By Tajudeen Kareem and Emeka Nwankpa
The outbreak and aftermath of the COVID-19 pandemic are sufficient lessons to the world that human health matters, and that adequate health financing is at the core of good life and livelihood to all.
The pandemic, which is still raging across the world, should serve as the shot-in-the-arm for responsible governments that truly care about their people.
Health matters indeed. No wonder comprehensive health insurance has come to stay as a major means of financing health care and guaranteeing global peace and order.
In the United Kingdom, for example, the health insurance system is governed by the National Health Services (NHS), which aims to publicly fund the health care companies in different parts of the country.
Available statistics by the World Health Organization indicate that government funding covers 85% of health care expenditure in the UK, while the remaining 15% is covered by the private sector. The NHS is a state-funded system that guarantees health care for all. In other words, every service, ranging from medical ambulance, emergency ward round, regular medical check-up, minor or complex surgery to radiation and chemotherapy, is free, paid for with payroll taxes.
In addition, every medication at the hospital is free just as the cost of most prescription drugs at a pharmacy is cheap and affordable. Private health care is paid out-of-pocket or through private insurance coverage, but only a small minority of residents opt for it.
The health care system in South Africa is called the National Health Insurance (NHI), which is a health financing system. It is designed to pool funds to provide access to quality affordable personal health services for all South Africans, based on their health needs, irrespective of their socio-economic status. This means that every citizen has a right to access comprehensive health care, free of charge, at the point of use at accredited health facilities such as clinics, hospitals and private health practitioners.
The NHI started in 2012. The public sector is state-funded and caters to 71% of the population. The private sector is largely funded through individual contributions to medical aid schemes or health insurance, serving about 27% of the population.
In Nigeria, the Federal Government, in an effort to subsidize and provide effective health financing to Nigerians, has put in place a 10-year strategic plan to provide full health insurance coverage by 2030, going by the projections of the National Health Insurance Scheme (NHIS).
The NHIS was established in 2005 to provide easy and affordable access to health care to Nigerians. Today, it covers only about 10% of the population, mostly civil servants who still complain of poor service delivery, thereby leaving the vulnerable population to unaffordable health care services. This raises the need for comprehensive health care service that enables Nigerians plug into a national social health insurance net to accelerate the drive towards achieving universal health coverage for all Nigerians.
Adopting the PPP model
A novel mechanism known as the public-private partnership (PPP) model has become synonymous with Garki Hospital, Abuja, where excellent, affordable and people-oriented medical services have been efficiently developed. It provides a beacon of hope for the critical mass of Nigerians in need of adequate health care, at least for residents of Abuja. This model has been found reliable and stress-free since its inception in 2007.
The hospital has earned an enviable reputation as a multi-specialty hospital, equipped with state-of-the-art facilities backed by a wide range of expertise and skilled personnel providing specialized and general care, in-patient and out-patient services. Many now reckon it as a living example of successful evidence-based PPP in the health sector.
Executive secretary of the NHIS, Prof. Mohammed Nasir Sambo, during a recent visit to the hospital, extolled the PPP model as a manifestation of efficient management of human and material resources, promising to partner with the hospital on its cost-effective method for delivering healthcare services.
The medical director of Garki Hospital, Dr. Adamu Onu, identified areas of improvement for Nigeria’s health insurance scheme to include proper documentation of beneficiaries and their records as well as standardization to streamline areas of insurance coverage.
Recall that Garki Hospital was accredited by the NHIS in 2008. It currently boasts of one of the largest numbers of NHIS enrolees in the FCT, apart from the fact that it is the only PPP arrangement that accepts secondary referrals from other facilities. The hospital is also the only facility that carries out specialized surgery under the NHIS scheme, including hip and knee replacement surgery and endoscopic procedures for gynaecological procedures.
The hospital, located in the heart of Garki, one of Abuja’s oldest districts with a high population density, is with constant water and power supply. It has over 187,000 patients registered on electronic medical record application and 33,906 NHIS enrolees spread across 55 health maintenance organizations (HMOs).
