By Chioma Obinna
The Director General of the National Health Insurance Authority, NHIA, Prof. Mohammed Sambo has said that the new NHIA Act 2022, is designed to make health insurance mandatory for all Nigerians even as the authority has trained Community Mobilization Officers, COMO, of the National Orientation Agency, NOA, with a view to drive grassroots enlightenment on the health insurance scheme. Speaking in Uyo at the training workshop for NOA’s personnel, Sambo explained that health insurance is to give people access to affordable quality healthcare regardless of their economic status and that insurance is not only for civil servants but for people in the informal sector as well.
Represented by the Acting Director of Media NHIA, Mr Emmanuel Ononokpono, Sambo said the training is geared towards creating knowledge and education as well as attaining Universal Health Coverage (UHC) in the country. He explained that the agency is to enlighten Nigerians living in rural communities in the state and to ensure that more people are captured in the scheme. His words: “Today, NHIA is collaborating with the National Orientation Agency to train community mobilization officers to the extent that they can bear the message and transmit same at the various local levels. The fundamental idea of the training is to ultimately see that every Nigerian wherever he or she lives hears about the health insurance scheme. We adopt this strategy to increase health awareness because Nigerians need enough information to enable them have access to affordable and quality health care.”
Commenting, the Akwa Ibom State Coordinator of NHIA, Mr Williams Ebiokobo said Health Insurance was the sure pathway to achieving the desired health outcomes in the Nigerian population and ultimately, the Universal Health Coverage. He explained that health insurance provides Financial Protection against rising medical costs, peace of mind without financial pressure in case of medical emergencies, affordable healthcare lifetime renewability (as with GIFSHIP with no age limit), cashless hospitalization and network of hospitals.
Ebiokobo, stressed that health insurance was not only limited to civil servants earning monthly salaries. The scheme had various programmes such as Group, Individuals, and Family Social Programme (GIFSHIP) that cover villagers, artisans and other categories of people in the society. He, however, noted that low awareness and funding had been the major challenges confronting the agency. He expressed optimism that the collaboration with NOA would step up awareness and the new NHIA Act will also help to develop innovative ways of financing the health insurance scheme.
Also speaking, the Director-General of NOA, Dr. Garba Abari assured that being an agency to disseminate all government policies and programmes, NOA will take NHIA’s activities to the grassroots. Abari represented by the Director, Human Resource Management, Mr Kehinde Ogunkuade noted that the health of all Nigerians also remains the concern of the agency, adding that “healthy manpower produces healthy development”.
“NOA is interested in taking the programme to the grassroots so that all Nigerians will benefit from the activities of the NHIA. Health is important to every Nigerian and we want Nigerians to be healthy. “Information is power. If you don’t have information about a thing, you won’t have trust in it and that is why we have to take the information to the grassroots” he added.
In a similar development, pharmacists under the auspices of the Association of Community Pharmacists of Nigeria, ACPN, petitioned President Bola Tinubu to urgently revitalize Nigeria’s healthcare system through reforms that would pave the way for the appointment of an Adviser on Pharmaceutical Services and Chairman, Reforms on Drug Distribution. The ACPN also called for urgent reforms in three areas which include: full implementation of the National Health Act 2014, defining and articulating the full potential of Primary Healthcare in Nigeria and running the National Health Insurance project in alignment with due process in the public interest.
The pharmacists in the letter dated 3rd July 2023, and titled: “Attaining Universal Health Coverage through Urgent Reforms in Pharmacy and Healthcare Practice” explained that the appointed adviser for Pharmaceutical Services/Chairman Reforms on Drug Distribution Endeavours would champion the resuscitation of drug distribution generally with a specific mandate on all the three agenda items.
