Universal Health Coverage In Nigeria - What Are The Possibilities?
This is a CMF Webinar Session Report 7#
Introduction
#CovidNigeriaMedics, had as its theme of discussion the topic “universal health coverage in Nigeria, what are the possibilities.”
Webinar Structure
The coordinators of CovidNigeriaMedics resident within and outside Nigeria. The webinar had over a hundred participants including domestic and foreign based Nigerian doctors, health insurance staff and other allied members of the health sector.
The total duration of the webinar was 1:33:25 (93 minutes).
It began with an introduction and historical background of the organization by Dr. Sadiya Gumi, and then proceeded with the agenda of the webinar and order of proceedings. The key speaker was Prof. Mohammed Nasir Sambo, executive secretary/CEO national health insurance scheme, while the discussants were Dr. Halima, Dr. Olatunji M.B., and Mrs. Uzor Okonmah_ofulue.
Coordinator Moderators
Dr. Sadiya Gumi Dr. Muhammed Sadiq & Dr. Sadiya Gumi
Overview of Keynote Topics
Dr. Sadiya Gumi welcomed all participants to the webinar and introduced the topic of discussion. She proceeded to introduce her co-moderator, Dr. Mohammed Sadiq who quickly gave an overview of the events of the day. He introduced the key speakers of the day. This was to be followed by a summary and finally, a questions and answers session as well as other contributions from the participants.
“Universal Health Coverage In Nigeria:What Are The Possibilities?”
The Need For The Nationl Health Insurance Scheme (NHIS) In Nigeria.
Prof. Mohammed Nasir Sambo, the Executive Secretary of the National Health Insurance Scheme (NHIS) Nigeria, was the key speaker. The outline of his presentation was an introduction and definition of universal health coverage (UHC), tracking progress towards universal health coverage, National Health Insurance Scheme NHIS and UHC in Nigeria, key achievements, moving ahead: what are the possibilities?, and finally, a call to action.
He stated that 1 in 10 Nigerians, translating to about 82.9 million Nigerians, live in poverty according to the national bureau of statistic 2019 with only few Nigerians having any form of health insurance. This situation is further worsened by the triple burden of infectious diseases, non-communicable diseases, and reemerging and emerging diseases with the potential to cause epidemics and pandemics. He acknowledged that Nigeria has one of the worst maternal and child health indices globally, evidenced by available data. Universal health coverage, he explained, aims to ensure that all people have access to needed key promotive, preventive, curative and rehabilitative health services of good quality at an affordable cost without the risk of financial hardship linked to paying for care, and he related this objective to target 3.8 of the sustainable development goals (SDGS), which seeks to achieve universal health coverage.
Road Map Towards Attaining UHC in Nigeria: The Financial Implications
A road map towards attaining universal health coverage projects a total health expenditure of at-least 4-5% of GDP, out of pocket expenditure currently considered to be one of the most retrogressive health financing models should be 30-40% of total health expenditure or less, 90% of the population should be covered by prepayment schemes, 80% of the poorest 40% of the population must have effective coverage to access quality health services, and lastly, 100% of vulnerable population should be covered by social assistance and safety net schemes.
NHIS and Nigeria’s Journey Towards Universal Health Coverage
The NHIS seeks to offer prepayment schemes and risk pooling services to a majority of the population. It is considered to be the Single most important pathway towards UHC. It was established by degree 35 of 1999 now CAP N42 LFN, and its mandate is to achieve UHC by the year 2030, inline with SDG’s. It has as its vision, to be a leading agency committed to achieving financial access to quality healthcare for all Nigerians, with a mission to mobilize resources to enable access to affordable health care for all Nigerians. Its core values include commitment, responsiveness, efficiency, accountability, transparency and equity. The law in Nigeria allows for non-mandatory participation in health insurance with amendments being made to the formal sector
NHIS-Key Objectives and Programs
Key objectives of the NHIS in Nigeria include ensuring access to good healthcare services by every Nigerian, protection of families from exorbitant health bills and prevention of financial hardship, ensuring high standard of healthcare delivery to Nigerians. The NHIS utilizes mechanisms for coverage expansion some of which include public sector mop up, mobilization of organized private sector up-scaling of basic healthcare provision fund, etc..
Re-branding and Reformation of the NHIS under the Leadership of Prof. Mohammed Nasir Sambo
The NHIS in Nigeria is being re-branded as a result of its immersion in multiple crises the recent past. This is being done through a three-point agenda which includes value reorientation, transparency and accountability, and accelerating drive to UHC. Prof highlighted some of his achievements in the NHIS between 2019-2021, some of which are restoration of internal peace and harmony in the NHIS, recreating the image of the organization and restoration of stakeholders confidence in the NHIS, recovery of funds owed to health maintenance organizations, development of a 10 year strategic plan for the NHIS, and many other landmark achievements which have re-positioned the NHIS into a trusted and reliable organization presently on track to achieving its goals. He enumerated some critical success factors which will move the NHIS forward and aid in quick attainment of UHC to include political support at all levels of governance, legislation for mandatory health insurance, effective private sector partnership in addition to other highlighted points of his presentation.
He concluded his presentation by expressing his optimism to the feasible realization of UHC through the road-map being implemented by the NHIS if given the necessary support.
Review Of Health Insurance Models For UHC Across Three (3) Nigerian States
A View From Kano State
The second speaker, Dr. Halima her began her presentation by acknowledging the poor health indices characterizing healthcare delivery in Nigeria with out-of-pocket payment being the most prevalent means of payment for health care by citizens. She emphasized the role of universal health coverage as a tool for sustainable development with sustained financing being very important to achieve these targets and proceeded to present the Kano State health scheme.
