Chairman of the National Health Insurance Authority (NHIA), Senator Dr Ibrahim Oloriegbe, in this interview with SADE OGUNTOLA, speaks on steps to ensure universal health coverage for Nigerians through the health insurance authority.

AS chairman of the Senate Committee on Health, you played a significant role in passing a bill that makes health insurance mandatory for all Nigerians. Now, as the chairman of that authority, what is your focus to achieve this target?

At the time, I was the Senate Chairman of the Committee on Health. I did not thinking I would be chairman of an NHIA council. So, it is just a good coincidence. However, it provides me with the opportunity to implement the thoughts behind the law that was passed. Now, ensuring health insurance is mandatory for all residents in Nigeria is just an aspect of our focus. Our other focus includes the actualization of other provisions in the Act. When we say that something is mandatory, it means everybody must have a basic minimum package of health covered by health insurance. As we know, insurance is a pool, so the aim of making it mandatory for everyone is to get a bigger pool. Insurance is about the payment of premiums. In Nigeria, about 70% of the population lives below the poverty line, say $2 per day. So, our first focus is to target those who have earnings and can pay a premium. What we are doing, which hopefully in the next few months will come to fruition, is to have the President issue an executive order that will mandate all registered companies in Nigeria, including all employers of labour with a minimum of five staff, to obtain health insurance for them. Just like PENCOM for ITF, without presenting evidence of insurance, a registered company would not be able to do any business with the government.

With that, we hope to expand almost immediately health insurance to every employer of labour. This will ensure that their employees are registered for at least the basic minimum package of health insurance. Of course, that particular order will also affect every private company, not necessarily just those that are doing business with the government. Evidence that they had insured their staffers will form part of the requirements for their registration with the Corporate Affairs Commission (CAC). That way, it will expand health insurance for the organised sector.

Also, related to that is the informal sector, which is huge in this country. As it is, the law may not be able to enforce them to enrol for health insurance. What we need to do is organise an awareness programme and use their various associations as guarantors for their members. Many of these informal sectors, including artisan groups, have associations, and many also belong to cooperative societies. These groups of people mostly don’t earn big money at a time. We have to modify the method of payment of premiums for health insurance in such a way that people can pay some contribution either weekly or monthly to cover what their premium will be. This way, we will expand the pool almost immediately.

The huge group are those who don’t have the money to pay for a premium, which is why that law also provided for vulnerable groups funds. For the vulnerable group fund, we are advocating for the government to put in more resources. In the 2024 budget, we had N5 billion appropriated for the fund. The Federal government has already started two programmes targeting the vulnerable groups: the programmes are the CEMOC programme, which is the Comprehensive Emergency Obstetrics, Maternal and Child Care. The other programme is free services for the management of Vesico Vaginal Fistula (VVF). Under CEMOC, pregnant women are provided with emergency Caesarean sections (CS), and thereafter, they are enrolled under insurance to continue to access health care without payment of any fees.

The NHIA is expanding the Vulnerable Group Programme to some other specialised cases; these include persons with sickle cell disease and some kidney diseases. These are not regular health insurance because they are groups of already known high-risk people. Insurance is about the healthy subsidising the sick. So, with the pool being increased, we’ll be able to subsidise for the people that have chronic diseases like sickle cell and kidney and some selected renal diseases. This is already a programme on board.

We also have a special programme for cancer, which is already on course. This is in partnership with Roche; it is a subsidy programme. Under the programme, Roche subsidises 30 per cent of the cost of drugs, the NHIA subsidises 20 per cent, and the patient will just pay 50 per cent of the cost of the drug. This is already ongoing for some cancers, for which Roche has the drugs. These are breast and prostate cancer. This is also linked with another government programme, which is the Cancer Health Fund. The Cancer Health Fund covers three cancers: breast, cervix, and prostate.

The inclusion of basic mental health conditions is part of the basic minimum package for health. What is under discussion is expanding coverage to other aspects of mental health care. It does not cover drug rehabilitation, which is a specialised case.

