Tuesday, September 30, 2008

The Nigerian Health Insurance Scheme (NHIS or Scheme) was one of the first projects created by former president Olusegun Obasanjo when he became the civilian President in 1999. Written into law that year, the program was further expanded via legislative provisions in 2004 and finally launched in 2005. Since then, the program has apparently disbursed over N23 billion to registered health care providers participating in the plan. The Scheme now covers 3 million Nigerians and according to the NHIS Director, Dogo Mohammed, all Nigerians will have universal insurance coverage in 2015.

It is exciting to know that Nigerian universal health care is not merely a concept. Health care should be considered a fundamental human right and every Nigerian, regardless of their wealth should have access to it. In furtherance of the program, the federal government allocated N6 billion to provide free maternal care and early-child care in 6 states - Bayelsa, Gombe, Imo, Niger, Oyo and Sokoto. In a country where "191 children die out of every 100,000 births and 1,100 women die out of every 100,000 deliveries," this money
is necessary and could impact an untold amount of lives.

Despite the reality that the Federal Government clearly has a practical and already implemented plan to provide access to health care, there remains many issues that must be concurrently tackled to make the rewards of future universal health care truly beneficial. The fact remains that Nigeria is 174 out of 191 countries ranked according to the life expectancy rates as listed in the 2007 CIA World Factbook, falling behind Haiti and Somalia. Nigerian life expectancy is only 47 years and has not improved but dipped since independence in 1960. Much more undoubtedly needs to be done to improve the condition of health and health care in the nation.

In order for Nigerians to benefit from universal health care, Nigeria obviously needs functioning institutions of health that can cater to the complex reality of the people's health needs. Institutions that do not just cater to curing citizens but also focus on preventative health care issues. These institutions must practice health research on a level competitive with research hospitals in the many countries Nigeria's President and other 'leaders' flock to for check ups and surgery. In addition, they must cultivate and incorporate our knowledge of local remedies into a general health approach that will not only improve our health care but extend lives and living conditions. Consequently, money must be pumped into the Nigerian school system, by the federal and state governments, to produce the skilled individuals needed in the country and limit the number of trained professionals that have to leave for better paying jobs abroad. Not to talk about the roads and power problems that still need to be tackled.
The prospect of universal health care as an option for Nigerians in 2015 is something every Nigerian should look forward to. It is definitely a step in the right direction and we must not take any more steps backward. On the eve of the country's 48th year as a nation state, one can only think that we have wasted enough time and must begin to implement and maintain the programs Nigeria, and its people, have always needed.

UPDATE (12/9/08): The World Bank has 'pledged' to support the NHIS program.
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21 Curiosities. Add Yours.:

Femi B said...

The hospital beds are full and all the Doctors have left.....

Unknown said...

Dr Muhammed definitly has a vision... a good one. Most Nigerians currently on NHIS work in the public sector and the organised private sector. So one major challenge is how to get individuals and those working in SMEs, and small businesses to buy into the scheme.

The other challenge is for NHIS itself. It is not clear if it is a regulatory agency or an implementing agency. What is the interface with State Governments and Local Governments whose remit it is actually to provide primary and secondary health care.

A few challenges yes, there is a lot of innovation in this area in Kwara State between the State government and Hygiea one of the major HMOs in the country as well as in Rivers State which is seriously thinking a State HIS.

Lets watch this space

Unknown said...

Universal Health insurance would be a great programme for Nigerians if it is implemented as planned. It is definitely a step in the right direction.

Anonymous said...


There is a blog I still need to write in tribute to the doctor who made it his life's work to introduce forms of managed health insurance and attention to geriatric health issues in Nigeria.

Dr. Iseoluwa Aworinde was our family doctor for over 20 years and sadly died last year, I am glad that some of these ideas still have life and prospects.



Anonymous said...

As you suggested in your write-up, Nigerians need better access to healthcare, for now, and not a universal healthcare (UH) concept solely driven by federal government policies.

Dr Mohammed appears to be playing the usual policy statement game as far as I’m concerned, becuae there is nothing on ground that indicate UH is feasible with 7 years given the way we do business in Nigeria. Even the so-called NHIS has not really achieved what it was created to accomplish. The bulk of the beneficiaries and patrons are those in the organized sector. And how many Nigerians belong to this group. At most, maybe 50% of Nigerians. What happens to the 50%?

UH works in countries with solid healthcare systems, and countries that have in place robust financing mechanisms to pay for the cost. UH can’t be fully functional without a solid taxation system, simply dashing out handouts from the federal purse would not work.

