To make health care accessible and affordable to all Nigerians, the
Akanji was diagnosed of end stage renal disease or rather kidney failure on
Akanji, a graduate of Economic was a vibrant Assistant Manager with one of the new generation Banks about a year ago with the prospect of making it to the top of the banking carrier but suddenly lost his job due to rationalisation in the industry.
With the challenges of fatherhood and a legion of family problems and cost of dialysis and treatment for his current condition, Akanji has completely cleaned out of his small savings and now needs at least N10 million being estimated cost of transplantation operation (N8 million) in
Akanji cannot afford the cost of saving his life.
Hadiza is a 65-year-old grandmother in Nassarawa district in
Shortly thereafter, Hadiza became ill, leaving her unable to work selling fried been cakes in the street corner for an income. She was forced to borrow money from other family members to pay for her medical expenses. When she could no longer borrow money she had to reduce spending on food items for herself and her grandchildren to buy medicine from the local medicine vendor in her village.
Akanji and Hadiza represent two of the over 150 million Nigerians that cannot afford and access health care when they need it because they have to pay out of pocket.
Akanji and Hadiza are some of the majority of poor Nigerians not covered by the National Health Insurance Scheme (NHIS) because they are not formally employed.
Akanji and Fatima's stories are very common in
Several studies have shown that falling ill can have devastating and long-lasting consequences especially for poor households, both through income loss and high medical expenditures.
Data from the
A recent study by Obinna E. Onwujekwe,
A key feature of UHC is that it includes prepayment and that it supports risk pooling, which ensures the spread of risk across time and across individuals.
Indeed, a broad range of risk-pooling mechanisms or insurance schemes are increasingly being utilized across the developing world to increase access and reduce the financial burden of health.
The Guardian learnt that while the
Executive Secretary of
To the Executive Director of NPHCDA, Dr.
Mohammed said UHC could be a major determinant of improved health outcomes for all citizens, especially the poorest.
According to the
Director-General of WHO, Dr
Chan described universal coverage as "the single most powerful concept that public health has to offer." In launching the "World health report 2013: Research for universal health coverage", Chan said: "Universal coverage is the best way to cement the health gains made during the previous decade. It is a powerful social equalizer and the ultimate expression of fairness."
Despite its launch in 1999, the
Unfortunately, nine years after
Little wonder the poor health indices being recorded by the country.
Until now, health insurance is recommended by the
But statistics from the
Nigerians can get health insurance cover with N250 weekly premium
With a premium of only N250 weekly, that is N1,000 monthly and N12,000 yearly, mobile subscribers will have access to standard and convenient health insurance cover on a pre-paid basis and are able choose their Health Management Organizations (HMO's) and retainer hospitals using their mobile phones for a range of pre-defined medical treatments.
Executive Secretary NHIS, Dr.
Thomas said it plans to begin mass registration of pupils in public schools starting from
He said the Scheme would be able to provide free medical care for pregnant women and children under five as soon as the National Health Bill is passed by the
Thomas said: "This is the first time mobile health insurance partnership is happening in
"At that time, that was in
"So the scheme is to leap frog from 5.2 million to 30 per cent of Nigerians by 2015. The mobile health insurance is firstly affordable and accessible by Nigerians. Since 2010, the
"Although we are starting with MTN, this programme is expected to extend to other operators as we go along. It is an application of information technology in the operations of
"We are creating a national health exchange for
Thomas appealed to Nigerians to make health insurance a campaign issue in the fort coming elections and be patient with the new programme because there are bound to be hiccups.
He explained: "You should be able to ask politicians what they want to offer in terms of health care... The programme may not be perfect initially and takes time to build. The whole process is learning process because we are the pioneers and do not have the opportunity to learn from other people. We are appealing to Nigerians that at this pilot phase there are bound to be problems. We are ready to learn and turn this into a brand for the rest of the world to look at."
Thomas said another challenge facing the programme is the inequitable distribution of health facilities across the nation and it is only a pilot scheme.
