Mr. Agu Michael is the Anambra State Coordinator of National Health Insurance Scheme (NHIS), in this exclusive interview with ABUCHI IFESINACHI in his Awka office, he speaks on the agency’s operations and related issues.
May we meet you, Sir
I am Agu Michael. The state coordinator of National Health Insurance Scheme, Anambra State Chapter. We resumed last year. We have not had office in Awka before, but NHIS deemed it fit that it is better to move into states so that people coming from the hinterlands will find it easier to access us, unlike before when it used to be that one needed to go to Enugu or Abuja to access our services. It used to be discouraging for some people. So, because of that, NHIS considered it better that every state should have their office.
When we came in was when Anambra State was in a little bit turmoil because of politics last year. We were around and people didn’t even know that we were around because everybody was interested in politics. But after December, people started knowing that we exist. So we are here as a full-fledged state office.
Can you share with us the nature of services you offer the people, sir?
OK. Basically, what we give is health insurance. Before now, Nigeria as a nation had been thriving on ‘out of pocket payment’ for medical services; if you are sick, you go to the hospital. The method of healthcare financing was ‘you paddle your canoe’. I won’t go so far into the history of NHIS, but it started in 1962, when they first hatched the idea. But because of the Tiv riot in 1964, it couldn’t take shape. After the war, in 1981, they started it again when we had a committee by Dr Eronini. But it was during General Abacha’s regime that it was founded and committees after committees were set up trying to model what type of shape it was going to take, but at the end of the day, it was Obasanjo’s regime that flagged it off officially in June, 2006.
So, since then, what we offer is health insurance.
What is health insurance?
It is really just pooling together resources, that is sharing financial burden. Health insurance is just coming together to contribute money (what we call premium) in a solidarity pool, so that anybody that is sick will deep hand into it and be treated by the group’s effort. So what it means is that when you come together as mutual health association; if it is in a formal sector like ours we pay a token. But basically what National Health insurance scheme is doing is social health insurance scheme. And what it does is that the strong will subsidize the weak, the young will subsidize the aged, the healthy will subsidize the sick. So that when we put them together, it seems like being your brother’s keeper. That is about health insurance.
We started with the formal sector; that is for those in the civil service, but incidentally it was federal civil servants that enjoyed it. Now, some states are planning to key into it so that the state civil servants can also enjoy it. Apart from the formal sector, we have semi-formal sector and informal sector.
Like in the informal sector, we have the CB-SHIP which is basically what we want to do here. CB-SHIP is the Community Based Social Health Insurance Program where you go into the communities, create awareness, they understand what is happening, you register them. After registering, they get an ID card, then start paying what we call ‘premium’; that is a monthly token, depending on the capacity of the community. It could be 500 naira, 400 naira or 300 naira as the case may be. It is just like a solidarity pool, so that anybody in the community who is sick will be treated from that money. They have particular health facility they have to choose, which NHIS will supervise to see if the facility has the capability to treat people. It will not be the issue of tomorrow when you come they would say there is no drug or the doctor is not around or maybe what they call ‘nurse Eliza’ here whereby anybody who wears white will come and inject you. No, anything NHIS is going to do will be with facilities that are NHIS accredited facilities where you must have sufficient doctors, equipments, drugs and very hygienic environment. So those four basic ingredients that makes standard health care what it is must be there and the people will be enjoying because they have already paid in advance. So, that is basically what we are doing. But it’s not only that. I just picked Community based social health insurance scheme because that is what we are focused on. You find that the social aspect of this scheme is more in the formal sector. But the formal sector in Nigeria covers only about 20-25 percent of the population who are civil servants. And you know we have our fathers, our mothers, our brothers and our sisters in the rural community. What do we do about them? And Nigeria wants everybody to enjoy health insurance program. That is why NHIS has developed programs based more on socio-demographic approach. What that means is that there is age-related program, occupation-related, and so on.
Apart from the Community Based Health Insurance Program for those in the communities, we have what we call T-SHIP the tertiary institutions social health insurance program for those in the tertiary institutions, so that segment of the society will be benefiting. And we have what we call ‘Under-5’. Anybody who is born from today till five years of age is covered free by the government, and that also takes care of the pregnant women who are covered from the time of their pregnancy till twelve weeks after delivery. You see why it is called socio-demographic because every age group has its own program to enjoy.
Now, by the end of this month or next month, we shall be flagging off ‘Under-12′. So what NHIS is trying to say is that if we take care of those under five and also also twelve years, it then means that the parents will be relieved of the health responsibility of their children till 12 years. By 18, it is believed that the person is already out of the parents’ house into a tertiary institution where you benefit from the ‘T-SHIP’.
Some people may say, I don’t even want the Community Based program, I’m no longer in school, we have a scheme for them called Voluntary Contributors’ Social Health Insurance Scheme. That one is 15000 naira in a year. If you want to start something we call ‘Stand Alone’, you’ll still have access to healthcare. It is not just having access to healthcare, it is having access to quality healthcare. And remember it is something you’ve already paid in advance for, so if you are going there, you’ll be going shoulder high. It will not be a case of having fears about how much you have in your pocket being commensurate with the hospital bill. We have another project in the Offings for the retirees. Supposing someone was in the formal sector and after serving for like 35 years, he suddenly retirees. He is weak and he is off the formal sector health insurance scheme, what becomes of him? So, we are working on their own scheme.
