‘Nigerians do not need free health but access to care’

Prof. Mustapha A. Danesi is a consultant physician/neurologist at the College of Medicine University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH). Danesi in this interview with The Guardian said health insurance is the veritable solution to achievement of affordable healthcare and universal health coverage. The neurologist said Nigerians do not need free health but free access to health. Danesi said free access to health is only available to those who have a lot of money. CHUKWUMA MUANYA writes. Excerpts.

Despite efforts by previous administrations, only about five per cent of Nigerians have a form of health insurance. Why?
The reason it is so because of the way the health insurance was started and the way it is been run by the authorities is what made it to be like that. For example the five percent you are talking about now are largely the federal government employees because the health insurance was launched in 2005 after the Health Act of 1999. When they launched it the federal government guaranteed that all his employees would be enrolled. They decide to put them on it with the initial idea that they will contribute five percent of their salary while government contribute ten percent of their salary into a pool whereby they are covered with their wives and four children. And this was what happened and that was distributed to different health management organisations (HMOs) and since then very few people or organisations have joined and it is not growing.

One of the reasons why it is not growing is that most state governments do not buy into it; it is not that they are not interested but the structure and the template that was given to them by the national health insurance scheme (NHIS) made it unattractive to states. For example I knew a few states that, what the insurance agency did was, okay give us the money. They collected money and some states paid money into the health national insurance agency in other to run their insurance for them but it collapsed. Some states where skeptical that there was so much fraud and corruption at the agency, so they did not join. This was a faulty template so right now the states have not bought into the programme so apart from federal government employees and a few private company that are into it, very few are into it, and the solution to this is obvious. In states, health is in the concurrent list of legislation. The states need not deposit money in the federal coffers. They should have their own laws and health insurance agencies. The state house of assembly has the right to legislate on health issue because health is not on the exclusive list of the federal government.

Lagos, Cross River, and Delta States have passed law now to have their own insurance agency, and I can tell you that if all other states follow suit and have their own laws and decide to do insurance within the state. The percentage will rapidly rise. The second thing is of course low enrollment is that that the law itself do not really make it mandatory if you. Read the law, it just encourages one to decline. Perhaps we have to decide there is no doubt that the only way to go in this country, if we want to make health care a viable business, is to make health insurance system compulsory like other countries are doing. So they all need to be looked at so that they can make it mandatory and even the states should make it mandatory.

What suggestion do you have for the National Assembly on the review of the NHIS Act to make the programme mandatory?
The National Assembly has so many issues on their desk but I believe they need to look into that law very well and if they want to revise the law of course they can have public hearing all stakeholders can come and give their own opinion even the users and the company that uses them can come and give their own opinion so that the law be revamped to make it much more better

Why the hype and push for universal health insurance?
Health insurance is very important in fact what I can say is that we underrate the importance of health insurance even the government and the politicians they are not too keen on it. Usually the average politician will campaign to his people, vote for me I will give you free health. Most of the them campaign on the issues of good health and giving people free health, and when they are voted in they try to give what they thought is free health and that is subsidised healthcare. You see in the general hospitals, you pay a token amount; you see the doctor and get the prescription. But the problem is that it is not free health that the people need. What people need is access to health, free access to health right now.

There is no free access to health. There is free access to health to those who have a lot of money. An example is that even here in LUTH, you see someone trying to see us in the clinic; they will leave home by 4am and will come and line up. They will take his card by the time it gets here and see the doctor it is already 2pm. Then prescription will just be given and a whole day is spent just to see a doctor. And that is not good access. Free access to health is when you are having health issues you go to the doctor then within few minutes you receive quality care. Health insurance is the only way you can have free access to health and that way the teaching hospital or the general hospital will pay N500 and if you go to private hospital you pay consultation fee of about N5000. So most people will rather go and line up the whole day at general and so that he can see a doctor. Whereas if everyone pays premium for health insurance cover, you are not bothered about the fee any longer because that health insurance covers your fee, whatever it is.