Shehu: Why states are reluctant to implement health insurance

Doctor Abdulrahman Shehu is the Chairman of the Nigerian Medical Association (NMA), Kaduna Sate chapter. In this interview with SAXONE AKHAINE, Northern Bureau Chief, he explained why the National Health Insurance Scheme (NHIS) has not taken root in the country and the challenges facing state governments in implementing the scheme.

What benefits do you think Nigerians can derive from the National Health Insurance Scheme (NHIS) if properly implemented?
In real terms, the objective of health insurance is to make possible an avenue such that healthcare needs of the people are met at the minimum possible cost. So, to be more specific, the objectives will include, ensuring that the populace are relieved of financial burden of huge medical bills and by so doing, you must also have limited the cost of healthcare services.

The Scheme is also another opportunity to redistribute the healthcare cost among different income groups. You know, of course the populace have different incomes, so, with health insurance you are able to redistribute the cost of healthcare across income groups so that the people who are having less would have a share of their health burden borne by those who are earning more. So, the essence of health insurance is to provide alternative financing for the cost of healthcare. These are some of the benefits that Nigeria and Nigerians can get from applying health insurance policy.

What is going wrong with the operation of the scheme?
Usually as you know, once you set out with any programme, you have objectives, but as soon as you are not able to meet your objectives, this is one of the major hindrances, of getting people to believe in the programme. When health insurance was introduced in Nigeria, it was very promising and, because it has been practiced elsewhere- in UK, US etc. In those places there are various forms of health insurance. Nigeria decided to embark on the easiest one at that point in time to start with the formal health insurance programme. That was essentially what the health insurance scheme was mostly about. But, along the line they also now brought in some forms of non-formal health insurance, in which case, the health insurance scheme now find a means of providing a coverage to people who are actually not in the formal sector. And so, it was supposed to be an idea that evolves from the formal sector and transcends through the non-formal sector and to even the informal in the community as it were.

But, unfortunately even within the formal sector, don’t forget that one of the objectives is such that the aim is to ensure that the citizens are helped to bear the cost of heavy medical bills. But, within the formal sector it happens such that the scheme was unable to cover certain essential health bills, which are hitherto on the high side, and which it would help the citizens to bear. So, if the citizens cannot bear the cost, for instance of cancer treatment and the insurance is not covering cancer treatment, if you are a citizen will you be encouraged to underwrite such insurance scheme? That will likely be no. That is one problem why our insurance scheme has not improved more than what it is today.

Secondly, if the focus as it were now in the formal sector, people who are employed in federal service, it means that state civil servants are out, it means that once the civil servants are out, so until we are able to expand the coverage from just formal sector, to include non-formal sector, and incidentally get into community health scheme you will now be able to expand. So, as it is now there is no much reasons or ground to expand into community health insurance scheme, and that is greatest impediment to the growth of our insurance scheme.

What is the response by people in Kaduna State?
I think people generally, will happily accept the healthcare financing option that will lessen the burden of the bill on them. You see, only few states that have actually attempted to key into the process. As it is now we have only two states in Nigeria that have adopted the health insurance scheme programme. And they have recorded some successes. We are even aware of a private organization that has carried out a small health insurance scheme in one community that was by medical doctors.

People are seeing that health insurance is an alternative, the only problem is the implementation. Now many times, those in the formal sector, those in the federal civil service when they get to the dealers they run into the difficulty of services being delivered to them. Either that they don’t get the services or that they don’t get coverage of such services and so it becomes so difficult. Why are states finding it difficult to key into it? Simple. I have already stated some of the challenges faced at the federal level on the insurance scheme.

So, if states are going to face some of those challenges it will be very difficult to be able to get patronage of civil servants in the states and community members. As soon as you go out there and you tell people that you coming up with a scheme that will provide alternative for health care and you have rolled out the coverage and people have subscribe then you are bound to provide the services within those coverage.

If anything happens, it is your responsibility as provider to ensure that those services are offered to the target population. I think it is the health bill burden that most state governments are looking into and it is bit scaring for them. But, what we are suggesting is that you can bring in those private practitioners and agencies that can give grants, and once those one comes in they will help to reduce the burden on the states government.