There are other workable alternatives though. A hybrid system that involves a bottom-up for-profit and nonprofit business model may work, particularly in reaching the high risk people (children and women) and the other 50% Nigerians who aren’t domiciled within the organized sector.

This will take some creativity, vision, and willpower on the part of local and federal administrators to bring to life culturally and economically appropriate healthcare delivery systems. This is one area incentive-based social business models appear really promising.


Anonymous said...

Nigeria could well go down as the country that sabotaged the one of the largest public health initiatives of our time. was taken from the Nigerian Heathwatch as other polio endemic countries including Afghanistan make significant progress.

Fine 3/120 million people are covered but A few challenges is not what we face but a mammoth one. Paying lip service and announcing grand plans are not enough. A system cannot function on its own, (as described by @Imnakoya) its inter independences are not the same as handouts or dashes. It is much more and until the FGN works in hand with the state governments, please make my share of the cola, a very large one.

Happy 48th all.

TheAfroBeat said...

Well it's about time. Universal Basic Education is another one on the agenda, let's hope that we will see significant progress come 2010.

Happy Independence DAY!

Doc A said...
This comment has been removed by the author.
Doc A said...

Nigeria o, universal wetin?? abeg leave that one for now

God's child said...

even the US doesnt have a solid universal health insurance system so while I'd like to throw blame at Naija, lets remember that.
1st of all who is a Nigerian? because there are many West African people holding Naija passports that arent Nigerian, how will we be able to deal with the influx of people coming in from around West Africa for the so called free health care?

2nd of all, the Nigerian situation is far more complicated than we all like to think sometimes. Instead of blurting out "Universal Health Insurance", what they need to do is break it down by states, and have the states accountable for all who live in their state. Notice I said "live", not "from", cause then someone from Sokoto who lives in Lagos shouldnt be expected to travel all the way to Sokoto to get treated.

Universal Health Insurance wont work unless other factors are considered such as environmental pollution and road safety. Fix the roads to cut down on the millions of accidents that kill the people, or cause them to seek medical attention. Deal with environment pollution that will down the road cause a ripple effect and trigger many other health conditions.
Continue to implement awareness programs, I've seen many local ones and that is good, but its more than the govt doing radio or TV ads, but seriously collaborating with the local leaders of churches, mosques, market leaders, school leaders, down to the grassroots.
Like was already stated with the polio incident (and here the rest of us in health care thought we had eradicated polio globally, naija just had to disappoint), we need to encourage (go door to door if we must) but check to see that babies are properly vaccinated against preventable diseases. Our people like awoof anyway so provide incentives that will encourage mothers to show up, give tins of milk, toilet paper sef...anything and they will come! Prevention is better than cure after all.
Most importantly pray pray pray, cause even with all this said, na God only fit save our country Nigeria.

One Naija...WaZoBia...E go betta my people!

Anonymous said...

I am really interested in the swift qualityvimplementation of this health program.

9ja's OT said...

implimenting the health insurance and health improvement does not have to be done by outsiders, we nigerian can do it too. change is what we really need as people, change in mentality, structure and unconditional love.

change is not focusing on the past or present it is focusing on how the future can be improved.~~ ME

Anonymous said...

As I Nigerian, I am optimistic about change, particularly change in the right direction. And at this point in time, it is vital that optimism occur among Nigerians.

Instead of doubting that Universal Healthcare can occur, we should be thinking about what we can do to help. This will in no doubt be a challenging task but with God all things are possible.

So I encourage everyone that reads this to investigate the possibility, attempt to take part in implementation, or at the very least remain optimistic!

Onu Michael(NHIS Ibadan) said...

The NHIS is one government intervention programme that any political could use to score easy point since it has the potential of not only alleviating poverty of over 80% of Nigerians, it also getting the citizen to log on whole heartedly to government other programmes.

The Scheme is making giant strides in repositioning it self for the chaalenges ahead, but it needs more development partners, much the same way the IFC is doing with her.WHO,ILO,etc could come up with programmes to enhance her Human capital development

Onu Michael(NHIS IBADAN) said...

The NHIS is one government intervention programme that any political could use to score easy point since it has the potential of not only alleviating poverty of over 80% of Nigerians, it also getting the citizen to log on whole heartedly to government other programmes.

The Scheme is making giant strides in repositioning it self for the chaalenges ahead, but it needs more development partners, much the same way the IFC is doing with her.WHO,ILO,etc could come up with programmes to enhance her Human capital development

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