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The many challenges of health insurance in Nigeria, by Nnamani

By KINGSLEY JEREMIAH
08 October 2015   |   12:39 am
Health insurance Penetration in Nigeria is still very low what do you think is responsible and how can this be resolved? The low penetration of health insurance in Nigeria has for a long time been a topic of discussion. First of all, the understanding of the populace about insurance is poor. Nigerians are yet to appreciate the essence of insurance in general, and health insurance is not exempt.
Dr. Dorothy Jeff-Nnamani

Dr. Dorothy Jeff-Nnamani

Dr. Dorothy Jeff-Nnamani is the Chief Executive Officer of Novo Health Africa Ltd, a firm accredited by the National Health Insurance Scheme (NHIS) with the objective of providing health care delivery solutions across Nigeria and internationally through collaborative partnerships. Being in the industry for several years, Dorothy Jeff-Nnamani discusses with KINGSLEY JEREMIAH some of the challenges confronting the industry and the way forward for the health sector in Nigeria, particularly health insurance. Excerpts:

Health insurance Penetration in Nigeria is still very low what do you think is responsible and how can this be resolved?
The low penetration of health insurance in Nigeria has for a long time been a topic of discussion. First of all, the understanding of the populace about insurance is poor. Nigerians are yet to appreciate the essence of insurance in general, and health insurance is not exempt. Religious and cultural factors further worsen this negative perception. Culturally, preparing for unforeseen unfortunate events is seen as an invitation to ill luck or ill health…and we see this everyday even in the urban areas and among very educated people.

Then again, Nigeria operates a system of federalism in which case different tiers of government have certain reserved powers. While the federal government has moved to insure federal public servants, many States are yet to do same at the State level. It should be mandatory at all levels of government so that everybody can be captured under one umbrella. Again particularly in the rural areas, the low penetration may be related to gross infrastructural deficiency. Health insurance removes financial barrier in accessing health care.

If you have other barriers to access, it means that solving the financial aspect does not necessarily bring healthcare to your doorstep when needed. The scheme would of course be considered dead on arrival and this is not the kind of outcome intended or objective of the scheme. When proposing health insurance you are also going to be providing hospitals and health personnel to give required care.

A significant number of the population resides in the rural areas and if you get to talk to the people in the rural areas about health insurance their immediate response or question is on available health facilities and drug stores. Most of them don’t have access to hospitals. They need to see the benefits of what they are keying into, so even if government subsidizes healthcare, there must be available infrastructure as well as the human capacity.

So, what is the role of awareness and orientation in all of these, do you think the NHIS has really done its job well in those aspects?
NHIS has done a lot in the areas of awareness and orientation. They have used various channels in efforts to improve penetration; they have also carried out advocacy visits and provided support at different levels of government. There is however an existing channel that I think should be harnessed properly and strongly focused on.

This is more grass root oriented and strong community participation. A number of community based health insurance (CBHI) scheme has been developed and I think there exists more opportunities. Nigerians are socially active people. Everyone belongs to one social group or the other whether formally or informally as a form of protective umbrella. The groups do cater for their members’ social welfare and in most cases members make some commitments as mandated by the group. This can be leveraged to create awareness and link many groups on the larger community level. The health insurance program will be built around and championed by the groups which ensure clear understanding, acceptability, strong community participation and ownership. The community needs to know that their health insurance program is not just one of those government handout programs.

They must become part of the decision makers in a very simplified manner and enjoy the benefits of participating in the scheme. NHIS has also done a lot to encourage participation of various players in the health insurance space. This has brought about creativity and innovation which of course creates and deepens awareness.

What’s your take on the national health Law?
That is history made. A milestone attained. It was long overdue and all health professionals welcomed the development notwithstanding the few initial bottlenecks. It will help to organize and streamline participation in the health sector. The next step is towards the implementation. Except for the few committees that were constituted by the former minister of health nothing much has happened. Now we are expectant of the implementation because it addresses challenges in the health sector to a large extent, and tells us who should be held responsible for what. I can’t say it is comprehensive enough but for starters, we are happy with it. As the implementation goes on, there will be reviews and it can only get better.

What are the strategies the new administration must adopt to improve health insurance in Nigeria, looking at the health law?
The new administration must appreciate and understand the economics of health care. Health insurance is a type of healthcare financing which in itself is also one of the veritable tools to improving a country’s health picture. So to improve health insurance is to improve the overall health care sector.

All the drivers work hand in hand. We cannot make any significant progress on the health insurance situation if the challenges on infrastructure and human capacity persist. We cannot improve on health insurance if doctors are not well paid and keep going on strike. We cannot improve on health insurance if the Nigerian public does not trust the existing medical professionalism and skill in the country. We cannot improve on health insurance if choice is limited and patients’ rights are not protected. The health law puts all this in perspective. It is left for government to follow up with immediate implementation. Also important for growth and sustainability is for government to attract the private sector to the healthcare space.

The future of healthcare in Nigeria does not lie solely with the government, not now, not in the future and not ever. To make remarkable sustainable changes, private sector participation must be encouraged and supported. This is not just in areas of hospital ownerships but across the value chain in healthcare to unlock the inherent potentials. The health sector is a very important part of the economy with huge potentials on its own and also in support of the other sectors. We must have learnt from lessons from the past that all the so called free this and that are not sustainable by government and in many cases are hijacked. Please don’t get me wrong…I am not saying there won’t be charities or missions etc. after all they exist in other sectors too. You have bonanzas, promos, whatever.

What am saying is the private sector should be encouraged to play in health sector. When we have an organized health sector, specific government and non-government programs designed to target the citizens according to their ability to pay will reach the desired segment and achieve desired results. Wastages will be significantly reduced.

With your experience in this industry, what are the challenges that have crippled the growth of health insurance and finance in Nigeria and what do you see as the way forward?
Well, luckily a lot of challenges are now in the past and we are still hopeful that others will be surmounted. It is a matter of breaking old habits. In the past health costs/ pricing were set randomly and direct fee paying method was used by patients where they made payment direct to the providers. Health insurance as a form of health financing is now widely accepted as many Nigerians continue to see the benefits. Secondly medical practice globally is moving towards patient centered care and providers are beginning to partner with both patients and the HMOs to find the best choice of treatment for the patients. Decisions for care are no longer made by doctors alone.

Patient-doctor interaction and a culture of adherence to first-line treatment protocols is promoted. This makes financing through health insurance less complicated and transparent. All stakeholders work with the patient utmost care in mind. Once stakeholders start working together many of the seeming challenges will disappear leaving the health insurance industry better opened for business and of course consequent growth.

What are the relationships between maternal, infant mortality rate and health insurance?
The relationships are all intertwined in the ability to access care. Women and children are considered amongst the vulnerable groups in our society.

Therefore providing a window through health insurance whereby they can have unhindered access to healthcare will help reduce infant and maternal deaths. Many of these deaths occur during child birth and linked to inability to access adequate care due to financial constraints seen in other methods of health financing. Health insurance removes this financial barrier and women can deliver safely in a hospital environment and get the necessary nursing and after birth care. The health insurance plan designed by NHIS covers childhood immunizations, pediatrics treatment, antenatal and delivery services, gynecological and obstetrics care.

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