Executive chairman of Salt and Einstein MTS, Dr.
Managing director and chief executive officer of Salt and Einstein MTS,
"There is no disputing the fact that, one of the best things to do at this time is to come together, working with
"MTN has demonstrated that they are interested in the social good and welfare of Nigerians. We hope to create more products that benefit Nigerians across the country."
Chief Executive Officer and Managing Director MTN Nigeria, Mr. Michael Ikpoki, said: "MTN's motivation to partner on the health insurance initiative with the Salt & Einstein MTS and
"The focus market for the Y'ello Health Cover is Nigerians who have no health insurance cover principally because they cannot afford the regular health insurance services in the market. These individuals like everyone else, need medical care.
"However, without access to insurance, they probably would be having occasional challenges paying for medical treatment, because such expenses would usually be without or at short notice. It is to take away this burden of impromptu medical expenses that we are partnering to introduce this product."
Presidential commitment and summit on Universal Health Coverage
A school of thought believes that less than five per cent of Nigerians are presently under any kind of health insurance. Even some unpublished studies put the figure to less than 10 million Nigerians.
In fact, almost 100 per cent of beneficiaries are in the formal sector. Besides some pockets of social and community health insurance schemes across the country, most enrollees of the
Interestingly, The Guardian reliably gathered that the federal government workers who constitute almost 100 per cent of the beneficiaries are yet to start paying five per cent of their salary, which is supposed to be their contribution to 15 per cent from the federal government. The Guardian learnt that the
However, to reverse the situation, President
Jonathan reiterated the Federal Government's commitment to make every effort to ensure that Nigerians have access to qualitative and affordable healthcare services under the UHC.
Jonathan who was represented by the Vice President, Namadi Sambo, said this while declaring open the Presidential Health Summit held on
He said that whereas the country had made progress but that the nation was not where it ought to be in health care coverage.
He said while the country's health insurance programme had been mostly successful with federal employees and private health insurance for the organised private sector, it was unacceptable that there were still several pilot schemes that had yet to cumulatively result in adequate level of cover for the people.
He said the country needed to keep abreast of other countries in its development bracket in social health insurance.
While saying that health insurance must become a part of the social culture, the President said Nigerians needed to be encouraged to imbibe the benefits of affordable and regular contributions to achieving guaranteed and sustainable long term health services.
He said the theme of the summit, "Universal Health Coverage: The Vehicle for Sustainable Growth and Development" captured the emphasis which his administration's transformation agenda placed on health care for all in
The President said the government was determined to elevate UHC to a national movement with substantial participation by local and international stakeholders, supported by the government and the private sector at all levels.
Jonathan said: "Government is not unaware of the numerous challenges limiting the attainment of UHC in our country, and the importance of political commitment in surmounting these challenges.
"Our gathering here is to reaffirm our commitment as political leaders both at federal and state levels that we will do all within our powers to provide Universal Health Coverage for our people.
"As a member of
"Every Nigerian, who earns an income, has an obligation to contribute to his/her health care, and we all owe it to those who do not have the means, to provide for themselves.
"If all the states, LGAs and the organised private sector join some form of pre-payment scheme today, our coverage level will increase by over 100 per cent."
Minister of Health, Prof.
He said the summit was also meant to attract more investment into the nation's health sector to discourage medical tourism by Nigerians.
Chukwu said the Federal Government of
Chukwu said universal health coverage was crucial to
"This is the beginning of a journey. There is no way within one year we will get 100 per cent but we have never tried it at all in
The WHO country representative, Dr.
The Presidential Summit which was preceded by a two-day pre-summit technical meeting with the lead paper Achieving Universal Health Coverage: Analysis of relevant options presented by WHO and attended by Executive Governors, Ministers of the
The Declaration affirmed that health is a fundamental human right and the responsibility of government in assuring the health of all Nigerians. It acknowledged the progress made despite the existing challenges towards attaining UHC in
The Declaration recommended that the Government of
It was further recommended that a standard benefit package of essential health services that address priority health care needs of all Nigerians should be defined. In addition, it was said that UHC cannot happen unless there is a functional health system, where there is adequate human resource for health, life saving commodities and supplies, sustainable financing and a mechanism to maintain quality services.