So it is a socio-demographic approach. Every sector of the society will be attended to. If you are rich and you want a special package, we have V.C SHIP for you. Whatever class or age is attended to. For those in the private sector, we have OPS – Organised Private Sector Scheme. And there, they can get what the formal sector is given. So, you can see we split this so that every segment of the society is covered by the health insurance scheme. So, that is how we are making it. Let me just stop here for now.
So, what efforts are you making to get the public to know about this?
So much, I must tell you. People are even coming, telling us that they heard about us in jingles. Go to the television, you’ll see us. Apart from that, we’ve been involved in a lot of seminars. Like in a couple of weeks, Private Doctors’ Association or something like that will be inviting me to speak to them. They had been getting the enlightenment but now, they want to hear from the horses mouth. So the public enlightenment is there, the seminars are going, even on radio. Because, we said, some people in some communities might not have a television but there are high chances they would have a radio. We are on when it comes to dissemination of information about NHIS.
Sir, what are the challenges you are encountering in carrying out this public service?
Apart from the general problems, let me just be specific. Let me take Anambra State for example. You find out that, though some people may try to argue it, but Anambra State is…I have gone for one work or the other in the whole 36 states, and worked in Abuja for years, Anambra State is the richest (by the Nigerian definition of what ‘rich’ means) state. It has the highest number of rich people in Nigeria. It is their greatest strength but it is turning out the be their greatest weakness. Some would say, ‘I can afford to fly to Hamburg Hospital in Germany if I am sick, and get the kind of services I want’ or ‘I can go to India at will’. That is why we have what we call Corporate Service Guide. We want to make the public know that when we talk about health insurance, it is not necessarily for the above average Nigerian who can take the next flight to India to access care (because, we have people like that). When we talk about social health insurance scheme, or even health insurance scheme here in Nigeria, we are talking about that woman in Obollo-afor who may not have known Enugu or Abuja; we are talking of that person who is in Borno State; we are talking of those people living in the creeks in the Niger-Delta regions. It is for them. Some people want to use ‘downtrodden’. If we want to use ‘downtrodden’ as a definition, I would say that social health insurance programme in Nigeria is basically for the downtrodden. The Have’s will enjoy, but we want those people in the hinterlands; the old woman to have access to the kind of health services Jonathan would get in Abuja. When I was in Abuja (I just got transferred here) I would not have been able to have access to services in Abuja clinic (if you know Abuja clinic – it is one of the first class), if it wasn’t for this program. That is what we want those people referred to as the downtrodden to be at par with when it comes to accessing care.
Coming back to the question of the challenges, I think the major problem is getting people to agree. Anambra state has what it takes to be number one state – at the fore-front. If you talk of civilisation, they have it; if you talk of education, they have it; if you talk of money…you don’t talk of money in Anambra state because that is not an issue. But, regrettably, for people to come together to agree in one thing is a very big challenge. We have people who can comfortably say, ‘OK, I take care of 100 people’s health insurance bills. That is one area we are trying to conquer. Such people might feel they don’t need the scheme but there are a lot of people that need it. I’m happy that, as I’m talking to you now, someone in Igboukwu paid for 400 persons in his community. This is the kind of thing we want others to do. We have many of them that are capable of this. So, when we are talking especially of the Community based social health insurance scheme, there is no place you go in Anambra state and you won’t see rich people. So because of that wealth, nobody wants to hear what the other person is saying. Everybody ‘zuru k’emee’. So to come together (and you know that for this CB Health Insurance to move, you need about 1000 registered persons) to form 1000 persons in Anambra State is very difficult. That is our greatest challenge. It is not that they don’t know about the insurance scheme, but they don’t want to know. Most people in Anambra see it as a competition of sorts: that you were sick two months ago and you were flown to America, this month if I’m sick I’ll go to Germany. So, instead of looking inwards – because of that strength that is turning into a weakness, the response we are getting is very low. But I told them that, by the grace of God, before I leave Anambra state, every knee must bow, because we are putting everything in place in order to surmount all the challenges. Because I can’t see why, if you go to other places that are not even as civilized as this place, people have known about health insurance and they are enjoying. But when you come to your own zone, the people show a laissez faire attitude towards it. People are rich as I said, but in Anambra state you can still find people who are not rich who need this subsidy from the rich ones. It is also erroneous to think that if a place is rich, it doesn’t need health insurance. Look at Germany for instance, are we as developed as Germany, but Germany has been making use of this scheme for more that 120 years. Developed countries all over the world use this as their health care financing approach. If you listen to American Congress, that is what they are talking about. I was in Switzerland, that was what they were talking about. I was in Germany, the same thing. So, if you look at us, you see that we are not as civilized as these people and they know that is the way forward.
So, what we are saying is that we are begging the people of Anambra state, don’t say you are rich therefore you don’t need it. The way forward for our collective health is health insurance.