The enactment of the National Health Insurance Authority Act 2022 has been hailed by all well-meaning Nigerians as a step in the right direction on Nigeria’s path to universal health coverage. It was expected that such a fine law would not sit on a shelf, but that immediate, targeted and calculated steps would be taken to begin its implementation. This speech reviews the key steps that were not taken after the President, Major General Muhammadu Buhari (Retired), approved the bill in May 2022. It points in the direction of a affirmative action that is needed to launch the new health insurance scheme for all Nigerians.
The World Health Organization’s definition of UHC means that everyone has access to the healthcare services they need when and where they need them without financial hardship. UHC evokes a scenario in which all people and communities have access to the health services they need, when and where they are needed without financial hardship. The services covered include: essential health services ranging from health promotion to prevention, treatment, rehabilitation and palliative care. Nigeria’s health indicators of maternal and child health, access to water and sanitation facilities, life expectancy, etc., do not reflect Nigeria’s status as a leading African country . The country is so far from the CSU dream.
A critical need on the path to UHC is improved health financing to generate more per capita resources for health services. However, it is recognized that improving health financing does not only depend on generating additional resources, but also on the efficient use of available resources and the efficient and equitable deployment of resources among different population groups. country, especially the underserved.
The first challenge is that the Board of Directors established in Section 4 of the NHIA Act has not been constituted. The functions and powers of the Board are so critical and fundamental to achieving the goals and objectives of the new regime established in the Act. Indeed, any new policy framework approved by the NHIA, when the board is not in place, would be of questionable legal validity. However, in accordance with Section 58 of the Act, it is recognized that the repeal of the National Health Insurance Act shall not affect the prior operation of the enactment or anything done or suffered under it. under the enactment, any right, privilege, obligation or liability. accrued or incurred under the law, etc.
The second problem is that a new system of compulsory subscription to health insurance has been created for everyone by law. But it’s the law on the books, not the law on the streets. It remains to be implemented. Moreover, the provision of the law in this regard seems deficient in the context where the law is the order of the sovereign, which must be disobeyed under pain of sanction. Pray, what is the punishment for non-compliance? The law is silent on enforcement and the penalties to be imposed on offenders. Such an important provision should not have been left to the regulations and directives of the board or governing authority.
The third problem is that the compulsory health insurance scheme for all those who do not belong to the category of vulnerable people may only be known to health insurance professionals, workers and relevant civil society organizations. . Indeed, the majority of the population, nearly 98% of the population, is unaware of this new regime. Therefore, enlightenment, sensitization, sensitization, education, etc., are imperative and relevant to achieve the objectives of the new scheme and to increase the penetration of health insurance. But has this massive enlightenment and awareness begun? It seems not.
The fourth problem is that the fund for vulnerable groups created by article 25 of the law has not been fully activated. The Fund has many sources. The first is made up of resources from the Provision Fund for Basic Health Care, which represents no less than 1% of the federal government’s treasury, which was apparently activated before the enactment of the law. The second source of financing is the health insurance contribution which is neither fixed nor imposed. It is not clear, given the widespread negative macroeconomic indicators, which sets of individuals, companies or organizations can afford to pay an additional levy. The third is the Special Intervention Fund which must be allocated by the government and allocated to the Fund. This is not yet in place, and it is surprising that the 2023 finance bill did not include a provision to this effect. Furthermore, the rationale for imposing sin taxes, including the sugar tax on soft drinks, increased duties on tobacco and alcoholic beverages, is related to health – obesity and other non-communicable diseases such as diabetes, cardiovascular disease, dental caries, liver disease. , etc. However, the proceeds of these sin taxes are not intended for health but go into the bottomless pit of common funds which can be spent on anything including frivolous, inappropriate, wasteful and sometimes illegal expenditures. .
Where is the database of vulnerable people needed to activate the VGF? Vulnerable groups are defined as including children under the age of five, pregnant women, the elderly, the physically and mentally handicapped and the indigent, as they may be defined from time to time. To be able to reach this group, the Authority and the state health insurance schemes need a census, a database of people who fall into this category, which must be regularly updated on a annually or at any appropriate interval. Pregnancy is a category that will last about nine months and therefore should be regularly updated in terms of people who have recently become pregnant and pregnant women who have given birth. Additionally, the under-five category must admit new entrants and phase out older members on a yearly basis. Is there a national or state registry of the elderly and mentally handicapped? If the answer is positive, this register will be updated at the time of death or when a mentally handicapped recovers the reason. Is there a register of physically disabled Nigerians or people living with disabilities? The existing register used by the Ministry of Humanitarian Affairs for the payment of cash transfers can only identify indigents and not other categories. And the validity of the ministry’s register, in terms of containing only and all indigent people, is questionable.
Next steps should include the following. The Minister of Health should promptly make recommendations to the President, while the President should constitute and inaugurate the Board of Directors. A vast information and awareness campaign on the new compulsory health insurance scheme should be launched by the authority in collaboration with the state health insurance funds. This should be followed by enforcement action after a few months. The Vulnerable Groups Fund is expected to be fully activated through the allocation of a special intervention fund as well as a health insurance levy from existing and new sin taxes channeled into the Fund. Finally, steps should be taken to launch a credible database on vulnerable people, to be updated at regular intervals through collaboration with a multiplicity of government and civil society agencies.
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