NHIA Guidelines and Pate’s Move to Boost Population Health
By Lawal Dahiru Mamman
It is not uncommon to see the destitute in motor parks, religious centres, T-junctions and other places that pull crowds clutching a doctor’s prescription, soliciting public support to purchase drugs.
Others plead not to be offered money but instead be accompanied by any good samaritan to the nearest pharmaceutical outlet to purchase the medication on their behalf. This is to free them from the accusation of preying on public sympathy to beg money without any justifiable reason.
These are indications that a number Nigerians cannot afford drugs to treat themselves owing to the fact that healthcare is predominantly financed by households, without government support. According to pundits, this among other factors have been instrumental in pushing many citizens into poverty.
In 2021, the World Health Organisation (WHO) said: “Up to 90 percent of all households incurring impoverishing out-of-pocket health spending are already at or below the poverty line – underscoring the need to exempt poor people from out-of-pocket health spending, backing such measures with health financing policies that enable good intentions to be realised in practice.
“Besides the prioritising of services for poor and vulnerable populations, supported through targeted public spending and policies that protect individuals from financial hardship, it will also be crucial to improve the collection, timeliness and disaggregation of data on access, service coverage, out-of-pocket health spending and total expenditure.
“Only when countries have an accurate picture of the way that their health system is performing can they effectively target action to improve the way it meets the needs of all people.”
WHO revealed during the 6th Annual Conference of the Association of Nigeria Health Journalists (ANHEJ) last year in Akwanga, Nasarawa State that: “With healthcare out-of-pocket expenditure at 70.5 percent of the Current Health Expenditure (CHE) in 2019, general government health expenditure as a percentage of the GDP was 0.6 percent while government expenditure per capita was $14.6 compared with WHO’s $86 benchmark for universal health coverage (UHC).”
Nigeria currently bears the highest burden of tuberculosis and paediatric HIV, while accounting for 50 percent of neglected tropical diseases (NTD) in Africa, contributing 27 percent global malaria cases and 24 percent of global deaths with Non-communicable Diseases (NCDs) accounting for 29 percent of all deaths in Nigeria with premature mortality from the four main NCDs (Hypertension, Diabetes, Cancers, Malnutrition) accounting for 22 percent of all deaths.
On the account of high disease burden, high out-of-pocket health expenditure and low enrollment into the NHIS now National Health Insurance Authority (NHIA), the Federal Ministry of Health and Social Welfare has unveiled operational guidelines for the NHIA, to ensure financial access to quality healthcare in line with Sustainable Development Goals, (SDGs), consequently putting the country on track of attaining Universal Health Coverage (UHC).
The Ministry said: “High out-of-pocket payment for health care services is not good enough and it is not sustainable. Only 9 percent of Nigerians have insurance cover as 90 percent don’t.
“Ill-health is pushing many Nigerians into poverty. We must therefore change the trajectory of healthcare delivery in Nigeria.
“Many people have wondered why the President added social welfare to the Ministry of Health. The answer is health insurance. Health insurance is the key to the Renewed Hope Agenda and it is the reason the President added social welfare to the Ministry. This is because the President is aware that we need social protection for our people,” the Minister said.
The guideline which harmonised crucial provisions of the old operational guidelines with the new Act provided legal basis for mandatory participation by all Nigerians, the Vulnerable Group Fund (VGF) for citizens who are enabled to service their insurance after keying-in and empowered the NHIA to promote, regulate and integrate health insurance schemes in the country among other provisions of the Act so as to contribute in poverty reduction as well as socioeconomic development.
The review expanded the operational guidelines from four to five. The first section, Governance and Stewardship provides which was not part of the previous guideline gives broad overview of roles and responsibility of the NHIA and stakeholders within the insurance ecosystem.
Second section, schemes and programs identifies, contributory, non-contributory and supplementary/complementary schemes to insure the capturing of public and private sector employees, vulnerable group including those not captured in the National Social Register (NSR) by pooling resources from government, private sector, philanthropists and even international organisations.
Standards and accreditation which is the third section will focus on bringing health workers, health facilities and equipment, and patients under one roof for meticulous running of the NHIA.
Fourth section of the operational guidelines, data management, allows the NHIA to provide and maintain information for integration of data health schemes in Nigeria. Such data will allow collaboration, data sharing between facilities, medical audit, research and aid seemless decision making for the authority.
Offences, penalties and legal proceedings, which is last of the guidelines ensures stakeholders’ compliance with the provision of the NHIA and provides legal instrument for investigation of grievances and disputes between stakeholder in accordance with protocols of the NHIA.
Implementation of this effort by the Health Ministry will make Nigerians worry less about the financial consequences of seeking medical care, providing avenue for early detection and treatment of diseases, which in turn will guarantee healthy citizenry and increase population health outcomes for national growth and sustainable development.
