Background

Medical insurance that can help reduce the strain of healthcare costs on families is rare in Nigeria. In emergencies, many often have to depend on the generosity of others, with avoidable deaths occurring from delays in pooling healthcare fees from various persons.

Past Reform and Achievements

In 1962, an attempt was made towards a national health insurance scheme, as part of a social security system. It failed. In 1984, the National Council on Health commissioned a study for a NHIS, a social health insurance scheme whereby the health care services of the contributors are paid for from the pool of fund contributed by participants in the scheme. In 1993, the Federal Ministry of Health was mandated to start the implementation of the NHIS report that was submitted in 1989. Six years later, in 1999, legal backing for the implementation of the NHIS was promulgated, and structures for the implementation of the NHIS established. After another six years, in 2005, NHIS became operational. NHIS offices were subsequently established in the 36 states of the Federation including the FCT.

The scheme has achieved some success. It covers 98% of federal government employees, and has enabled private organizations to provide health insurance for their employees. It aided the expansion of MDG project from 12 states to all the 36 states of the Federation inclusive of FCT, as long as the respective states make their own funding contributions. It has enabled the introduction of a Mobile Health Insurance Programme, which is the first of its kind in the world.

Challenges and Next Steps

Government should consider amending the NHIS Act to make all private organisations and state governments cover their employees in the scheme, towards covering more Nigerians and reducing losses of essential human capital to ill health. An aggressive awareness programme should be conducted to increase uptake of the scheme in the country. Programmes that advocate preventive health measures should be established by Government to reduce the incidence of adverse selection that may burden and then crash the NHIS scheme.