According to the World Health Organization (WHO), in 2005, Nigeria was ranked 197th out of 200 nations. Life expectancy was put at 48 years for males and 50 years for females; while Healthy Life Expectancy (HALE) for both sexes was put at 42years. In HALE estimation, Nigeria only ranked higher than five countries; Sierra Leone, Afghanistan, Zimbabwe, Zambia and Lesotho.
The WHO report further states that Nigeria accounts for 10 per cent of global maternal mortality figure, with 59,000 women dying annually from pregnancy and child birth. It adds that for every maternal death, 30 others suffer long term disabilities while 40 per cent (about 800,000) of global obstetric fistulas occur in Nigeria.
The frightening report also states that the health situation in the country has been so deplorable because only 39 per cent of births are delivered by skilled health professionals. It also states that the risk of a woman dying from child birth is 1 in 18 in Nigeria compared to 1 in 61 for all developing countries and 1 in 800 in developed countries, adding that only 23 per cent of children (12- 23months) receive full course of immunization against childhood killer diseases.
However, reducing child and maternal mortality rates are part of the Millennium Development Goals (MDG) which the government is committed to.
It targets a reduction of the mortality of children under the age of five by two-thirds between 2000 and 2015, that is, from 207 in 2000 to 67 by 2015. In the same vein, MDG also targets a 75 per cent decline in maternal mortality rate by 2015, that is, from 704 in 2000 to about 176 in 2015.
It is therefore, obvious that unless there is a quick intervention, Nigeria will get to 2015 without a change in her health status. That is where the National Health Insurance Scheme (NHIS) comes in.
In order to provide equitable access to healthcare delivery in Nigeria, the Federal Government of Nigeria introduced National Health Insurance Scheme (NHIS). This essay explores the knowledge or perceptions of Nigerians and their attitude towards the scheme and how it affects the realization of Vision 202020.
Nigerian National Health Insurance Scheme (NHIS) was launched with the major aim of improving accessibility and equity in healthcare delivery. The scheme suffered a long lag between conceptions and implementation due partly to the opposition by healthcare professionals, administrators and even the general public owing to misconception and inadequate knowledge of the principle of health insurance.
But with the innovations, techniques and publicity brought in by this patriotic Nigerian in person of Dr Abdulrahaman Sambo (Mni) the Acting Executive Secretary,cretary of NHIS, professional health expert per excellence.
He has been able to actualize the mandate of the Scheme through introduction and launching of Community Base Insurance Scheme to cater for those in the informal sector; who are not beneficiaries of this scheme as a result of the defect in the Act Establishing the Scheme. However this giant stride has endeared him to Nigerians who believe in his wealth of experience as the emancipator of the health sector.
A key element in assessing the level of implementation of the (NHIS) scheme in Nigeria and the achievement it will attain under the present leadership cannot be over emphasis. The Blue-Print presently caved to assess the knowledge and attitude of the healthcare professionals and Nigerians in the formal sector informal sector and how the indices will serve as a yardstick to the actualization of vision 202020 blue prints in the health sector.
This is no gainsaying as all the findings from the hospitals visited by the writer indicate that all the hospitals have registered with the scheme. Most of the respondents indicated that they got the information from seminars in their respective hospitals of work. This finding tends to underscore the importance of such seminars in hospital when the target audiences are healthcare professionals.
The Blue- Print also revealed that the high level of awareness of the existence of the scheme is not translated into participation as more than half of the respondents did not register with the scheme mostly those in the state who have failed to key in to this programme to bring succor to the health system of their people.
But with the campaign/publicity undertaken by the present leadership Dr Abdulrahaman Sambo (Mni) Nigerians can be rest assured that in 2018 there will be universal coverage of the health insurance in Nigeria.
Sambo, in his doggedness to ensure that every Nigerian have access to qualitative health care system is proposing the 1kobo per minute billing for every call from all the GSM communication service providers.
This idea will help to cater for those who are in the informal sector to access good health care system. He further enjoins all the states in the federation to part take in the scheme. This idea is yielding result as more states are now flagging up the scheme in their various states.
Dr. Sambo in his Blue-Print allude that all over the world where majority of the population enjoys excellent health service delivery, the vehicle employed to achieve this has been the health insurance scheme. The scheme enables those who would not have been able to afford the cost of health service to have access to the same quality as anybody else by just paying a basic premium.
In its six years of existence, the NHIS is yet to fully service its first category which is the public sector, however majority of the over five million people accessing healthcare through the scheme are Federal Government employees and members of their families and a percentage of the organized private sector, it is certain that only Cross River and Bauchi State governments have subscribed to the scheme but it is uncertain whether any local government has enrolled for the NHIS services. This fact necessitated the need for the blue print to underscore the challenges facing the scheme.
Since the establishement six years ago, the scheme have recorded a number of pluses, some of which are:
Over 5 million enrolees accessing care through the scheme, two states of the federation (Cross River & Bauchi) already folded into the scheme, about 20 more at various stages of folding in, Developed operational tools e.g. operational guidelines, protocols etc., Accredited 7850 health facilities across the country, Accredited 61 HMOs to run the scheme, Developed blueprints for implementing the informal sector programme, community — based and Tertiay Institution Social Health Insurance programmes, Secured approval to implement MDG subsidy funding for pregnant women and children U-5, Employment generation from activities of new HMOs and expanded capacity of providers, completion of a robust IT platform (e-NHIS) to drive operation and regulation of the scheme, Establishment of a vibrant National Call Centre, Establishment of central data centre, Draft of new NHIS Act, which has passed second reading at the Hallow Chambers of the National Assembly, under the leadership of Honourable Ndudi Elumelu chairman House Committee on Health.
Re-organization and restructuring of the NHIS to meet future challenges, Monitoring and evaluation system in place for HMOs and providers, Enhanced funding to providers (public and private) and improvement of quality of care.
Conclusively with this gigantic efforts in revamping the health sector Dr. Abdulrahaman Sambodeserve a pat on the back.
Tersoo Adagher
A Public Affairs Analyst writes from Abuja
