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Kudos, knocks trail Health Insurance Scheme implementation

By Nkechi Onyedika-Ugoeze, Abuja
08 July 2017   |   4:17 am
Criticisms have continued to trail the implementation of the National Health Insurance Scheme (NHIS) almost 12 years after its take- off in Nigeria

Criticisms have continued to trail the implementation of the National Health Insurance Scheme (NHIS) almost 12 years after its take- off in Nigeria

For most enrollees, the scheme has not lived up to expectations, considering the fact that they still have to procure most of the drugs prescribed for them from the pharmacy, while chronic ailments that cost people their fortunes are not covered by the scheme.

NHIS was introduced by former President Olusegun in 2005 to reduce out of pocket spending for medical services and ensure access to affordable quality health care service by Nigerians. Despite setting a target of achieving universal coverage of all Nigerians by 2015, only about five per cent of Nigerians, mainly those in the formal sector (civil servants) are presently on the scheme.

But according to the Act establishing the scheme, it is supposed to encompass government employees, the organised private sector and the informal sector.

So far, the Federal Government has spent over N381bn on the insurance scheme since 2005 through deductions from the salaries of civil servants registered under it.

However, the implementation of the insurance scheme had in recent times been marred with allegations of fraud and complaints from some enrollees, who petitioned National Assembly complaining of non-delivery of services by Health Management Organisation (HMOs) and service providers.

When The Guardian visited some of the Federal government hospitals in Abuja, it was kudos and knocks for the implementation of the scheme after a decade.

An expectant mother, who identified herself as Mrs Uju, said it is a very good initiative, which should be sustained by government.

Uju who displayed her drug prescriptions and the NHIS receipt said, “these are the drugs prescribed for me by the doctor and NHIS is paying 90 per cent of the cost while I pay 10 percent. This is the second time I am using NHIS for child delivery so personally, I have not experienced any challenge with NHIS. As a pregnant woman, if you are under NHIS, the antenatal is free. Delivery is free whether vaginal delivery or cesarean section. Almost all the laboratory tests are free. So the scheme is very good and I am enjoying it.”

Another enrollee, who uses Healthcare, told The Guardian that from his personal experience, the scheme simply covers only cheap drugs.

He said:   “When you want to do certain test, they will tell you that it is not covered by the NHIS. I had an experience the other day, I wanted to do a particular test, the cost was N25,000.000 and I was told that it is not covered by NHIS and I had to pay from my pocket. I was also told that some of the drugs prescribed by the doctor are not covered. I was told that NHIS covers only generic drugs. I discovered that once the cost is beyond a certain amount, they will tell you that it is covered by NHIS, in fact NHIS covers only cheap drugs. Government should review the scheme so that it cover every drug so that subscribers will enjoy a complete free medical services.

“After all, they deduct money from my salary every month, but it is not every month that I visit the hospital. I have been in the scheme for so long, but this is the first time I am visiting the hospital due to the health challenge I started experiencing some weeks ago, so this is my first time of using NHIS.”

A cancer patient, Ali said the essence of the scheme has been defeated as people still pay from their pockets. Narrating his experience, Ali said, “ they always tell you that some drugs are not covered and I end up buying from the pharmacy. Cancer drugs are supposed to be covered but they are not, if drugs for cancer, diabetes and HIV are not covered by scheme, then what is the essence. I have prostrate cancer.  Also the stress involved is another thing.”

A patient in the orthopedic unit, who has been in the scheme since its inception in 2005, said she prefers to buy her drugs from the pharmacy than going through the stress of the scheme.

Her words: “I hardly use the scheme because of the long protocol, they make you go up and down, the trouble is much. So, I prefer to go to pharmacy and buy my drugs, when I consider the stress. I feel it is not worth it. I have been in the trauma section, they referred me to this place and I have been here for over 30minuites waiting to get this, how much is it? When I consider the stress, I do my stuff outside. Also, the way they treat NHIS patient is bad. There is this attitude of “after all you are not coming with money, they forget that the money has been taken in advance.”

She urged government to review the scheme to enable it cover all ailments.

“It should cover every sickness because if some are covered and others are not, it is giving them the opportunity to tell you that it is not covered even when it is covered. So they should make the scheme cover every ailment and ensure that the drugs are available. That is how it can become effective.

‘In the past a lot of drugs were not covered but I think they have reviewed it and so many drugs are now covered. I think there is an improvement. But what I am carrying these POP materials are supposed to be covered but they don’t have it so I bought it outside. But the treatment is free, I did not pay for consultation or for X-ray,” she added.

But for Danladi, the scheme is a laudable but its implementation has been compromised due to the failure of the NHIS to play their regulatory roles

He said: “I cannot describe the NHIS scheme as a fraud, but its implementation cannot be totally exonerated from fraud. I am a living witness of the setting up of the programme and an active participant in it. But I can categorically say the implementation had been another fraudulent means to siphon our hard earned money. At times you get to the hospital and they’ll tell you they can’t give you a particular drug (or service) because your contribution did not cover it.

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