NATIONAL HEALTH INSURANCE SCHEME IN NIGERIA
By
Aderounmu A. O
Director, Health Services, OAU, Ile-Ife.
Introduction
Nigeria’s Ten Year Plan for Development and Welfare (1946-56) incorporated the
first attempt at planning for Health Services in Nigeria. Since 1st October 1960 (
Nigeria’s Independence), successive Nigerian Governments (Civilian and Military)
have come up with the 2nd, 3rd and 4th National Development Plans all of which
has substantial portions dedicated to addressing issues related to National Health
care Systems. Today the Nigerian Health system is stratified into Primary,
Secondary and Tertiary Health Care levels with the primary level designed to take
health care delivery literally to the doorstep of the populace and act as the
gatekeeper to the Health care system. Before the advent of the National Health
Insurance Scheme (NHIS), Heath Care services to Government officials, their
dependants and students were supposed to be free while the general populace
was expected to pay out of pocket (OOP) for Health services received at all levels
of the Health Care system.
Provision of free Health Services has hitherto been a major political campaign
issue. However in States where this was implemented ,the health Facilities were
mostly merely consulting clinics as drugs and other supplies were constantly out
of stock and there were gross infrastructural decay and/or inadequacies.
The result is very poor socio-economic indicators like high infant and childhood
Mortality rates, high Maternal Mortality Rate and an average life expectancy of
53years.
By the 1990s- Nigeria ranked 187th out of 191 countries in health care
performance
- Government expended $5per capita as against $34 expended in the
1st World on Health.
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Over 70% of Health expenditure was OOP.
There was low community participation in Health Care.
There was weak Public/Private Partnership.
There was no co-ordinated broad based Health care financing
strategy.
This situation was similar to what obtained in developed countries when their
Health financing was solely from Government allocation and Tax or Levy driven.
These Countries initially tried to improve their Health financing by Introducing
new/special taxes or Lotteries with profit dedicated to Health with little or no
impact. Subsequently, these countries adopted compulsory Health Insurance as a
strategy for financing Health care delivery with remarkable success.
Health Financing Reforms has since been a core part of Health sector
development in low and middle income countries. The trend globally now is to
move away from excessive reliance on OOP payment as a source of Health
financing towards a system which incorporates a greater element of Risk pooling
which affords greater protection for the poor.
NATIONAL HEALTH INSURANCE (NHIS) IN NIGERIA
The Nigerian NHIS is a Social Health Insurance Programme (SHIP) which
combines the principles of Socialism (being one’s brother’s keeper) with that of
Insurance (pooling of Risks and resources).
It is a body corporate with perpetual succession established under Act 35 of
1999 to provide Social health Insurance (SHI) in Nigeria whereby the Health care
services of the contributors are paid for from the pool of fund contributed by
participants in the Scheme.
THE GOAL OF NHIS- is to improve the Health status of Nigerians as a significant
Co-Factor in the National Poverty Eradication Efforts.
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THE MISSION OF NHIS-is to undertake a government – led comprehensive Health
sector Reform aimed at strengthening the National public and private Health
System to enable it deliver effective. Efficient, qualitative and affordable Health
Services.
THE OBJECTIVES OF THE SCHEME- These are to:
i)
ii)
iii)
iv)
ensure that every Nigerian has access to good health care services
protect Families from the financial hardship of huge medical bills
limit the rise in the cost of healthcare services
ensure equitable distribution of healthcare costs among different
income groups
v) ensure high standard of healthcare delivery to Nigerians
vi) ensure efficiency in healthcare services
vii) improve and harness private sector participation in the provision of
healthcare services
viii) ensure equitable distribution of health facilities within the
federation
ix) ensure appropriate patronage of levels of healthcare
x) ensure the availability of funds to the health sector for improved
services.
EVOLUTION OF THE NHIS IN NIGERIA
 The Bill on the introduction of a NHIS was first introduced to
parliament in 1962 but this was not approved
 The idea of NHIS re-emerged in the 1980s
 The National Council on Health commissioned a study on NHIS in
1984
 Report of the study was submitted in 1989 and directive was given to
the Federal Ministry of Health to start the NHIS in 1992
 The formal launching of the scheme was performed in 1997 by Gen.
Sanni Abacha, the then Military head of state
 An enabling law was promulgated in 1999
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 Some sporadic activities were carried out from 1999 to 2004
 The scheme kicked off in earnest in May 2005 under the Government
of Chief Olusegun Obasanjo.
CLASSIFICATION OF NHIS PROGRAMMES
In order to ensure that every Nigerian has access to good health services
the NHIS has developed various programmes to cover different segments of the
society.
