In all respects, the eventual take-off of the National Health Insurance Scheme (NHIS) qualifies for a revolution in the history of medical care in Nigeria.

Conceived as far back as 1962 by Dr. Moses Majekodunmi, the then Minister of Health, the NHIS came into being only last year. Since then the scheme, which had its first working annversary recently, has registered about 700,000 Nigerians from both the public and the private sectors who can now access healthcare services under the health insurance scheme. In addition, the NHIS has accredited 5,290 healthcare providers across the country comprising 1,880 primary service providers and 3,410 secondary service providers. Also accredited are 20 Health Maintenance Organizations (HMOs) which are responsible for collecting contributions, payment of health care providers and monitoring of the quality of services rendered.

The NHIS is arguably the best thing that could happen to health care delivery in Nigeria. The scheme harnesses finances from contributions of both the government and workers for future healthcare delivery. With the scheme in place, a health fund pool is created to take care of those who may not be able to provide the immediate cash for their health care at the point of illness.

This facility is particularly needed in a country where, because of large-scale poverty, only about 35 percent of the population has access to primary health services. There is a poor enrolment of patients in dire need of medical attention and health care providers are either reluctant or unable to modernize their hospitals and clinics, and improve on the quality of services because of the poverty of the patients they cater to.

However to guarantee the success of the scheme, the government must take some important steps. First, the enabling NHIS law must be amended to take care of the excesses and abuses which may crop up in the implementation of the scheme. In addition, there should be a mechanism for referrals under the scheme, and primary healthcare, needs to be separated from tertiary care. For example, a patient registered for primary health care should be able to choose his own physician. Above all, the issue of corruption has to be tackled if the scheme must work. Already some HMOs are said to be referring patients to their own clinics. Government has to devise ways of ensuring that the money collected by HMOs are paid to the doctors and not diverted into private accounts. For the scheme to work successfully there must be adequate funds and grants for upgrading and standardising hospitals and the medical care they deliver.

Finally, the doctor to patient ratio in Nigeria is still below the World Health Organization standard of one doctor for 200 to 500 patients. Therefore to ensure the smooth operation of the scheme, the shortage of medical manpower needs to be redressed.

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This Day (Lagos)
EDITORIAL

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