ATTAINING UNIVERSAL HEALTH COVERAGE IN NIGERIA: “HEALTH INSURANCE UNDER ONE ROOF” HOLDS THE KEY.

Stakeholders of health insurance in Nigeria, supported by Development Partners, the Organised Labour and Civil Society Organisations have adopted the conceptual framework of Health Insurance Under One Roof (HIUOR) as the veritable tool for the attainment of universal health coverage in the country.

This is in line with the expectations and objectives of the Sustainable Development Goals, the Presidential Mandate and particularly the Health Sector Next Level Agenda of President Muhammadu Buhari.

The overwhelming adoption of the Health Insurance Under One Roof concept was the major outcome of a 3-Day Retreat for stakeholders of health insurance in Nigeria, held recently at the Goshen City, Nasarawa State.

The concept is designed to provide a coordinating and regulating framework for the implementation of health insurance in Nigeria, thereby bringing to an end, the fragmentation of the past in a decentralised ecosystem which militated against tangible progress in rapid enrolee uptake towards universal health coverage.

The retreat was also aimed at defining roles, responsibilities and additional modalities for the implementation of a decentralised health insurance system, as well as develop a framework harmonizing innovative financing opportunities for effective risk equalisation.

The technical sessions of the retreat, which featured paper presentations, plenary, group work and panel discussions, identified certain challenges in the process of implementing  health insurance in Nigeria, including poor coordination of operations, poor political commitment to health financing, weakness of institutional and regulatory frameworks, poor ICT infrastructure for seamless interoperability, differences in the design of State Health Insurance Schemes, inadequacy of human and material resources which impacted negatively on the access to and quality of care and absence of defined structure for engaging stakeholders.

Other impediments identified are general poor awareness leading to limited acceptance of health insurance in Nigeria, inadequate financing resources, as well as the inadequate engagement of key stakeholders including beneficiaries.

To effectively arrest these defects and ensure a paradigmatic shift that will accelerate the attainment of UHC, the retreat resolved as follows:

  1. Health Insurance Under One Roof is a veritable concept for the coordination and harmonization of Health Insurance in Nigeria for which the commitment of all stakeholders is imperative.
  2. A conceptual framework for Health Insurance Under One Roof be adopted by all stakeholders.
  3. A Technical Committee be set up to drive the process for production and adoption of a policy document with clear monitoring and evaluation strategy.
  4. NHIS and SSHIS shall ensure timely implementation of the adopted policy document through necessary administrative and technical actions that may be required.
  5. The National Health Insurance Scheme and other stakeholders should engage with the National Assembly to fast track the review of the NHIS Act, with a view to making Health insurance mandatory, accelerate the passage and assent to the law.
  6. NHIS shall facilitate the integration of the various existing ICT platforms by operators, to allow for seamless interoperability and easy implementation of health insurance in Nigeria
  7. The NHIS shall institutionalize a functional Health Insurance Information Management System (HIIMIS) to ensure generation of evidence-based information for effective decision making at all levels.
  8. Political leadership at the different levels of Government should demonstrate more commitment to Health at the level of inclusive policies and funding to achieve Universal Health Coverage.
  9. NHIS and SSHIS shall adopt innovative financing mechanisms to mobilize additional resources and catalyse access to care and quality improvement towards the attainment of UHC in the shortest time possible.
  10. All Nigerians and legal residents shall subscribe to the National Health Insurance Scheme or the State Social Health Insurance (Contributory) Schemes for the statutory basic package for effective pooling to enhance the achievement of UHC.
  11. All Ministries, Departments and Agencies (MDAs) and other personnel of Federal, State and LGA shall enrol as a matter of urgency in the available Social Health Insurance Schemes.
  12. All States that are yet to establish their Social Health Insurance (Contributory) Agencies and implement the Scheme shall do so as a matter of deliberate Policy.
  13. NHIS, SSHIS and Development Partners shall institutionalize strategic quarterly stakeholder engagement and coordination meetings, to ensure the effectiveness of Health Insurance Under One Roof.
  14. NHIS in collaboration with Partners shall facilitate regular capacity building activities for SSHIS.
  15. Appropriate communication strategies and tools should be developed and deployed to support the implementation of Health insurance under one roof.
  16. The NHIS Gateway of the BHCPF should be used as equity fund directly into SSHIS to ensure equitable benefit for all especially the vulnerable.
  17. National Health Insurance Scheme` with the support of Partners will produce and disseminate guidelines for health insurance implementation, while ensuring adequate engagement from all stakeholders in the process.

The vision er of Health Insurance Under One Roof, who was also the convener of the retreat and Executive Secretary of NHIS, Professor Mohammed Nasir Sambo acknowledged the consistent support of the Minister of Health, Dr. Osagie Ehanire for the initiatives to reform health insurance in Nigeria.

He also expressed appreciation for the support of the Development Partners, particularly the European Union (EU), and World Health Organisation (WHO). Other supportive partners, according to Sambo, included HP+, R4D, HSCL, IHP, DFID-PERL and PSI.