These are stratified as follows:
FORMAL SECTOR-Public sector (Federal, State, Local Government)
-Organised private sector-Workplace with minimum of 10 employee
-Students of Tertiary Institutions and voluntary participants
INFORMAL SECTOR-Rural Community
-Urban self employed
VULNERABLE GROUP-Permanently disabled persons and the Aged
-Children under the age of 5years
-Prison inmates
OTHERS
-Diaspora family and friend
-International Travel Health Insurance
-Pregnant women and Orphans
-Retirees and Unemployed.
The Formal sector SHIP (FSSHIP) is what is being implemented for now
while the other groups would be brought on board as the scheme becomes
established.
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BENEFIT PACKAGE WITHIN THE FSSHIP
This include: PRIMARY HEALTH CARE SERVICES
i)
Access to curative services for common ailments including
consumables as out patient care.
ii) Essential drugs from NHIS accredited pharmacy providers+ provision
of pharmaceutical care by the Pharmacist. Beneficiary is expected to pay 10% of
the total cost of drugs (Co-payment)
iii) Routine Laboratory investigations
iv) Health education to prevent and control health problems such as
counseling and testing for HIV/AIDS etc.+ Health Education.
v)
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Maternal and Child care
- Primary Eye care, Dental and Mental services
- Accident and Emergency services.
SECONDARY HEALTHCARE SERVICES
-Specialist care for medical, surgical, Paediatric, Internal Medicine,
Obstetric
and Gynaecology,
Psychiatry, ENT, Ophthalmology,
Management of HIV/AIDS e.t.c
-Hospitalisation in a general ward for a maximum of 15days per annum
-Physiotherapy for restorative and rehabilitative services
Radiology/Medical imaging and diagnostic laboratory services
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-All prescribed pharmaceuticals from FMOH essential drug lists + Copayment
TERTIARY HEALTHCARE SERVICES
All Referrals from primary and secondary health care levels
CONTRIBUTIONS
Contributions are earning-related and currently stand at 15% of basic
salary. The employer will pay 10% while the employee pays 5% of basic salary to
enjoy healthcare benefit. For now only the employers contribution is being
implemented. The contribution made by/for an insured person entitles him/her, a
spouse and 4 biological children under the age of 18 to health benefits as
contained in NHIS health benefits package. Additional contributions will be
required for extra dependants.
HOW THE PROGRAMME WORKS
An employer registers itself and its employees with the scheme. Thereafter,
the employee enrolls him/herself with an NHIS approved Health Maintenance
Organisation (HMO), who will thereafter provide the employees/contributors
with a list of NHIS approved Healthcare providers (public and private). The
employee registers him/herself and dependant(s) with the provider of his/her
choice.
Upon registration, a contributor/employee and his/her dependant(s) will be
issued identity cards with personal Identification Numbers (PIN). In the event of
sickness, the contributor/employee presents his/her identity card to his/her
chosen primary care provider for treatment. The enrollee will be able to access
healthcare after a waiting period of 30 days. This will enable the completion of all
administrative processes.
An enrollee reserves the right to change his/her primary healthcare
provider after a minimum of 6 months, if he/she is not satisfied with the services
being given.
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The HMO will make payment for services rendered to an enrollee to the
healthcare provider an enrollee may however be asked to make a small copayment (where applicable) at the point of service.
PAYMENT SYSTEM
Healthcare providers under the scheme will be paid by capitation, Fee-for –
Service per diem or case payment.
a) CAPITATION
This is payment to a primary Health care provider by the HMOs on
behalf of a contributor, for services rendered by the provider. This
payment is made regularly in advance for services to be rendered
irrespective of whether enrollees utilize the service or not.
b) FEE-FOR-SERVICE
The HMO makes this payment to non-capitation –receiving Health care
provider who render services on referral from other approved
providers.
c) PER DIEM
Per diem are payments for services and expenses per day (medical
treatment, drugs, consumables, admission fees etc) during
hospitalization.
d) CASE PAYMENT
This method is based on a single case rather on a treatment act. A
provider gets paid for every case handled to the end.
ARBITRATION
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The state Health Insurance Arbitration board in each state of the
Federation and the Federal Capital Territory shall consider complaints by
aggrieved parties.
FOR FURTHER READING:
1) STANDARD TREATMENT GUIDELINE AND REFFERAL PROTOCOL FOR
PRIMARY HEALTHCARE PROVIDERS, 2005, NHIS
2) OPERATIONAL GUIDELINE- NATIONAL HEALTH INSURANCE SCHEME, JUNE
2005, NHIS
3) LIST OF HEALTHCARE SERVICE PROVIDERS, JULY 2005, NHIS
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