One of the things, especially when it was basically a scheme, was that the focus was more on federal government workers. Also, the perception is that the service is poor and they don’t give good drugs. That is our focus, which we are changing by increasing capitation and fee-for-service for providers. For instance, the fee-for-service has increased by threefold or fourfold because we know that the cost of drugs and the cost of treatment have increased. With more resources, the providers will be able to attend to our patients more.

Our one-hour policy says that if anybody who is under health insurance is taken for secondary or tertiary care, where you have to pay fee-for-service, if the provider waits for one hour and he doesn’t get a response from the HMO, he should continue to treat the patient, and he will be paid. It is to improve the quality of service.

Two, in NHIA, we have a monitoring and enforcement unit that has been strengthened to be able to monitor the providers, receive complaints from beneficiaries and follow up and provide sanctions where necessary for any erring providers. We are bringing in technology to make it better so that you can make complaints through the phone.

The other focus is to strengthen our regulatory arm. The National Health Insurance Act gives the NHIA three functions: promotion, regulation and integration of health insurance in Nigeria. Its regulatory aspect covers regulating HMOs and health providers. To be able to do this better, NHIA is strengthening this regulatory arm, particularly for the HMO registration. We are increasing the capital base – money that a company must have to be able to be an HMO – to enable them to meet up with any risks.

Also, we are setting some new rules and standards for registration and for monitoring of HMOs. Additionally, we are improving and strengthening the use of technology in all the operation processes of health insurance in Nigeria. We are trying to introduce mobile registration. In the next few weeks, it should be possible for anybody who wants to register for health insurance to do so on his or her mobile telephone. We want to ensure that everybody has a unique insurance number. If you are on insurance in Nigeria, you have a number that is unique to you. It will also be linked with NIN for the transparency of people who register. This is to be able to eliminate fraud. This way, it is easier to track any report to any facility. Toward that end, we created two new departments, the strategic purchasing department and the department that will be dealing with claim management.

Essentially, our focus in summary is about actualising the mandatory provision as well as increasing coverage significantly and improving the quality of services provided to our clients. The coverage is not only to target the organised sectors but also the vulnerable group.

The NHIA is also implementing a scheme that enables individuals to provide health insurance for others.The programme is called the Group Individuals Family Social Health Insurance Programme (GIFTSHIP). Towards this end, we are trying to relate with Nigerians in the diaspora so that they can purchase insurance for their people at home, be it in their community, their nuclear family or their extended family. The more you increase the pool, the better it is in terms of available resources to improve the quality of service.

How are you building synergy between the authority, HMOs and providers in the overall interest of bettering the system and ensuring the health of Nigerians is optimised?

The authority is trying to set new guidelines for the registration of HMOs and improve the current services; we call it the guideline on the registration and the monitoring of providers. We have had a robust engagement with the critical stakeholders, the HMO, the health providers and even the employers of labour. Everything we want to do, we do in consultation with them. More importantly, we are strengthening the NHIA’s capacity to regulate those stakeholders better.

What’s your projection in terms of coverage in the next five years?

The presidential target for the agency is to increase the health insurance enrollees to 20 million by 2027. We have already met this target, but we have not set new targets. Nonetheless, our aim is that by 2030, Nigeria will have achieved universal health coverage. But I think in the next five years, we’ll be working towards having 50% of Nigerians being covered by health insurance.

From your perspective, what is required to ensure that Nigeria builds a resilient healthcare system?

It shouldn’t be rhetoric that we have a functional health system. But to achieve this, we need to increase the resources we are allocating to health, particularly the public sector. Currently, out-of-pocket spending on health is still very high. Nigeria is a signatory to the Abuja Declaration of 15% of the budget to health. So both state and federal governments have to allocate more funds to health.

Two, we need to also increase insurance coverage by bringing in resources from the private sector and from the informal sector. When we have resources, we’ll be able to get human resources, we’ll be able to get infrastructure, and we’ll be able to get services even better.

Issues with the quality of drugs and laboratory tests are challenges many people with health insurance encounter. What will you advise them regarding such complaints?

There will be a call centre, which will be released very soon, where you can call in. Then it will also be possible to send messages, and they will be handled. That is where we are working on. I’m sure it will be out by the middle of September; the complaint centre will start working.

Copyright © 2022 Nigerian Tribune Provided by SyndiGate Media Inc. (Syndigate.info).