As stakeholders in the health sector continuously advocate for the enrollment of more citizens into the National Health Insurance Scheme, it is necessary to consider some limiting factors that could hinder the effectiveness of the NHIS Scheme. One of such limitation is the infrastructural gaps in the health sector. It is no longer news that poor infrastructures have been the bane of Nigeria’s health systems. As a result of this a lot of Nigerians seek medical attention abroad. Only very few government hospitals have the required facilities to treat secondary health cases. Considering the health burden of Nigeria with over 200 million population, the teaching hospitals, general and specialist hospitals are usually over stretched. The crowd at the various secondary health care facilities would have been reduced by 70 percent, if the Primary Health Care centers are revitalized and made functional. Another limitation is that of personnel, there are inadequate personel at the Health Care Facilities. The doctor to patient ratio in Nigeria is one of the lowest in the world. Despite the paucity of personnel, available health care workers are seeking greener pastures abroad. The past three years have witnessed huge number of doctors who left Nigeria for oversea jobs in droves. The situation is already affecting users of NHIS in various government hospitals.
Enrollment into the NHIS has a lot of benefits compared to out of pocket expenditure for health. The co-contribution of funds by government and its employees into the NHIS pool have saved a lot of government workers from the risk of financial burden in the assessment of health care. However, visitation to any of the general, teaching or specialist hospitals reveals the large number of patients experiencing delays while seeking medical attention from the facilities. A protocol of routine has to be observed before a patient registered under the National Health Insurance Scheme gets care from the hospitals. For every round of attention they seek from the Health Care Facilities an approval from the HMO must be obtained. The problem is not with getting the approval but the waiting period, wish is usually occasioned by large crowd of persons waiting for the same purpose. The average waiting period for each round of approval is usually between 30-40 minutes. Most times delays are experienced from the HMOs who might not be proactive enough to respond to requests for approvals on time. An estimated time expended by an NHIS patient in any government hospital is usually between 5-6hrs before they can conclude activities leading to such visits. The over-stretching of facilities and medical personnel working at the secondary and tertiary HCFs is responsible for these delays.
To avoid delays most registered NHIS patients who have the capacity to pay from their pocket, takes it as an option. The situation would get worse if the enrollment rate of NHIS increases beyond the current 5 percent of the population. The teaching, general and specialist hospitals may not be able to accommodate an additional 40 percent of Nigerians who chooses to register under the NHIS. With the signing of the National Health Insurance Authority Act, which makes provision for every residents of Nigeria to compulsorily belong to one form of health insurance, whether formal or informal, it is time to improve the health infrastructure and human resources for health. If not the implementation of health insurance scheme would experience a setback.
To avoid this, there is need to prioritize investment on health at the Primary Health Centers. The PHCs are located at the various wards and local government areas across the country. However most PHCs are short staffed and lacks the required facilities for in-patient and out-patient care. Despite the fact that the PHCs are closest to the people, Nigerians still develop penchant for the use of PHCs due to the infrastructural decay and poor quality of care at that level. For Nigeria to achieve massive enrollment into the health insurance scheme, the Federal, State and Local Government needs to collaborate, to revamp the PHCs and provide it with qualified health workers. The PHC’s must adopt basic standards for measuring quality of care, facilities and personnel’s. It must be run efficiently and effectively with core accountability mechanisms put in place to checkmate its operations. Where necessary, more PHCs should be built and properly equipped with staff and facilities, while existing ones be revamped to meet up with the required standard.
Staff welfare of medical workers at the PHCs must also be prioritized and the facilities at that level must be continuously maintained. The National Health Insurance Authority should commence massive enlightenment and sensitization of Nigerians on the appropriate levels of health care offered at the secondary, tertiary and primary care centers. It should also work with the Health Maintenance Organization to register enrollees under the NHIS scheme in at least one PHC, provided the facility is upgraded and accessible to the enrollees. Until these recommendations are implemented, it would be difficult to achieve massive enrollment of Nigerians into the National Health Insurance Scheme
Victor Emejuiwe
Program Manager (Good Governance)
Writes from
Centre for Social Justice, Abuja
08068262366
