Globally, access to qualitative and affordable healthcare services is seen as a right rather than a privilege, irrespective of one’s socioeconomic status. In Nigeria, access to healthcare services is constrained by the ineffective and inefficient health system characterised by poor maternal and child indices. The culture of high out-of-pocket expenses on healthcare in Nigeria significantly contributes to high poverty rate in the country.
Health Insurance, which can be social or private, is a system of advance financing of health expenditure through contributions, premiums or taxes paid into a common pool to pay for all or part of healthcare services specified by a policy or plan. Since the creation of National Health Insurance Scheme (NHIS), which is the regulator of health insurance industry in Nigeria, only the Federal civil servants (under the formal sector) and very few people in the category of informal sector have been enrolled in it. It is however worrisome that, the enrolment of Nigerians by NHIS is still less than 10%, despite the huge amount of money spent so far on the scheme since its creation.
We are aware that part of the constraints of NHIS in recording substantial enrolment of Nigerians is the fact that health in not on exclusive list, but on concurrent list. Moreover, the Act 35 of 1999 that set up NHIS did not make it mandatory for all Nigerians. These identified challenges led to the concept of decentralising health insurance to all states in the federation, so that there can be state-owned health insurance agencies that will enrol their workforce and communities for larger coverage.
As a Civil Society Organisation that is passionate about good governance in Kwara state, Elites Network for Sustainable Development (ENetSuD) commends Governor Abdulfatah Ahmed administration for the enthusiasm displayed in creating the Kwara State Health Insurance Scheme. We are proud to note that Kwara is one of the few states in Nigeria that have created an autonomous State Health Insurance Scheme. This is the kind of people-oriented policies and projects that we are expecting from any responsible government, as it has a direct and significant impact on all the citizenries and the only step towards universal health coverage. There could not have been a better way of providing value for tax-payers’ monies other than this. We are impressed with the commitment of state government to dedicate 1% of the state annual Consolidated Revenue Fund for financing the scheme. We are also grateful to the state government for making the premium (25 naira per day, which is less than 10,000 naira per annum) very affordable for the masses.
If well implemented and monitored in compliance with global best practice, this mandatory scheme will benefit all citizens and residents of Kwara in the following ways, as highlighted in the operational guideline of National Health Insurance Scheme:
- There will be access to good healthcare services
- Families will be protected from the financial hardship of huge medical bills
- The rise in the cost of healthcare services will be limited
- Healthcare costs will be equitably distributed among different income groups
- High standard and efficiency of healthcare services delivery will be maintained in the state
- It will improve and harness private sector participation in the provision of healthcare services
- It will ensure adequate distribution of health facilities within the state
- It will ensure equitable patronage of all levels of healthcare (primary, secondary and tertiary)
- It will ensure the availability of funds to the healthcare sector for improved services
We are volunteering ourselves to assist government in enlightening the citizens and residents of Kwara on the benefits of the scheme, so as to enhance enrolment. We want to invite the state government to learn from the weaknesses of NHIS that led to her low patronage. We call on the state government to pay attention to the following:
- Aggressive marketing of the scheme should be done, to enable the citizens know its benefit to them and enrol accordingly with greatest enthusiasm
- Robust enrolment plan that must be carried out by the scheme, but not by third party (e.g. HMO), to avoid frivolous enrolment data and corruption
- Effective and continuous quality assurance monitoring of the scheme, so that the enrolees of the scheme (citizens and residents of Kwara) will not be short-changed
We are also encouraging politicians, philanthropists and selfless Kwarans to voluntarily enrol vulnerable Kwarans (that have been obviously perceived to be poor) into the scheme by paying for their premiums.
This could be a better investment in people of Kwara, rather than giving them stipends that will not have any meaningful impact on their lives. Legislators can also pay attention to massive enrolment of their constituency members into this scheme as part of their constituency project, instead of wasting our public funds on irrelevant empowerment projects that do not make any meaningful impact on our lives and can also not be tracked.