Financial protection awaits 17m Lagosians as Lagos plugs gaps in private healthcare financing

Financial protection is at the core of universal health coverage (UHC) and one of the final coverage goals. While financial protection is achieved when direct payments made to obtain health services do not expose people to financial hardship and do not threaten living standards, Lagos State is set to change the dynamics in Nigeria’s health insurance space as plans have been concluded to capture 17 million Lagosians including artisans under its State owned Health Insurance Scheme.

With out-of-pocket payments for health causing households to incur catastrophic expenditure, which in turn can push them into poverty, key to protecting people is to ensure pre-payment and pooling of resources for health, rather than relying on people paying for health services out-of-pocket at the time of use.

A 2014 study by the World Bank revealed huge health inequality gaps with 95 percent of Nigerians accessing health care via out-of-pocket payment. This is not only left with less than 5 percent of Nigerians covered by National Health Insurance Scheme.

The planned premium of N40,000/year will see a family of six pay a fee of N8,500 annually for individual, providing coverage for a range of medical issues including antenatal and postnatal care, normal delivery and Caesarean section, HIV management, childhood illnesses, tuberculosis (TB) and leprosy, malaria, prevention and control of non-communicable diseases, diabetes, emergency health services and minor surgeries, the scheme could live up to the hype.

“It shows the state’s readiness to distinguish itself from the mess happening at the national level. There is hope for Lagosians, and it will be of great impact to the health of the citizen helping them to save from spending out-of-pocket,” Ojo Sikiru, a Lagos-based medical practitioner, says.

The programme, which is billed to take off this year, has met bumps on the way. Dearth of reliable data, information communication technology (ICT) infrastructure and pulling the informal sector into the scheme are some of the most difficult challenges.

“We are yet to kick off with the state health insurance scheme because of limited data in the industry. We thought of sourcing data at the national level, but we found out that even at that level there is a problem with data,” Jide Idris, commissioner for health, Lagos State, told BusinessDay.

“In addition to data, we need a robust ICT to kick off the scheme in the first quarter of 2018. We are targeting 17 million residents of Lagos,” Idris said.

As experts say, the mess at the national level stinks a mile away. The plan for a national health insurance scheme dates to the Heuvi committee, which passed the proposal through the Lagos Health Bill of 1962. It was ditched in 1985, when Emmanuel Usman, then minister of health, set up a committee on national health review. The introduction of the structural adjustment programme in 1986 sounded the final death kneel as health care allocation sank.

The National Health Insurance Scheme (NHIS), established in 2005, though it became law in 1999, was formed to increase healthcare access for Nigerians, but has performed below expectation on both the public and private health insurance schemes managed by 60 accredited Health Management Organisations (HMO) in the country.

“At the moment, both the NHIS and the HMOs have covered less than 5 percent of the population,” Tunde Ladele, chairman, Health and Managed Care Association of Nigeria (HMCAN), the umbrella association of private health insurers, said.

The NHIS management is embroiled in a corruption probe, there is poor awareness of the scheme, and funding required to cover Nigerians adequately is still a mirage. The Federal Government is spending only N340.45 billion for the health sector in 2018, which is just 3.9 percent of the total budget, lower than 4.1 percent of budgeted last year.

Anthonia Obokoh