Nigeria’s healthcare in danger – Part 2
From the pool of funds from everybody, payment will be made to treat the few who fall ill. Most of the time, the medical bill paid on the average contributor to the pool is a lot higher than what the person contributed, and far less than if the person was paying out of pocket as a private patient. This is what health insurance does.
The biggest challenge facing the health insurance programme in Nigeria is the fact that less than 10% of the population have been covered. Until the scheme covers majority of the people, the benefits of health insurance will not be reaped. On account of the very low population participating in our health insurance programme, capacity is low. This is made worse by the wanton behaviour of some of the operators of the scheme who flout the rules for undue personal and corporate gains, HMOs and providers alike.
On the whole, the providers, the real actors, who interface with the patients in their state of ill health and who face the full brunt of patient care are very unfairly treated by some of the HMOs. These providers are owed unduly and often treated with impunity to worsen matters. The providers are the burden bearers of our entire health insurance experience and deserve to be appreciated.
The providers are the Doctors, Nurses, Pharmacists, Radiographers, Laboratory Scientists, Physiotherapists, Optometrists, etc. They are the ones bearing the burden of our dysfunctional health insurance system. As already stated, the greatest challenge facing these providers is the monster of majority of the HMOs failing to pay them as and as at when due. Their bills are frozen in the hands of the HMOs for several months and sometimes, years. That is the impunity that prevails here.
In a nutshell, there are three arms to the running of a health insurance scheme in Nigeria:
1. The National Health Insurance Scheme, through its council, regulates the operations of the program.
2. The Health Maintenance Organizations (HMOs), manage the scheme by accrediting providers; hospitals, pharmacies, diagnostic centres, etc., and monitor them to ensure continuous quality improvement and the delivery of efficient services. They also receive the money to pay providers as and at when due.
3. A sick person needs attention immediately and gets the attention as and at when due.
The good HMOs pay the providers as and at when due. But this group of good HMOs are in the minority. The rest owe providers recklessly and with impunity and this is the greatest challenge facing our health insurance operation.
To help build awareness, grow the critical number and help our health insurance programme succeed, the ANPMP is championing a nationwide campaign to educate and sensitize our governments as well as Nigerians to support the scheme and register. This way, the scheme will enroll the critical population and function effectively and efficiently and Nigerians will spend less and become healthier.
This is our Awake Nigeria; project 2030 campaign. It is our effort to support our government to actualize Universal Health Coverage by the year 2030. The ANPMP is also driving the save one million Nigerian mothers initiative. This project is aimed at helping to reduce the very high Maternal And Infant Mortalities in Nigeria, a situation where more pregnant mothers die in Nigeria than in most places and more children die here before their fifth birthday than in most countries of the world.
A N10 billion private sector healthcare intervention fund raising to support the project is ongoing. Donate to this fund as we approach you and together, let us restore dignity into our healthcare space. As I write, the average provider under the health insurance scheme in Nigeria is providing services to his patients at a loss. With our sick and slumbering economy and the somersaulting Naira, made worse by the COVID-19 pandemic, the cost of every item used to provide services in the hospital, ranging from medications to consumables and laboratory reagents and medical devices and equipment has gone up by more than five times over the last three years but most people do not expect medical bills to go up. Nigerians accept to pay more for everything in the market including “pure water”, but are irate and often on the offensive when medical bills are involved.
We bear with our poor struggling Nigerians and feel their pain but appeal to them to understand that whatever affects cost of general goods and services affects cost of medical services. Healthcare providers in Nigeria do not enjoy any form of subsidy or protection from the system. Hospitals buy from the open market like everybody else.
The doctors are not responsible for the bad economy. They are even worse hit. They therefore do not deserve the unfair treatment sometimes meted out to them by some members of the public when payment for medical bills is an issue. A functional health insurance will protect every Nigerian from the pains of paying medical bill from our pockets. Let us support it.
Seven years ago, The NHIS approved a capitation of N750 when the dollar was exchanging for n150. Today, the dollar is exchanging for N600, the medical services tariffs remain the same. Let somebody out there give us the economic concept that best defines this scenario as we find it difficult to understand. All we see and experience is devastation; essentially spending more than we earn and posting losses at the end of the month.
This is certainly not a characteristic of a functional health insurance, the type we advocate. Health insurance is meant to build the health industry in all ramifications not to compromise it. The experience of providers in all these and more, is seriously contributing to the medical brain drain. When providers can no longer meet their basic needs from their practices, they shut down and join the queue to leave the country.
The present leadership came with a transformational agenda that has taken the agency to high pedestals. It has brought discipline and accountability especially introduced the concept of non-indebtedness where HMOs are meant to get letters of non-indebtedness from providers before they can be eligible for several entitlements including accreditation by the NHIS.
These are commendable strides and are gradually taking grip. I commend the leadership of the scheme and encourage providers to take advantage of these regulatory provisions. The performance of this leadership gives us hope that the Health Insurance of our dream is soon to be established. It encourages us to keep the up with drumming support for UHC.
Poor, struggling Nigerians deserve more than they are getting. They find it difficult to pay medical bills out of pocket and often take it out on innocent doctors who are there to help. Our health insurance system needs to work the way it should work to save Nigerians. As a people we must not accept that we can’t afford to be decent, responsible and given to integrity, the cardinal pillars of interpersonal relationship and human existence and so, we must strive to live above board in all things and at all times.
Our population and our economic potentials make the successful implementation of health insurance readily achievable if the political will is there and personal and corporate discipline is given a chance. Health insurance is the way to go. I enjoin Nigerians of all walks of life to support government effort in this direction, support the program and register to be covered. Every Nigerian that registers for health insurance brings us closer to the attainment of Universal Health Coverage (UHC).
Our government on its own must demonstrate visible and palpable political will to make our health insurance scheme work. Nigerians truly deserve the best from her sociopolitical ecosystem.
Odo is national president, Association Of Nigerian Private Medical practitioners (ANPMP).