On mandatory medical insurance in Nigeria

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THE Federal Government recently made progress within the health sector by repealing the National Health Insurance Scheme Act 2014 and enacting the National Health Insurance Authority Act 2021. The goal of the Act is to make sure effective implementation of a national medical insurance policy that ensures the attainment of universal health coverage in Nigeria. For a long time, stakeholders within the health sector have clamoured for the implementation of universal health coverage to make it mandatory for all Nigerians no matter their status within the formal and informal sector to be captured in any type of prepaid medical insurance package. This became mandatory given the indisputable fact that 70 per cent of Nigerians incur out-of-pocket expenses on health. When residents are usually not covered in any type of prepaid insurance, they’re left with no option but to pay for each health related service incurred. Out-of-pocket expenditure contributes largely to the poor health indicators and mortality rates in Nigeria.  In a society with scarce resources and competing needs for survival, out-of-pocket expenditure leaves families with the selection of caring for their emerging health needs and satisfying other basic necessity corresponding to education, food and shelter. Compared with other countries in sub Saharan Africa, Nigeria’s out-of-pocket expenditure is high. Countries like Angola, Benin, Burkina Faso, Cote D’Ivoire, Gabon, Kenya and Rwanda all have lower out of pocket expenditure than Nigeria.

The Sub Saharan African average is 29.98 per cent as against Nigeria’s 70.52 per cent. With the recently signed law, 80 million vulnerable Nigerians, including the elderly, children, pregnant women and individuals living with disabilities are entitled to free medical insurance coverage under the vulnerable group fund. States are to enjoy these funds with the establishment of their very own compulsory state medical insurance scheme. The law also provides that one and all resident in Nigeria shall be required to acquire medical insurance. S. 14 (2) of the Act provides that nothing under this Act shall preclude a resident in Nigeria from obtaining private medical insurance provided such an individual  participates in any state mandated health scheme. The implication of this section is that medical insurance is mandatory for all residents in Nigeria.

Nigerians should applaud the brand new law given its huge advantages. First, beyond reducing the out of pocket expenditure, it’ll function an enormous resource mobilisation for the health sector. The health sector has historically suffered from the dearth of resources. For the past 10 years, Nigeria’s budgetary allocation to the health sector has hovered between 3 to five per cent of the entire national budget. Considering the large demands for health commodities, infrastructure and human resources for primary, secondary and tertiary healthcare, the budget has been invariable low. The budget for the health sector also negates the Abuja declaration of 15 per cent of the entire budget for health. Again, Nigeria falls amongst countries with the bottom allocation for health within the sub-Saharan region. The minimum allocation for health in most countries in sub-Saharan Africa is 7 per cent, whereas some countries in Africa allocate 15 per cent of their budgets to health. Prepaid insurance is a pool of funds which might aid investment within the health sector and supply for the much needed health commodities, infrastructure and human resources.

Secondly, the brand new law will boost the country’s attainment of the Sustainable Development Goal 3, which seeks to advertise good health and well-being for all in any respect ages. It’s going to increase universal health coverage from its current ratio of lower than 5 per cent of the population to at the very least 70 per cent of the population.  Nonetheless, for the Health Insurance Authority Act to be effectively implemented, the operational guidelines ought to be quickly developed. The rule should provide key directives on mandatory enrollment and coverage of all residents under any of the prepaid health schemes. The possession of a medical insurance identity card or certificate by residents ought to be regarded as mandatory requirements to derive certain advantages from the federal government. Health facilities ought to be properly equipped and so they ought to be manned by trained medical personnel who would respect the rights of patients. The equipping of facilities with skilled treatments of residents would function an incentive for Nigerians to key into the scheme.

Recent interactions with stakeholders on the evolvement of medical insurance coverage in Sokoto State, shows the willingness of residents within the formal sector to key into the prepaid health scheme of the state. The state has succeeded in enrolling vulnerable residents into its medical insurance scheme under the Basic Health Care Provision Fund but residents within the formal sector feel left behind. The Federal Government should work with sub-national governments to make sure that the suitable categories of persons are enrolled under the vulnerable group fund without leaving those within the formal sector behind. Stakeholders answerable for implementation of the law ought to be open and accountable to the general public. Civil society organisations should arrange an accountability framework to watch the implementation of the brand new law.

  • Emejuiwe, a/public affairs analyst, writes in from Abuja’

 

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