‘Increased private sector participation will grow NHIS scheme’
With less than 10% of Nigerians enrolled on the country’s health insurance scheme, Umar Oluwole Sanda, president of Healthcare Providers Association of Nigeria, tells Anthonia Obokoh and Tiamiyu Adio that increased private sector participation in the scheme would mean adequate coverage of the informal sector. Excerpt:
What is your assessment of National Health Insurance Scheme (NHIS)?
NHIS is a very good programme that started in 2005, but implementation is the major problem. There are three stakeholders – the regulator, which is the NHIS, health maintenance organisations and the service providers.
Enrolees are the bedrock, as they pay premiums, good service should be offered to take care of them. Payment of premium saves patients paying out of pockets.
If this scheme is well implemented in our country, the accessibility to health will be better and people will not patronise quacks as well as being free to come to the hospitals.
The private sector and government scheme have been able to cover about 10 per cent out of 180 million of the Nigerian population. Nigeria needs to find a way to cover with the informal sector.
Nigerian has health facilities that can cover a large ground presently. The private health facilities cover about 60-65 percent, even according to World Health Organization statistics of health problems in Nigeria and the government covers about 30 per cent.
The private sector needs to assist the government to cover the health of Nigerians and to reduce problem of health indices, even with the new initiative by the Minister of health which is a good one, having primary healthcare in all senatorial districts, later in the local governments and Nigeria at large, but still it cannot cover without involving the private sector.
NHIS will be the scheme to drive these primary health centres, because paying out of pocket is a lot of problems for Nigeria, it minimises cost of health facilities, so health insurance is paying down for raining day when you will need it, to the downtrodden citizens who have nothing in their pockets to pay for their health care.
So, what are the core functions of Health & Managed Care Association of Nigeria?
According to the law setting up the NHIS, Health &Managed Care Association of Nigeria (HMCAN) is more or less a middleman. The members facilitate the registration of the enrolees and send them to their preferred accredited health facilities.
HMCAN also facilitates payment of capitation or fee for service to the health care providers and carry out advocacy/market the NHIS.
We are supposed to be working hand in hand if they send enrolees to our facilities, then there is a relationship between us, we sign, an agreement is reached on what should be covered and how much should be paid and in the progress. If there are challenges, it should be sorted out. The relationship exists between us.
What are the challenges of managing health in an economy in recession?
The challenge we face is claims of providers and organizations. Some HMOs are indebted to providers just as expected and they claim some organisations are equally indebted to them.
Just like any other sectors, the economic recession has really affected the rate of registration. People are not registering in the scheme because the earning power is reduced. Providers cannot afford some of the needed things because of the financial system, but we still try to treat some of our patients.
The recession is really affecting the practices but we cannot stop treatment, we ask NHIS to assist to improve capitation and fees for service, and at the private level we want the premium to be universal, so as to able to cover the cost to avoid short changing anyone.
What is your opinion to claim that substandard services are provided to some categories of staff by some hospitals, particularly the junior staff cadre?
I won’t say the services are below standard. The benefit package of any enrolee will determine the treatment he or she will receive. If someone is paying a premium package of N12,000, you cannot do more than that because nobody would pay for that.
The way out is that they should be a standard premium, standard benefits package, minimum standard benefit package that can cover the most junior person and adequate premium for that benefit package not just a token.
The premium should be adequate and should cover the benefit package and then capitation fee for service providers should be adequate enough for the management of any ailment in that benefit package.
What is your reaction to the reluctance of some hospitals to join the scheme and the way out?
I will cite an example, in a private sector; utility you provide it yourself, your generator is 24 hours working, you provide your water system, your security you provide it, your overhead you cannot do without employing doctors, nurses some employed pharmacist, you may even have a pharmacist technician, with other categories of worker.
For those of us, who are in the private practice we know what we going through every month to pay salary, it is not an easy thing. If you put up all this factors together, for example Caesarean section by the time you put all the cost together is about N120,000 – N180,000 and somebody now comes around and say for caesarean section we are paying you N40,000, you see the subsidy gap, who covers it?
We are on the losing side; those are the reasons some of our colleagues are reluctant to take it. And again what has been in existence before the former sector came in; it has been a sort of master servant relationship.
So let it be private public partnership (PPP) system, it will really move the scheme faster that is what NHIS is all about.
Presently without the private hospitals taking part, the scheme could not have achieved the 4 percent covered by the private sector.
What is your assessment of the budget allocations to the health sector over the years, particularly this year?
It is very poor, we are not meeting the World Health Organization standard and the Abuja declaration that 15 per cent should go to health, it is about 3-4 per cent or less than 5 per cent that was given this year.
Health sector is large, the tertiary, secondary, primary centres, preventive aspect and look at the population of Nigeria, emergencies can arise. Health is a social responsibility of the government; they should cater for the less privileged Nigerians.
Government, lawmakers should look into it and argument it, we may not achieve the 13 per cent, but we may get closer to it.