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The Nigerian National Health Insurance Scheme (NHIS): A Case for the Extent of Reform Required

  • College of Medicine, University College Hospital, Ibadan

Abstract and Figures

Good health and well-being is focal to achieving sustainable development in any society. The realization of this fact prompted the Nigerian government to introduce the National Health Insurance Scheme (NHIS) in 2005 with the view of achieving Universal Health Coverage amongst other objectives. However, fifteen years down the line, less than 5% of Nigerians is covered by the scheme. In fact the World Health Organization (WHO), in 2017, ranked the Nigerian Health System as 187 out of the 190 World Health Systems. This implies that the scheme has not succeeded in achieving its mission. Hence, a reform is needed. But how much so? This paper aims to draw the attention of policy makers and health advocates to the need for reform of the Nigerian NHIS and the extent of reform required. It does this by firstly analysing the impacts the scheme has had so far and its potential for further impact generation, particularly in promoting the achievement of the Sustainable Development Goal 3. Also detailed in this discourse are the loopholes of the scheme identified from its systematic comparison to Ghana’s NHIS, a scheme touted by the WHO as a “shining example for Africa”. Furthermore, specific recommendations for bridging the identified gaps are highlighted in this paper.
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The Nigerian National Health Insurance Scheme (NHIS):
A Case for the Extent of Reform Required
By: Esther Ejiroghene Ajari (MB;BS Ibadan in view)
www. pos te rs es si o n. c o m
Over 5 million registered Nigerians
accessing NHIS provided healthcare
100% coverage for pregnant women and
children under 5 years in 12 states with 1.6
million of them registered across 86 local
government areas
Coverage of 95 per cent of federal
government employees.
Accredited 34 Health Maintenance
Organizations, 5,949 Healthcare Providers,
24 Banks, 5 Insurance Companies and 3
Insurance Brokers to participate in the
Establishment of a vibrant national call
centre and central data centre.
Coverage of over 250,000 students in
Nigerian tertiary institutions.
Introduction of the NHIS Act of 2004.
NHIS is a publicprivate tripartite system
established in 2005 under Act 35 of 1999 by the
Federal Government of Nigeria with the sole
objective of making quality and affordable
health-care accessible for all. This is made
possible by the deduction of 5% of the
employee’s basic salary and 10% of the
employer’s salary.
However, despite this intervention, the World
Health Organization, in 2017, ranked the
Nigerian Health System as 187 out of the
190 World.
Make the scheme compulsory for allto facilitate resources pooling
Implementation of the scheme by all the three tiers of government
Intensify public awareness of the scheme by translating its attributes into
the major Nigerian languages and by collaborating with NGOs community
leaders and the media
Allow a daily contribution of token amounts towards the pre-payment sum.
Diversify source of fundingIntroduction of special tax contributions or
formation of a health trust to bridge subsidy gaps.
Capacity building at every level of management and implementation
Monitoring of the activities of all stakeholders
Ensure effective record keeping for continued evaluation and upgrade.
Efficient exchange of information and data between the relevant bodies.
Engage international organizations and collaborating partners in provision
of technical and financial support to the Scheme
Ghana’s NHIS which was promulgated in 2003 recorded a
62% enrolment rate of the general population in 6 years,
whereas Nigeria’s has recorded only about 4% in 15
years. This huge disparity might be because Ghana’s
NHIS is compulsory while the Nigeria’s caters mainly for
formal sector workers. Other factors contributing to the
unsatisfactory state of the Nigerian NHIS include:
Poor knowledge of the scheme’s existence and
awareness of its benefits
Low accessibility to the schemeNot run on all
levels of government.
General distrust of the Nigerian populace in systems
run by the government: leading to resistance by
labour unions
Inadequate coverage of rural areas: due to
reluctance of health workers to move to these areas.
N.B: Over 90% of disease burdens are in rural
Long waiting period before a subscriber could access
care due to the poor referral system, inadequate
manpower and lack of digitalization in the accredited
Low funding, fund misappropriation and other corrupt
Difficulty with meeting up with the pre-payment plan
due to the high level of poverty in the country
Delay in healthcare provider reimbursement by the
Lack of collaboration between organizations
responsible for patient’s information management
and records keeping
Non-involvement of scheme’s beneficiaries in
planning and implementing the scheme
Suboptimal monitoring and supervision of the
Lack of coverage for terminal diseases
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