It was also proposed that there should be a committee or taskforce to ensure that UHC is initiated, implemented and sustained in
Best practices for moving forward universal health coverage
As the country works towards meeting the Presidential mandate of putting at least 30 per cent of Nigerians on
The partnership model tagged
The State government representing the Public built the facility and provides staff for secondary care; the Private, which is the
The scheme was kicked off in
The IA cluster communities include; Rumuobiakani; Rumuomasi; Rumueziolu; and Oginigba.
The Guardian who visited the facility found that with a premium of N3,600 per annum for indigenes and N7,200 for non indigenes for registration into a model CHIS offered by the Hospital, patients can obtain 'free' secondary health services including: antenatal, delivery and postnatal care; obstetric and gynaecological services; Caesarean Section (CS); Prevention of Mother to Child Transmission (PMTCT) of Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and HIV Counselling and Testing (HCT); minor surgeries; breast examination and cancer screening programme; treatment for minor illnesses such as malaria, typhoid, d iabetes and hypertension.
Other services offered by the scheme include: family planning; immunization and growth monitoring; health education; nutrition education and food demonstrations; baby friendly care services.
It was also gathered that with the new CHIS concept, the Hospital which had only two nurses and no resident doctor before 2010 now has six doctors on permanent basis, two visiting professors of medicine in obstetrics and gynaecology and paediatrics, 42 nurses, 39 non medical staff, 13 volunteers, three
There are several lessons from the Colombian experience for Nigerian policymakers:
-Payroll-based funding needs a strong employment base, preferably with additional mechanisms to tax the self-employed. Self-employed people are generally not as easy to tax, especially if they are not registered taxpayers. It is important to devise other mechanisms for collecting contributions, such as the flat monthly rates or installments proposed for
-When designing a contracting model, it is important to avoid disadvantaging public providers by saddling them with additional rules or obligations. In addition, public providers may not be competitive for service contracts. In
-True universal coverage may require a higher percentage of spending as a proportion of gross domestic product (GDP), so it is possible that countries such as
-Monitoring and evaluation systems are crucial to measuring performance and ensuring the efficient use of resources.
The Rashtriya Swasthya Bima Yojana (RSBY) is the premier national health insurance programme established in 2008 to cover secondary care for families living below the poverty line. Contributions are very low and are required only at the time of enrollment into the scheme. The programme receives funds from the federal level covering 75 percent of the total costs, with state (provincial) contributions covering the remaining 25 percent.
A recent review of RSBY suggests that it is "on track" to achieving its objectives of increasing access to healthcare as well as reducing the financial risk among its beneficiaries.
As described in this report, lessons learned from RSBY's operational experience are appropriate for the
- The successful launch and continuation of a massive health insurance scheme targeted at the poor is only possible if there is political will and fiscal commitment at all levels of government.
*Creation of a clear-cut targeting mechanism based on established lists and appropriate incentives for insurers and third-party administrators, along with the use of technology, can help lower the cost of enrollment for the poor.
*Any health insurance scheme that aims to target the very poor may learn from the foundational premises of RSBY: Make the system cashless, paperless, and portable.
*Standardization of documents and processes along with the proper use of technology helps in situations of low administrative and managerial capacity.
*The focus on secondary care (i.e., lower complication inpatient procedures) within a defined package of benefits for RSBY members has meant lower cost per family covered.
- Use of IT applications for enrollment and patient management at the provider level has benefited the scheme, beginning with the smart cards similar to those used by
*Health insurance is now 24 percent of the central government budget for health. This is evidence of considerable political support and budgetary commitment. Moreover, these percentages have been achieved while keeping premiums to insurers low, thanks to competition among companies.
The debate in
The public sector has already invested significant funds in the primary healthcare system. It has also invested in improved access to secondary healthcare and financial protection in its use of RSBY and other schemes.
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