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The many challenges of NHIS in Ondo

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Dr. Dayo Adeyanju

Dr. Dayo Adeyanju

The implementation of National Health Insurance Scheme (NHIS) in Ondo State has some peculiar constraints such as, poor sensitization, poor and irregular salaries and lack of political will on the part of government and critical stakeholders.

A civil servant in the state, Mrs. Remilekun Agbonmuserin, recounted her experience under the Scheme, which to her is one of the channels by which her income was drained, without any concurrent advantage to her and the family.

“I have never benefited from the free medical treatment. Aside having a family doctor, there was a time my kid was sick and he needed medical attention, we took him to the hospital and no one was on ground to attend to him. Why? The doctors were on strike. Yet, I still pay for the scheme.”

Executive Director of Kids and Teens Resource Centre, an Akure based Non Governmental Organisation (NGO), Mr. Martin-Mary Falana said the programme is good, but the awareness is very low among Nigerians.

“According to him: “It is a programme that the fund is supposed to be sourced from one per cent of government revenue, as well as, donor agencies, to provide basic minimum package of health services to citizens through the primary or secondary health care facilities, even some private hospitals too have been accredited.”

Falana also raised the issue of strikes by doctors and other health professionals based on the fact that they are either not paid or severely underpaid, which he said, have crippled the health sector for the past three decades.

“Non-payment of salaries and other benefits lead to nonchalant attitudes of health workers to the patients. Routine strikes disrupt the delivery of health services and lower the overall quality of the healthcare services. The government refuses to pay Nigerian doctors the salary they deserve; Nigerian citizens often have to resort to traditional medicine,” he said

He maintained that payment of better emolument for medical personnel would curb the incessant migration to foreign countries, including better working conditions.Meanwhile, the Chairman of Nigeria Medical Association, Ondo State chapter, Dr. Dolani Gbelela, pointed at lack of political will among the tiers of government and poor workers salaries as the bane of poor implementation of the Scheme.

However, he said, “If there is increased awareness of the Scheme, they will key into it, because that is the way to go. Invariably, if we must improve on health care delivery, we must have Universal Health Coverage; and if we have that, it can now be a better leverage for HMO to be more efficient than the way they are now.”

The NMA boss said poverty should not be an excuse for the poor implementation of the scheme, as long as it will take away the burden off anyone that is in critical need of health care.

“So I don’t think it is a thing the State Government probably wants to run away from it. It is just the way to go; either they are reluctant about it or not, it will definitely come to pass.”

Similarly, the State Commissioner for Health, Dr. Dayo Adeyanju, lamented the poor coverage in Nigeria, which he ascribed to the faulty structure of the scheme, being voluntary contribution rather than mandatory.

According to him, “Being mandatory will make it cover all the entire workforce that are in the formal sector and then have a way to make it mandatory for those who are equally in the informal sector through the various association.”

“I think the time is right for the country to fashion a better way for the scheme to work. In the history of the Universal Health Coverage (UHC), one of the global discussions is to make health insurance mandatory for everybody in this country.”

From a professional vantage point, the commissioner stated that political will is what is needed to make the healthcare mandatory for everyone but “probably, there can be subsidization of the premium, that is what I think the government can do. If the premium is a thousand naira, government can pay N500 out of it and leave N500 for the beneficiaries and make it mandatory for everybody so that we can pull resources for health.”

“This is one reason why people cannot take risk of putting their money in the NHIS because the health system they are supposed to put money in is not solid. And there is the rural-urban disparity in the health system, which often times poise a big threat.”


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