Established by Decree 35 of 1999 now CAP N42 (LFN), the National Health Insurance Scheme (NHIS) law provides for non-mandatory participation in health insurance with formal sector focus.
This has been the stumbling block to the growth of the NHIS since it began full operation in 2005.
There have been many attempts in the past to correct the anomaly and make the Act mandatory, but all the efforts were fruitless.
This has therefore, forced the NHIS to concentrate its energy on the enrolment of the federal government worker force which is provided for in the law.
At an informal interaction with Health journalists in Kaduna, weekend, the Executive Secretary of the NHIS, Prof. Mohammed Sambo, insisted that unless the law is amended, attaining the much talked about Universal Health Coverage (UHC) in Nigeria in 2030 will be a mirage.
“Because the law does not make it mandatory for organizations or people to enroll in NHIS, private organization can decide to or decide not to enroll their employees.
“Since when the Act was sign into law in 1999, the desire to amend it started and for 20 years, there has been attempt to make the law mandatory without necessary. The state government refuse to buy-in, the private sector also refused to join.
“If the law made it mandatory, the current aggression by the NHIS to get people to enroll would have been averted. Therefore, NHIS has tried. The federal government has done its best because since 2005 they have been deducting some money from the wages of its workers and remitted to the NHIS which is the service they are providing.
“When you read the law establishing the NHIS, there is no mechanism of the coverage of the vulnerable and the lower segment of the population. It is not the fault of the NHIS if they did not go to cover any body outside the formal employees, it is not their fault.
“Unless the law is amended, I am bold to say that Nigeria cannot achieve UHC. No matter how much we tried.”
He explained that because of the deficiency in the law: “NHIS now concentrated on the employees of the federal government, and I can tell you that, apart from few MDAs in the country, all other agencies of the federal government have keyed into the NHIS.
“Over the years, the NHIS have been making attempts to amend to law to ensure that it is mandatory for all Nigerians to enroll in the scheme to no success until the 8th Assembly when the Senate passed the amended bill, but before it get accent, the dispensation elapsed.
“When we came, we have now initiated another process. Without the law being amended, no matter how hard NHIS tried to cover the entire country, it will not be possible.”
The ES noted that in an effort to ensure that Nigerians at all levels are covered in one form of health insurance or the other, the NHIS has created a forum for synergy with the states across the country.
“The Health Insurance Under One Roof is the platform we have created to strengthen synergy with the states. “Because we believe we are all working to achieve UHC, we have seen that if we do not work together, there is no way we will achieve any result,” he said.
Prof Sambo however, took time to explained the NHIS is not requesting for 3 trillion budget allocation in order to enrol the over 200 million Nigerians in the scheme.
According to him: “I went to NAN and I said that 3 trillion naira is required to cover the entire Nigerians.
“I have not alluded to the fact that NHIS should be given three trillion naira, no. But I say that three trillion naira is required to cover Nigerians with health insurance.
“This is very simple. We have a package which has been costed to be N15,000 per head per annum. The simple analogy of the amount of the money required to cover all Nigerians in health insurance, you multiply that 15,000 by 200 million estimated number of Nigerians and it will give you 3 trillion naira.
“We are not saying that federal government should do a budget and give us 3 trillion naira. The federal government is not responsible for the coverage of everybody in Nigeria.
“The federal government has its own workers, state governments have their own workers, so also is the local governments and the private sector.
“Assuming that the government will say that nobody should participate in health care, it will require 3 trillion naira to cover all Nigerians base on the calculation of 15,000 per capital per annum multiply by 200 people.
“This means if you put together the money that the private sector and individuals and all government workers are required to pay all over the country and multiply it by N15,000, you will get the 3 trillion.
“Nobody said that the government should give us one third of its annual budget to cover Nigeria. We don’t have the right. We cannot collect money from the states, we cannot collect money from the local government. The private sector can go to the state health insurance or they can go to the NHIS.”
On the achievements the Scheme recorded in the past one year, the ES said they include restoration of internal peace and harmony, addressing human resources/ administrative/ financial management bottlenecks, recreating the organizational image and restoring stakeholders’ confidence, addressing technical/operational challenges and introducing innovative financing initiatives.
Other achievements are GIFSHIP, Catastrophic fund for Cancer, NYSC coverage, National Coverage for the elderly; development of concept of Health Insurance Under One Roof (HIUOR), e-NHIS project.
The total health insurance coverage as at August 2020, he revealed, is 10,269,996 million.
It is therefore, pertinent to call on the Nigerian Senate and the House of Representatives to expedite action and ensure that the Act establishing the NHIS is amended to make it mandatory for all Nigerians to enroll in the Scheme.
Without this, Nigeria will labour without achieving any result in its efforts to attain UHC in 2030.