26 February 2020

The National Health Insurance Scheme (NHIS) established in 1999 with the mandate of extending health insurance to all Nigerians by the year 2015. However, a few defects in the legal, institutional and operational frameworks of the Agency impeded this Universal Health Coverage (UHC) quest, such that naturally the 2015 target was invariably missed.

Moreover, frequent changes in leadership of the Agency also proved to be a cog in its wheel of progress as many of its previous Executive Secretaries did not enjoy stable tenure to execute their policy directions to logical conclusions. Indeed, over the twenty year period of its existence, a total of twelve Chief Executives have mounted the saddle at the agency, making an average of 2 years for each CEO. In an environment of that level of instability, it can be seen that policy, strategy, corporate direction and focus are the first casualties.

However, this situation has not reduced the reality that the way to go for Nigeria was universal health coverage, which essentially means expanding healthcare coverage of high quality through effective health insurance to the citizens to achieve improved health care access and with financial protection.

Realizing the daunting tasks of achieving UHC by 2030, the strategic importance of health insurance to the Next Level Health Agenda of the present administration and the ambitious endeavor by Mr. President to lift a hundred million Nigerians out of poverty, the current leadership of the NHIS in collaboration with development partners, State Social Health Schemes (SSHIS) in 36 states and FCT designed a landmark policy framework that is bound to finally produce the elusive transformation of  the health insurance landscape in Nigeria.

Given the fragmented nature of the existing health insurance industry, featuring a wide array of actors , health insurance stakeholders, led by NHIS, recently unveiled Health Insurance Under One Roof (HIUOR) as a unique coordination framework that brings NHIS, SSHIS, Private Health Insurance Schemes and Health Maintenance Organizations (HMOs) under one coordination platform for synergy, effectiveness and efficiency of the landscape. The new coordination framework clearly defines roles and boundaries of operations by actors. The framework prominently features provision of high quality of health services to teeming population of Nigerians.

The new conceptual framework for health insurance in Nigeria is reinforced by five important pillars. The first pillar for achieving the much-needed turnaround in the health insurance space is garnering of political support for the new vision at all levels. In other words, this means stimulating political interest in the quest to reposition the health insurance landscape in the country. This will no doubt attract the needed investment for expansion of health insurance coverage based on the new policy framework. Another important pillar of the framework is transformed legal and institutional framework for health insurance in Nigeria. Legal and institutional frameworks that are compatible with international best practices are central to achieving institutional viability that will deliver the Health Insurance Under One Roof reform agenda.

The much-desired institutional capacity will remain a mirage without effective funding of health insurance operations and subsidization of the poor and vulnerable citizens that are not able to pay health insurance premiums. The new framework therefore identifies innovative sources of funding for health insurance coverage expansion and needed institutional arrangement for mobilizing additional resources. The HIUOR also harnesses and aligns new technology including Information and Communication Technology (ICT) towards supporting the ambitious goal of leapfrogging health insurance coverage in Nigeria.

The last pillar of the framework is strategic stakeholders’ engagement and partnership geared towards forging strategic alliances with wide array of local and international partners, with the aim of harnessing financial and technical support needed to reshape Nigeria’s health insurance practice.

The new framework is a product of a participatory process that brought a wide range of public and private sector actors in the health insurance space together and it will henceforth guide health insurance operations in Nigeria. HIUOR also provides a veritable basis for holding stakeholders accountable for expanding access to quality health services with financial protection nationwide.

As unveiling of the new health insurance framework marks the beginning of new chapter in Nigeria’s health insurance history, all hands must be on deck to set the country on the trajectory of Universal Health Coverage and set the stage for quality health access revolution in Africa.

–Dr Alawode is Programme Director, DGI Consult, Abuja.


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