Separating health insurance from constituency projects
Attempts by the House of Representatives to broaden health insurance and its benefits to Nigerians deserve closer attention, given that the National Health Insurance
Scheme, if well implemented, can make a difference between life and death of many hapless citizens. It is not in doubt that the country is among those with very poor healthcare system, both at the primary and higher levels; a fact that has resulted in untimely deaths and health complications of millions of ordinary Nigerians who are too poor to afford reasonable healthcare; while the more privileged members resort to medical tourism abroad, even for simple ailments. Governments at all levels clearly need to do a lot to extricate the country from its present health quagmire. But the plan by the Representatives to tie health insurance to constituency programmes raise doubt about sustainability of the scheme, besides being a novel system that is at variance with global best practice.
The House of Representatives recently approved the inclusion of National Health Insurance Scheme (NHIS) in the constituency projects of lawmakers. The Lower House argues that this step will improve health care service standard, because both the lawmakers and their constituents will demand satisfactory services from the scheme. They also explained the workings: Legislators are to choose beneficiaries irrespective of status; and a lawmaker can sponsor 1000 people yearly at the cost of N10 million or N15 million up to 24 calendar months.
While compulsory health insurance will provide a pool of resources required to provide decent health care for Nigerians; turning National Health Insurance Scheme (NHIS) into a constituency project for legislators, raises issues around sustainability and access, which are critical for positive outcomes in the search for solution to the challenges in the health sector, especially as they affect the grassroots.
Commendable as the lawmakers’ intention may be, a piecemeal approach without a sustainability plan may not deliver to Nigerians a ‘healthy’ and accessible health care service. The legislators should be concerned that all Nigerians deserve adequate health care, irrespective of their party affiliations. Indeed, it is the intendment of the constitution of Nigeria that all Nigerians have access to good healthcare no matter their status. Making health insurance a part of constituency projects will invariably politicise healthcare unduly, to the detriment of many citizens.
Furthermore, what model are legislators using for making NHIS a constituency project? A look at the workings of NHIS in other countries, will point to the right direction on the workings of the scheme, which a publicly funded health care financing designed to meet the cost of all or most health care needs from a publicly managed fund.
Some countries with significant public funding of health care are Canada, United Kingdom, Brazil and India or through a government social security system as in Australia, France, Belgium, Japan and Germany with a separate budget and taxes or contributions; and the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. Again, when taxation is the primary means of financing health care and sometimes with compulsory insurance, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors.
In England, the National Health Service (NHS) is a publicly funded nation health care system; primarily funded through the general taxation system with a small amount being contributed by National Insurance payments and from fees levied. It is overseen by the Department of Health and provides health care to all legal English residents, with most services free at the point of use. Some services, such as emergency treatment and treatment of infectious diseases are free for everyone, including visitors.
So, the proposal to use NHIS to improve access to health care is a welcome development, but making it a constituency project will unduly politicise the scheme and deprive many people of its benefits. The English model could be adapted and contextualised, working with experts such as the Nigerian Medical Association (NMA), Nigerian health professionals and experts in the diaspora, health professional organisations, development agencies, health related not-for-profit organisations, ServiCom, Consumers’ Protection Council of Nigeria (CPCN) and other relevant regulatory bodies as applicable. This strategic participatory solution can lead to more people having access to quality health care at a lesser cost; and also reduce health tourism.
ServiCom is important because service excellence is not a common thing in the country’s business environment. Even, the front desk staffers at some service points are not properly trained in the culture of excellent service. As such, Nigerian customers have ‘no right’ and are not respected, despite the fact that they are the live wire of businesses. This is a national tragedy!
For instance, a PwC survey of Nigerians found that more than 90 per cent of respondents associated with advanced health care delivered in Nigeria with ‘low quality’. The Survey further stated that this has been established over the years through personal experiences and those of others, media reports and the visible state of disrepair in health care infrastructure. Apart from the clinical function (effectiveness of care provided in hospitals, there are also the issues with the hospitality function (aesthetics and ambiance of hospital, courtesy of staff). Hence, the need to contextualise solutions and continuously invest on facilities upgrades and organisational culture change.
Obviously, restoring trust and quality service in Nigerian health sector goes beyond health insurance. As such, duty bearers and the National Council on Health should realise that quality customer service will improve quality of Nigerian life and economy and push for the institutionalisation of service excellence in the health sector.
Hence, there is need for total quality service; and seamless service delivery in the sector. So, ServiCom, Consumers’ Protection Council of Nigeria (CPCN) and other relevant regulatory bodies as applicable, should rise up to this occasion to ensure that the Nigerian health sector is customer centric and have service delivery road maps.
Thus, NHIS in Nigeria should be a holistic scheme that would address the health needs of the poorest of the poor Nigerians, who die because they do not have money to treat malaria. The National Assembly should rethink the proposal of making NHIS a constituency project and act for the good of all.