The letter addressed to the President, Bola Tinubu, and jointly signed by the ACPN National Chairman, Adewale Oladigbolu and National Secretary, Pharmacist Ezeh Ambrose, read in part: “In contemporary times, the ACPN has continued to monitor the evolving and progressive strides of the Bola Tinubu Presidency which is gradually beginning to engender a season of fulfillment in national life. It is in the light of this ray of hope that the ACPN wishes to canvass for urgent reforms in pharmacy and healthcare that can birth fruitfulness in the health sector as well as activate sustainable Universal Health Coverage, UHC. Full implementation of the National Health Act 2014, NH2014, ordinarily ought to be the supreme legislation in healthcare in Nigeria. It was a product of twists and turns spanning over a decade before it was eventually enacted as an Act of Parliament. One of the most positive reflections of this Act is the creation of a Basic National Healthcare Provision Fund which is meant to be an accrual of 1 percent from the Consolidated Revenue Fund.
“This proviso of the law, if well implemented, will make healthcare more impactful as it will guarantee better funding of the Health Sector which groans under both a paucity of funds and gross mismanagement of budgeted funds often bordering on an average of just about 5 percent relative to the 13 percent prescribed by Heads of Government that facilitated the Abuja declaration of 2021. The BNHPF remains a major tool to drive the actualization of UHC as it lawfully provides that the BNHPF should fund Social Health Insurance to the tune of 50 percent of dedicated funds, while 30 percent of these funds be devoted to the procurement of essential drugs and vaccines, 15 percent of the funds will be employed to undertake the training of health personnel and 5 percent will be used to cater for National Emergency Health Services. A synopsis of the areas covered above indicates that if experienced and transparent managers are made to run the MDAs in the health sector, we might just begin to reverse some seemingly irreversible indices in our sinking health system.”
They added that one of the landmark reforms in the NH-2014 was the proviso in law that changed the advisory status of the National Council on Health to the Health Minister to that of a decision-making body which was structured to involve all the frontline professional bodies in healthcare for detailed input in the spirit of a true democratic order. They alleged that the Federal Ministry of Health, FMOH, in the last nine years has deliberately truncated the section of the law as most professional bodies were never part of the NCH meetings. ACPN further lamented that the interpretation clauses of the NH2014 list the categories of professional practices officially designated as Health Facilities in Nigeria including pharmacies, clinics, hospitals, medical laboratories, PhysioClinics, and among others.
“It is a major irony however that the health authorities have often times failed to explore the proximity of community-based health practices in the logistics and protocol designed for a rendition of all cadre of services which is a major reason for systemic failure in Nigeria’s fumbling health system. ACPN further noted that for so long, health policy chiefs and advisers negated primary care services for pecuniary interests or other normal professional gains. They pointed out that the quest for UCH would continue to be a ruse if it was not grounded on a well-worked primary healthcare concept. They noted that the National Primary Healthcare Development Agency, NPHDA, should be empowered to go full throttle as it designates community pharmacies as immunization centres for all clinical disease states, adding that it would pave the way for routine immunization as opposed to the presently imposed National Immunization Days (NID) with a propensity to improve coverage rate in vaccination.
“Nigeria can substantially reduce infant and maternal mortality albeit significantly if we encourage the setting up of community pharmacy-based ante-natal clinics as we see in some climes.” On running the National Health Insurance Project in alignment with due process in the public interest, they stressed that one of the biggest monumental failures recorded in the healthcare sector remains the uninspiring nature of the Social Health Insurance portfolio in our nation. “For over 13 years of the 18 years of the establishment of Social Health Insurance in Nigeria, it has been anchored by extremely inexperienced physicians with attendant corruption and undiluted failure. The highlights of the failure were hinged on factors including unlawful payment mechanisms and indiscriminate capitation payment.
ACPN stated that to smoothen administrative convenience, the NHIA Secretariat continued to employ an unlawful payment mechanism called global capitation to compensate providers of Social Health Insurance. “In Nigeria, Social Health Insurance has become a public sector-driven concept rather than a private sector-oriented agenda which is one of the main reasons it does not inspire confidence in enrollees.
“8 years ago, the coverage rate in social health insurance dropped from almost 10 percent to 1.72 percent with a chance that it might drop even further. If the gains of social health insurance would be ever reaped in Nigeria, it becomes expedient that a seasoned actuarist or insurer be engaged to save the remains of the scheme while also allowing professionalism through separation of roles to be built into the ailing project in the professional and public interest.” The ACPN scribes pledged their willingness to collaborate with the Government as they target a revival of dead structures across board in all sectors of the Nigerian economy including health in the months ahead.