National Health Insurance Authority (NHIA) is a welcome development. The first is the 'capitation fee' paid monthly by the government to Health Maintenance Organisations (HMOs) and other providers for each enrolled patient, regardless of actual cost. It is now up by 93 per cent. The second component is fee for services, a separate payment for specified procedures that has also increased by about 378 per cent. It is the first review of the fees in 12 years and is in line with the current administration's sector-wide strategy for improving the country's health indices which is being implemented by the Federal Ministry of Health under Coordinating Minister, Muhammad Pate. Both fees are globally recognised incentives at the heart of the health insurance system.
It is reassuring that the reviews were preceded by rigorous stakeholder consultations and actuarial analysis to ensure that the new rates are realistic and sustainable. The increases are significant because the failure of successive governments to act despite the downturn in the economy and accelerating inflation, had become a major disincentive for providers in health insurance. For years, they had complained that higher costs had eaten up their margins and they could no longer afford to deliver the required standard of service to enrolled patients. The administration deserves commendation for taking this long delayed and very necessary step.
The expectation, underscored by NHIA Director General, Kelechi Ohiri, is that providers will work harder to improve service quality for patients whose welfare is the most important consideration. Higher service standards in hospitals and health centres will encourage more Nigerians to sign up for health insurance and boost the current low enrolment figures. Twelve years after flag-off, less than 10 per cent of Nigerians out of a potential 200 million have signed up for health insurance. While there has been an uptick in enrollment rates within the last nine months (adding over two million Nigerians, pushing total coverage to 19.18 million by the third quarter of 2024), the total number is still far too low.
On the bright side, Nigeria achieved full nationwide coverage of state social health insurance agencies in 2024, with Akwa Ibom the last to come on board. With the full complement of the 36 states and FCT schemes in place, the NHIA's strategy of close partnership with sub-national agencies to drive improved service and higher enrolment should deliver better results. A surge in numbers will generate more funding, boost investment and create the necessary synergies to deliver better service to many more Nigerians. Health insurance remains the most efficient, most sustainable and most democratic means of ensuring access to healthcare.
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The urgency is evident in a nation with some of the worst health statistics in the world--life expectancy of 55 for men and 56 for women; under-five infant mortality at 104 deaths per 1,000 live births; maternal mortality at 814 deaths per 100,000 live births. The focus on supporting disadvantaged groups through available mechanisms and funds as part of health insurance is also notable. This will help to reduce suffering and deaths, while increasing the numbers. Implemented under the umbrella of Comprehensive Emergency Obstetric and Newborn Care (CEmONC), it includes the Free Fistula Programme coordinated by NHIA which has brought succour to 1,629 beneficiaries since its June 2024 launch, operating across 42 healthcare facilities nationwide.
While these initiatives are laudable, there is much work to be done for the target of universal health coverage by 2030 to be realistic. The recent appointment of Ibrahim Oloriegbe, who, as Senate Health Committee Chairman, played a leading role in the passage of the NHIA Act as the agency's new Governing Council Chairman is commendable in this regard.