She explained the origin of the state-based scheme which draws its resources or funding mainly from the civil servants contributory scheme and also political office holders who contribute a preset amount.
The scheme is also expanded to carter for the health needs of the vulnerable such as those in internally displaced persons and orphanages through the informal arm funded by the state government as well as a basic health care branch. The scheme has covered over 400, 000 persons in the state and also offers secondary referral services to those in need. Payments are usually as capitation (74.2%) and fee for service (14.6%) which are paid directly to the facilities involved in healthcare provision, comprising about 562 facilities encompassing both private and government facilities which offer both primary and secondary care.
The enrollee are mainly children under the age of 10. She acknowledged the high level of political support given to the scheme making it feasible for migration of the scheme to a pure telemedicine based system. Routine inspection of facilities for monitoring and evaluation purposes are in place as well as well-structured referral systems. She spoke on continues dialogue as a means to engage facilities that have declined enrollment, which is non-compulsory and also the possibility of a review of the extant laws to increase coverage and participation of individuals and facilities in the state health scheme.
Bauchi State Perspective
Dr. Musuru Dada, the executive secretary of Bauchi state health contributory management scheme founded in November 2017 and became operational in 2019, presented the Bauchi state model. He explained that the model was multifaceted with some of the components being the legal, institutional and operational framework. according to him, the legal framework establishing the model had already been completed, given the health scheme a robust legal framework on which to operate. The institutional framework encompasses building and staffing. The operational sector is made up of the formal, informal and the vulnerable sector. The Bauchi state model, he said, was similar in design to the model of other states in Nigeria. The scheme is aimed at providing the financial means to health services which would be rendered at the primary health care facilities with hopes of meaningful achievements before the year 2030.
Ogun State Perspective
Dr. Elija Ogunsola, shared the Ogun state approach, which he said was no different from that across other states. He stated the state leverages on the basic healthcare provision funds and registration of vulnerable persons eligible for health coverage across the 20 local government areas in the state. He said while the primary health centers are ready to provide services for registered persons, they were constrained by inadequate personnel, and this was a major limitation to achieving universal health coverage identified in the state. Through the basic healthcare provision fund, they intend to ensure the presence of sufficient health personnel through the 232 wards. He solicited support from the NHIS, seeking for more involvement at the state level through integration of state offices to ensure proper channeling of funds for premium payments and capitations for coverage of vulnerable persons in the state.
Edo state Perspective
Mrs. Uzo Okoma Ofolule, a health economist and engagement partner of Lauren Parker, noted that 77% of health expenditure is out of pocket making the country more susceptible to health payment challenges during the Covid pandemic. She introduced the organization Lauren Parker and gave a quick run through of the services they offer as relates to health care coverage and funding. According to a lancet medical journal report, less than 10 % of the population was covered by the NHIS in both the formal and informal sector with 92% of the population not covered by insurance.
She highlighted the non-success of the previously applied strategies and advocated a change in strategy which she said her organization had applied in Edo state. Many Nigerians in her opinion, have no clear understanding of the health law. She was of the view that available records from banks, National identity management and Nigerian communications commission could be used to pool vulnerable and eligible persons into the health scheme. This could be done through collaboration between concerned agencies with focus on health services delivery and funding to allow enrollment and payment of enrollees into the health scheme.
She stressed the need for cooperation through incentivised models to the organizations involved to improve cooperation between the private sector and government organizations to ensure widespread health care coverage as currently done in Edo state.
Role of civil society organisations
Dr. Aminu Magaji, spoke on the role of civil society organizations in healthcare funding. He referenced available statistics indicating that only 13 states implementing the have commenced distributing funding to the primary health facilities, even though resources had been released agencies. He explained that civil society organizations raise the bar of transparency and accountability through engagement of government agencies to enhance delivery on the needs of Nigerians. This is done through meetings with relevant government agencies and stakeholders to ensure that the requisite services are rendered to Nigerians, health wise. Civil society organizations also engage with stakeholders to lobby for adequate funding, timely disbursement of funds and monitoring and evaluation of services of offered by concerned organizations to ensure transparency and accountability and the quality of health rendered to Nigerians.
Summary:
The key points from the webinar include:
- Available statistics indicate that about 82.9% of Nigerians live in poverty, with no means of affordable health insurance coverage, a situation which has led to poor maternal and child health indices, and is further compounded by infectious diseases and emerging/re-merging disease.
- The NHIS has as its goal, provision of adequate health coverage for all Nigerians including poor and vulnerable Nigerians and is constantly undergoing modifications to meet its targets.
- Adequate support and financing are necessary to achieve UHC for all Nigerians by the NHIS.
- The NHIS remains the best platform for affordable, expansive and quality healthcare model to usher in UHC Nigerians.
- State health insurance models are generally modification of the NHIS with varying levels of implementation and coverage currently being achieved by different states.
- Public-private partnerships which allow for sharing of information from data bases such as banks and telecommunication companies would aid proper planning, which can be efficiently implemented through incentivised approach to expand health care coverage for Nigerians.
Conclusion
The webinar was brought to a close by Dr. Sadiya Gumi who appreciated all the participants and speakers. and also announced the date for the next webinar to be held in May. She informed participants the webinar recording will be available across all the media platforms of #CovidNigeriaMedics, including YouTube.
