– As Lagos mandates health insurance to access public services
Healthcare professionals across Nigeria have called for the enforcement of compulsory health insurance nationwide, asserting that it is the surest way for Nigerians to access quality healthcare services. This move, they believe, will help the nation achieve universal health coverage.
At the Afrihealth Conference and Exhibition, held in Lagos from 3-5 July, 2024, professionals expressed concerns over the low enrolment rates in the National Health Insurance Scheme (NHIS), managed by the National Health Insurance Authority (NHIA). They emphasised that quality healthcare is expensive, and only a few privileged individuals can afford it. However, with health insurance, everyone can access quality healthcare as it ensures adequate financing.
The NHIA Act 2022 mandates all Nigerian residents to obtain health insurance, covering public and private sector employees and informal sector workers. Despite this, enrolment remains low, undermining the scheme’s effectiveness. Healthcare professionals are calling for the act’s enforcement to increase the number of enrolees, which they argue is crucial for the scheme’s success.
A major point of contention is the government-set capitation rate. Capitation is a fixed amount of money per patient per unit of time paid in advance to physicians for healthcare services. The last capitation under the NHIS was N750, temporarily increased by 60 per cent in July. However, professionals argue this is still insufficient.
Dr Chijioke Mbelu, convener of the Afrihealth Conference, urged NHIA to launch a massive enlightenment campaign to encourage people to enrol in health insurance.
Also speaking, Dr Jimmy Arigbabuwo, national president of the Healthcare Provider’s Association of Nigeria (HCPAN), stated that healthcare financing can be cumbersome, stressing that health insurance is the best way to reduce out-of-pocket payments for medical care.
Prof. Emem Bassey, chief medical director of the University of Uyo Teaching Hospital, noted that only N1.3 trillion, or about 4.7 per cent of the 2024 budget, is allocated to health, far short of the 15 per cent Abuja Declaration target. He argued that the capitation rate should not be less than N10,000 given Nigeria’s current economic realities.
Bassey, who is also chairman of all chief medical directors in Nigeria, said the major reason government hospitals are owing pharmaceutical companies is because of the consumption from NHIA enrolees, adding however that the agency is not paying the hospitals enough as and when due.
The CMD further called for the establishment of a Health Tertiary Development Fund, just like Tetfund that is aiding infrastructural development in education.
Dr Kayode Adesola, national president of the Association of Nigerian Private Medical Practitioners (ANPMP), reported that only 3.526 million Nigerians were enrolled in the NHIS as of June 30, 2024, which he described as abysmal. He mentioned that a temporary 60 per cent increase in capitation and 40 per cent increase in Fee-for-Service (FFS) payments were negotiated in July, but these adjustments are set to expire in September 2024.
Dr Makinde Akinlemibola, chairman of the Lagos State chapter of ANPMP, stressed that mandatory health insurance is essential for affordable quality healthcare financing.
Pharm. Biola Paul-Ozieh, Chairman of the Healthcare Provider Association of Nigeria, Lagos Chapter, called for greater commitment from the government and more advocacy from the NHIA to boost enrolments.
According to her, “Healthcare providers should have one unified voice and segregation of facilities, so as to make health insurance work. Since 2022, when the NHIA act was signed, we have not moved fast enough. Even though the DG of NHIA has been trying since he took over a few months ago, everybody must be part of the health insurance scheme. Today, I don’t know how many pharmacists are still operating under NHIA because when they supply drugs, they are not being paid.”
Pharm. Dr. David Ehikhuemen, Managing Director of Caremax Nigeria Limited, emphasized that NHIA is crucial for healthcare financing in Nigeria and must be made compulsory. Mrs. Aisha Haruna Abubakar, Coordinator of the Lagos State Office, NHIA, reiterated that the NHIA Act, passed in 2022, should be enforced, and all Nigerians must cooperate to ensure its success.
Pharm. Wale Oladigbolu, Chairman of the Association of Community Pharmacists of Nigeria (ACPN), urged the federal government to investigate NHIA’s activities to make the scheme more beneficial for Nigerians. He pointed out the poor coverage of health insurance, with less than 5% of the population covered.
He said, “The reality of health insurance in Nigeria is quite dismal. Coverage is poor, with less than 5 percent of the population covered. Out of this, 4 percent are in public service and the remaining 1 percent are in private service.”
He said, “Paying capitation for 1,000 patients every month regardless of the actual number seeking treatment is not sustainable. Facilities without pharmacists are being paid for drugs, which shortchanges patients by not providing the requisite oversight from pharmacists.”
In response to these issues, Lagos State has implemented compulsory health insurance. Governor Babajide Sanwo-Olu issued an executive order requiring all ministries, departments, and agencies to provide services only to those enrolled in the health plan provided by the Lagos State Health Management Agency (LASHMA) or other Lagos State NHIA-accredited private health insurance providers.
He added that the exception to this are life-threatening situations. “In emergencies, healthcare facilities must stabilise patients without requiring evidence of insurance. However, once stabilised, patients must provide proof of enrollment or register,” the governor said.
This order, effective from July 16, mandates full compliance to ensure quality healthcare services for all residents, regardless of their financial status.
