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Health insurance now mandatory—NHIA

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By Abraham Adekunle

The NHIA Act 2022 seeks to achieve universal health coverage by 2030.

The Osun Coordinator of the National Health Insurance Authority (NHIA) has said that the NHIA Act 2022 now makes health insurance mandatory for every Nigerian, regardless of age or status. Mrs. Nafisat Adekunle revealed this during an interactive forum with representatives of federal ministries, departments and agencies (MDAs), health care facilities and health maintenance organizations on September 15, 2022, in Osogbo, Osun State. She explained that unlike the former National Health Insurance Scheme (NHIS) in which health insurance was optional, this Act signed by President Muhammadu Buhari now mandates it.

Mrs. Adekunle said that the aim of the forum was to familiarize stakeholders with the NHIA Act. She said that the aim of the Act is to achieve universal health coverage by 2030, according to the Sustainable Development Goals set by the United Nations. Simply put, the Act aims to give Nigerians access to affordable and quality health care. She said, “Under the NHIA Act, all Nigerians, irrespective of whether they are self-employed, government workers, private workers, vulnerable groups, retirees, or corps members, are adequately covered.”

Nigeria’s out-of-pocket health expenditure is more than 50%.

Presently, this Act may be suitable to the Nigerian situation. According to Knoema, Nigeria’s out-of-pocket expenditure had consistently been at least 70 percent of all health payments from 2008 to 2019. Out-of-pocket health expenditure are spending on health directly out-of-pocket by households. This means that Nigerians have to pay for 70 percent of expenses incurred on their health. This also shows that the health sector in the country is largely unsubsidized especially when surgeries and complex treatments are involved.

In Nigeria, one of the causes of Poverty for an otherwise stable family is health problems. An average family is one terminal illness of a member away from becoming poor. This is because when families have to bear the cost of expensive treatments, which they cannot afford, and they may not recover from it. Treatments such as chemotherapy is one of such. There are also expensive surgeries that are not subsidized such as cesarean section and removal of tumors.

Nigerians are doubtful of insurance in general.

This is not supposed to be widespread, but Nigerians are generally doubtful of insurance. It is not until emergencies occur that the need to have subscribed for insurance becomes wise. Statistics also show that Nigerians do not generally like to pay for insurance however it is mandatory. According to the Nigerian Insurance Association (NIA), as of January 2022, only approximately 3.4 million cars out of 12 million on the roads in Nigeria are insured. This means more than 70 percent of vehicles in Nigeria have no insurance.

In the health sector, survey data shows that 97 percent of Nigeria’s population is not covered by any kind of health insurance. The remaining three percent who have health insurance are provided for by employee health coverage. In other words, Nigerians do not care about health insurance except a minute percentage. And those who care about it only do so because they have to consent to its coverage by their employer. This is why Mrs. Adekunle said that the agency has embarked on continuous community mobilization and sensitization of people at the grassroots on the need for them to key into the health insurance. She also appealed to service providers and health management organizations to always treat beneficiaries of the health system with respect and dignity.

How does Nigeria plan to implement the Act of law?

Nonetheless, the NHIA Act is a good piece of Legislation that is meant to help Nigerians in the area of health coverage. However, since adequate documentation is still lacking in Nigeria generally, how does the government plan to implement the policy? If documentation is not incorporated into Nigeria’s core system, the policy may hit a wall at some point. Also, will all hospitals, including private-owned ones, support the scheme? This is important because government hospitals cannot cater to all patients in the country.


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