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Nigeria: Kaduna Rolls-Out Contributory Health Scheme, But It Must Learn From The Mistakes Of NHIS

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Governor of Kaduna State, Nasir-el-Rufai


By Iliya Kure

Health Insurance Scheme in Nigeria is at various stages of implementation, especially at the state levels.

As at December 2017, only 14 states (Lagos, Oyo, Ekiti, Delta, Bayelsa, Cross River, Akwa Ibom, Kwara, Abia, Adamawa, Kano, Anambra, Sokoto, and Enugu) have laws in place created to run the scheme. Other states were either having drafted bills before their Houses of Assembly or were yet to take any known action in relation to the scheme.

The federal government has been running the National Health Insurance Scheme (NHIS) for more than 10 years, but less than 5% of citizens are covered. Partly because it is not a compulsory contributory scheme.

Health insurance is generally seen as the most sustainable strategy to attaining a subsidised healthcare service and ensuring Universal Health Coverage (UHC), a global concept, aimed at providing access to quality healthcare to humanity.

The United Nations have advanced campaign imploring nations to embrace it as a means of reaching all with healthcare services. It is a clear call on for political and financial commitment on part of the government.


Contributory Health Scheme in Kaduna

Kaduna plans to commence the rollout of its Contributory Health Scheme in the last quarter of this year. Validation meeting on plans and rollout is scheduled to take place end of June.

The scheme will be a major step in addressing out of pocket expenditure of N19,000, spent by an individual in accessing healthcare services in the state. Currently the level of out of pocket expenditure as a share of total health expenditure in Kaduna is placed at 89%.

Governor Nasir El-Rufai signed into law the State Contributory Health Scheme on 16th February, 2018. The draft bill was developed in 2015 and approved by the State Executive Council on 26th September 2016.

Unlike what obtained at the federal level, the Kaduna Scheme will start with both the formal and informal sectors in the first quarter of next year when registration for enrolees commences.

Already stakeholders in the state including Government Officials, Development Partners, Civil Society Organisations (CSOs), and the Media had reviewed report of Readiness Assessment for the roll-out of the Scheme.

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They looked at recommendations on Resource Mobilisation; Pooling and Purchasing; Service Delivery and Governance; as well as Political Economy of the state.

Stakeholders are hopeful that the Kaduna Scheme will address most of the errors made by the federal government in the implementation of the NHIS.

Commenting on the development, Vice Chairman of Family Health Advocates in Nigeria Initiative (FHANI), Bala Mohammed Tijjani, said, Kaduna State must be careful to take steps that will lead to success of the scheme.

“A Team from the State had visited Oyo State to under-study the model there, they had also taken part in experience sharing meetings, all in an effort to ensure success of the scheme. We expect them to bring all these to bear and have a smooth implementation.

“I also advise them to put in place a strong monitoring and evaluation system that will ensure adherence to rules. They must be ready to revoke licenses when the need for that arises. This is the sure way of success for the scheme,” he said.

Speaking at the Pre-Validation of the Readiness Assessment Report of the Kaduna Scheme, State Chairman of Health Reform Foundation of Nigeria (HERFON), Lawal Abubakar emphasised the need for attention on the vulnerable, who according to him will require more healthcare services compared to the working class.

He said CSOs had approached the State Assembly prior to the passage of the bill and stressed the need for adequate cover for the vulnerable, including pregnant women, accident victims and children under the age of 18-years.

“Apart from injecting at least 2% of the state consolidated revenue into the scheme, we also suggested that the scheme be made compulsory. This will help the Agency generate more funds to cover more people, especially the vulnerable group,” he said.

Commenting on the willingness of households to pay up to N500 per month for the scheme from a survey conducted, Chairperson of Maternal and Child Health Civil Society Partnership, Dorcas Adeyemi, said, greater sensitisation is needed to ensure people’s buy-in.

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“if residents don’t understand what the benefit is, they are not likely to enrol into the scheme, especially when they think they are paying for someone’s healthcare need, not theirs.

“As civil society organisation, we are willing to support government in sensitisation and community mobilisation,” she said.

In a comment last year, on what individuals will pay, Commissioner for Health and Human Services, Paul Manya Dogo told journalists that “the premium will be determined by the agency that will be supervising the contributory health scheme, but one thing I can say is that it is going to be very affordable because the scheme is about providing affordable quality health package for the people of the state, so it is involving all residents.”

Chairman, Kaduna State House Committee on Health, Isaac Zankhai, said, the law has made it mandatory for all to participate thereby reducing the out of pocket expenses on individuals and families.

“As a matter of fact, the Health Insurance Scheme should be seen as a source of succour to our people. We at the state house of Assembly will do everything within the law to see that this scheme succeeds.”

In an interview with AFRICA PRIME NEWS, Coordinator of Africa Media Development Foundation (AMDF), Sekyen Dadik, said her organisation is ready to support in the area of media engagement.

“We have been valuable in media engagement on various aspects of health in the state, especially maternal health and child spacing.

“Unlike what transpired in the past, where wrong information and messages were passed to residents on Free Maternal and Child Health Programme, we are ready to support them in the development of media strategy on the Scheme.

“We can work with the communication and media team to come up with strategic approaches for the scheme,” she said.


Why The NHIS Failed

Commentators have advanced major reasons for failure and poor coverage of the NHIS to factors including the following; (i) in-effectiveness in the implementation of the Act (ii) weak legal framework for the scheme (iii) provision for optional enrolment as against compulsory enrolment (iv) poor funding of the scheme (v) weak political will (vi) corruption at the implementing/regulatory agency, service provision centre and the Health maintenance organisations.

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A Kaduna based health activist, Benjamin Maigari, believes that strong political will on part of the government will address all the challenges faced by the NHIS.

According to him, once this is addressed all will take shape and there will be speedy enrolment.

“All the government needs to do is, take back the Act to the National Assembly for strengthening of the law and ensure enforcement of the Act, everything will fall in place.

Commenting on the role of government at a meeting to commemorate the UHC in Abuja last year, Nigeria’s Minister of Health, Isaac Adewole, said, “It is the statutory role of government to ensure that all citizens, irrespective of the geographical divide have access to affordable and needed health services in an equitable manner without falling into financial catastrophe.”

Nigeria’s National Assembly had noticed limitations of the NHIS 2014 Act. It had already started action towards amendment of the law to make it both mandatory and attractive to citizens, especially those in the informal sector.

Stressing the benefit to citizens, Chairman Senate Committee on Health, Lanre Tejuoso, in a chat last year told journalists, “assuming 100 million Nigerians pay N200 monthly, that will amount to N20 billion, and with this, poor Nigerians needing healthcare access will get it without them paying money from their pocket for it. Once you are a contributor to this pool, you will have access to any of our health facilities. This will significantly settle some basic healthcare issues in the country,” he said.

The Senator expressed optimism that year 2018 would witnessed improved actions towards better Health Insurance and UHC in the country.


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