Medical Experts have pinpointed reasons behind the minimal uptake of health insurance in Nigeria, even though the Federal Government made it obligatory for all citizens and legal residents via the National Health Insurance Authority Act of 2022.
The National Health Insurance Scheme introduced in 2005 has been superseded by the NHIA in 2022.
Even though the name has changed, the available information indicates that fewer than 20 million Nigerians are included in the health insurance program in a nation with more than 200 million inhabitants.
As stated by the NHIA, only 19.2 million individuals have signed up for health insurance plans since 2005.
The experts cited low health insurance enrollment among Nigerians due to inadequate awareness, distrust, systemic inefficiencies, and financial constraints.
In a separate interview with PUNCH Healthwise, The senior public health specialists stated that approximately 90 percent of Nigerians lack coverage from any type of health insurance.
They mentioned that this development was increasing dependence on personal expenses for healthcare, which has been recognized as a factor contributing to poverty among Nigerian families and deteriorating the nation’s health statistics.
A Public Health Physician at the University of Ilorin, Professor Tanimola Akande, identified ignorance, poverty, and lack of trust in government as major reasons for the poor health insurance uptake.
"There has been a minor uptick recently in health insurance coverage. Nevertheless, nearly 90 percent of Nigerians remain uninsured according to Akande," he stated to our reporter.
The public health professor stated, "Healthcare coverage varies significantly across different regions in Nigeria. Several factors contribute to this inadequate coverage: lack of knowledge about the advantages of health insurance programs, economic hardship, limited availability of high-quality healthcare services due to poor infrastructure, and insufficient efforts to educate people about these issues."
The ex-National Chairman of the Association of Public Health Physicians of Nigeria pointed out that despite being knowledgeable about these programs, numerous individuals feel disheartened due to their beliefs regarding the standard of healthcare offered. "A significant obstacle is the absence of faith in the government’s ability to deliver high-quality medical services post-enrollment," he emphasized.
Akande pointed out that the difficulties faced by those in the informal economy and people living in rural areas were exacerbated by inadequate mobilization efforts and different healthcare-seeking practices.
"The key elements for involving the informal sector revolve around low awareness of the program and its advantages, as well as inadequate engagement with this group. Additionally, limited availability of good healthcare services in remote areas plays a significant role," he stated.
"The significant support for complementary medicine over conventional treatment by these individuals is also a crucial aspect," the public health professor mentioned.
Akande suggested implementing comprehensive reforms and effective communication strategies to restore confidence. He stated, "In order for the government to enhance trust within the presently fragile public health infrastructure, they must guarantee that resources are properly and fairly distributed across the nation."
He emphasized the importance of hiring experienced staff, improving infrastructure, and ensuring a steady availability of medications and medical supplies. "Moreover, the administration should implement multiple approaches to promote public awareness about healthcare and encourage people to participate in health insurance programs," Akande stated.
As for Professor Adebayo Onajole, who specializes in Community Medicine and Epidemiology, he points out that the low usage rate can be blamed on the financial burdens and administrative obstacles encountered by many Nigerians attempting to utilize their health insurance.
numerous Nigerian individuals run their own businesses and do not receive their income in large sums at once. Additionally, navigating the administrative processes can be overwhelming. For instance, one must consult with service providers and obtain documents from Health Maintenance Organizations (HMOs). This level of complexity may prove challenging for people who lack sufficient education to easily manage these steps.
"And once they reach the providers, these individuals are told by the provider, 'This service is covered, but this one isn’t.' Due to their lack of understanding about the extent of their coverage, many end up feeling let down," he explained.
Onajole highlighted a lack of transparency in insurance policies, noting that many individuals still face higher out-of-pocket costs despite being officially covered.
It’s a field where payments are being made; I mean, for those who have coverage, yet there isn’t clear information about what exactly is included. Often enough, the amount paid exceeds what should theoretically cover the services.
He similarly called out the inefficiencies within Health Maintenance Organizations (HMOs), stating that the strictness of their claim procedures often leads individuals to give up entirely.
"However, overall, insurance remains the best option. It works through pooling resources and sharing risks," he stated, simultaneously advocating for more rigorous oversight of Health Maintenance Organizations (HMOs) and healthcare providers to guarantee adherence and responsibility.
Experts suggested large-scale awareness initiatives, active community participation, and more stringent rules to enhance coverage in the upcoming years.
The don stated, "For the realization of Universal Health Coverage (UHC), the administration must significantly expand present initiatives focused on attaining UHC within the nation. While the creative approach of employing the Basic Health Care Provision Fund for covering low-income and marginalized populations is commendable, it should swiftly be escalated by boosting the allocation from the Consolidated Revenue Fund to a minimum of two percent."
On his end, Onajole urged for immediate changes.
“The don stated that various approaches should be implemented, including anonymous ones, to assess their effectiveness and identify gaps. It’s crucial to continually review and rectify these discrepancies.”
Efforts to expand are in progress – NHIA
In the meantime, the NHIA states that there are initiatives and reforms intended to broaden the scope, inclusivity, and effectiveness of healthcare coverage throughout Nigeria.
In discussions with PUNCH Healthwise, Dr. Kurfi Abubakar, who serves as the NHIA Director of Planning, Research, and Statistics, mentioned that the organization's current initiatives revolve around four primary foundations.
As per his view, the key elements consist of broadened coverage, better equality, elevated standards of care, and optimized market performance.
"We strive to narrow the divide between those who have access to healthcare and those who do not. Our focus is on vulnerable groups such as children under five years old, expectant mothers, senior citizens, individuals with disabilities, and persons burdened by substantial medical expenses—including cancer patients and those suffering from sickle cell disease," he stated.
Regarding the progress made so far, he highlighted substantial growth in enrollment during the last couple of years. He stated, "Although I don’t have the exact figure at hand, more than 20 million Nigerians now benefit from health insurance coverage. This represents a remarkable accomplishment."
He stated, "In response to ongoing concerns about delayed service delivery, the NHIA has recognized this issue and implemented crucial measures to prevent such delays from occurring going forward."
"For instance, the NHIA has imposed a deadline of one hour on healthcare providers and Health Maintenance Organizations (HMOs). Following enrollment, within sixty minutes, an insured individual seeking secondary care should be provided with a referral code. Should this code fail to be issued, the medical facility is advised to proceed with treatment, knowing that they will still be compensated by the NHIA," he explained.
He added, "An additional factor contributing to the delays was the tariff—what NHIA offered previously. However, under this administration, the tariff has undergone revision, resulting in an increase of up to 600% for service fees. This adjustment reflects current economic conditions."
To ensure accountability among Health Maintenance Organizations (HMOs), Abubakar stated that the National Health Insurance Authority (NHIA) has established comprehensive operational guidelines and is entering into new contracts to mandate adherence.
“At present, the NHIA is entering into Memorandums of Understanding with various HMOs. These agreements will explicitly outline the responsibilities for each party—detailing what is expected from them as well as what they can anticipate from us,” he stated.
Provided by SyndiGate Media Inc. ( Syndigate.info ).
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