Under the FCT Health Service Scheme, the hospital attends to 8,139 enrolees from three HMOs while its Private Health Insurance Scheme has 1,831 enrolees spread across 35 organizations, providing corporate services to 10,502 persons from 16 registered organizations.
Dr. Onu disclosed that the hospital’s highly effective scheme is driven by its open and transparent billing system, which ensures that no patient waits for more than 30 minutes before seeing a doctor.
The hospital has received no fewer than two million patients and encountered more than 40 open heart surgeries and 26 kidney transplants, including over 100 hip and knee joint replacement surgeries. It conducts training in family medicine, obstetrics and gynaecology, paediatrics, anaesthesia, assisted reproductive technology, nursing services and in-vitro fertilization.
He also said that the hospital was a pioneer in the use of electronic medical record application in all facets of healthcare and has been operating a paperless system since 2016. It is fully self-sustaining under the PPP arrangement and has continuous operation 24 hours a day, seven days a week, with no strikes or interruptions in service.
Challenges of the scheme
Prof. Sambo has described the ills of health insurance scheme in Nigeria as “systemic,” contending that it urgently requires a complete paradigm shift to change the narratives. He explained that the NHIS has worked assiduously towards engendering value re-orientation to make the scheme credible and result-oriented. He added that it was very important to entrench transparency and accountability in the entire operations of the national health insurance scheme as well as introducing many initiatives to accelerate the attainment of universal coverage.
Panel of inquiry
In a bid to deliver quality health care to Nigerians, a presidential committee, last year, examined all governance issues bedevilling the scheme, ranging from administration, financial management to procurement.
The Secretary to the Government of the Federation, Boss Mustapha, while receiving the report of the committee, noted with disappointment indiscipline in some government parastatals even as he expressed government’s intolerance of corrupt practices among public officers.
“I receive this report with deep sense of appreciation and I assure you that the report would be expeditiously processed for implementation, let me also assure you that the decision of government on the recommendation will be made public at the appropriate time”, he said.
The report highlighted recommendations aimed at repositioning the scheme and it also proffered solutions to the challenges hindering the scheme in achieving its set objectives.
Reshaping healthcare financing
Recently, the Federal Government announced an expansion of the health insurance system with the launch of a new health insurance package known as Group Individual and Family Social Health Insurance Programme, GIFSHIP.
The Minister of Health, Dr. Osagie Ehanire, said that the new insurance product was the outcome of wide-ranging and far-reaching reforms within NHIS to significantly increase the fiscal space for healthcare services.
He expressed expectation that the new product will address the challenges and barriers encountered during the implementation of other insurance packages by the beneficiaries and operators.
“It will also eliminate known difficulties, as it creates additional value by expanding and upgrading other insurance packages for better reach, service quality and user experience,” the minister said.
He said the major objective of GIFSHIP was to rapidly expand the scope of healthcare coverage in an urgent quest to attain Universal Health Coverage (UHC) in which Nigeria is determined not to leave anyone behind.
He said: “GIFSHIP offers Nigerians opportunity to participate and benefit from the health insurance system. There’s opportunity for affordable individual enrolment, family unit or a group of people. Any of the enrolments can also be sponsored by well-meaning individuals, Trusts, or organizations.”
The chairman, Senate Committee on Health, Dr. Ibrahim Oloriegbe, disclosed that the Senate had passed a Bill that will make health insurance mandatory for all Nigerians, and noted that the National Assembly also passed the National Health Insurance Authority Act changing the nomenclature from National Health Insurance Scheme to National Health Insurance Authority.
“The NHIA will be authority that will cover all schemes and everything will be brought together. The most important aspect of it is to make health insurance mandatory for all Nigerians,’’ he explained.
Experts have however suggested that to meet set targets, the scheme must fine-tuning its policies and programmes with a view to engender closer collaboration with healthcare providers, health maintenance organizations and sundry stakeholders.