Govt sets 2015 target for universal health insurance
By Chukwuma Muanya
BARRING last minute hitches, the Federal Government has set 2015 target to get all Nigerians enlisted into the National Health Insurance Scheme (NHIS).
It is also planning to put 600,000 pregnant women and children under five in six states on the scheme by the end of 2009 through the Maternal and Child Health Project (MCHP) as well as to start with another six states from the funds got from the debt relief.
The government is also considering reviewing the capitation and making the programme compulsory.
Capitation is payment, which the client makes on a regular basis (usually monthly) to the provider - a clinic or a hospital - and it is currently N550 monthly.
NHIS is a contributory health insurance put in place in May 1999 by then President Olusegun Obasanjo's administration. The scheme encompasses government employees, the organised private sector and the informal sector. It also covers children under five, permanently disabled persons and prison inmates.
Executive Secretary of NHIS, Dr. Dogo Mohammed, in an exclusive interview with The Guardian in Geneva, Switzerland said: "The target is to cover the whole of Nigeria by 2015. Over four million Nigerians at the federal level are accessing care. We have six states under the MCHP with the expectation of over 600,000 pregnant women and children that are to be covered. We have registered over 200,000 now. We started it around January this year and then we are going to upscale it this year.
"We have some allocation to take six more states. We intend in about 2011 to cover Nigeria for maternal and child care from the debt relief gains. So, if you look at those who already doing private health insurance, we have about three million people. So, I can say under this arrangement, we are looking at seven million Nigeria."
Mohammed said there are problems with getting this done "but we have taken care of most of the grey areas and we are ready now to roll out to the community and who ever wants to join."
The executive secretary added: "We have three models on how we are going to engage the various segments of Nigeria. It is critical that Nigeria should take it as its own gain. It has nothing to do with the Federal, state or local government; it is a Nigerian programme."
Mohammed said the states and local government areas (LGAs) are critical to the success of the universal coverage. "The engine block of Nigeria are the states and councils. No matter the idea at the federal level, it only covers federal employees and their families. But if you want something to spread all over the country, you need to buy into the states and councils," he said.
Mohammed said Nigeria is the only country in the world where health insurance is optional and making the scheme compulsory may be the best way of ensuring universal access.
"At the moment, it has really being optional social health insurance in Nigeria. We are the only country that I can remember in the world that has made it optional. All the time, social health insurance is mandatory. If we had made it mandatory, then it would have made every state, every council to buy into it.
"But another side of it is that for those Nigerians who cannot afford it, then it will be the responsibility of the government enacting the law that will make it mandatory to make provision to cover them. So, if you cannot afford it, then somebody has to pay. That is where the government may have to make arrangement," he said.
On call for an upward review of the capitation, Mohammed said: "It is supposed to be revised annually. It can only be revised based on statistics. There is what we call encounter return. Every facility that has patient registered with them, they are supposed to give a report every month on how many people went there, what were the diagnosis, what were the treatment.
"It is based on the data that we are going to see whether there is need to increase the capitation or reduce it; increase the contribution or reduce it. We have over 8,000 providers registered now with NHIS and I can tell you we do not get up to a 100 encounter forms come in monthly. So, do I use that kind of information to review the capitation? It is not possible."
