National Health Insurance Scheme in Nigeria (Prospects and Problems)…

Dr Aderibigbe Adedayo,a Clinical Epidemiologist, talks about the Challenges, problems and prospects of that National Health Insurance Scheme (NHIS) in Nigeria.


For many years, we have been telling ourselves the bitter truth that only UHC can find proper healthcare in this country. We have agreed that to avoid catastrophic health expenditures, citizens must stop paying out of pocket for their health care needs.

Health insurance was introduced in Nigeria and it kicked off gradually not moving past a coverage of about 5-7percent of Nigerians enrolled in it mostly from the FG formal sector and the organized private sector.

National Health Insurance Scheme in Nigeria (Prospects and Problems)
National Health Insurance Scheme in Nigeria (Prospects and Problems)

The National Health Insurance Scheme (NHIS) has been bedeviled with so many problems that it saddens me to own these few thoughts in a thread. This became necessary for posterity sake because in my opinion I believe the health insurance industry though might be the answer will crash in a few years.

In Nigeria, nothing is ever the same as it is. No matter the program of any government, people or groups of people will always find it easy to steal, loot and enrich themselves illegally.

Now, let me right the problems and prospects of National Health Insurance Scheme (NHIS) in Nigeria

Challenges, Problems and Prospects of NHIS in Nigeria

1. The first problem of the NHIS is leadership. All past leaders (ES) of the Scheme safe for the pioneer Executive Secretary have all been removed on account on one allegation or the other. It was either they were truly corrupt or there’s a cabal that makes them corrupt.

There has not been stability in the Scheme such that periodic reviews have become impossible. The regulators who are supposed to provide direction and leadership are in need of direction and leadership themselves.

The Scheme is in a mess that is not understandable both by this government or the past one. Several committee have been set up to unravel the mystery but they come up short.

2. The Scheme is voluntary. How does a Scheme expected to provide services for all Nigeria’s give Nigerians the option to choose to be a participant or not. That was the first mistake. The NHIS Act needs to be changed or best ammended.

There have been several attempts to change or modify the Act establishing the Scheme but it ends up not being attended to by successive Parliaments; the 8th Assembly also being a culprit.

Insurance generally is not an easy product to market as Nigerians never believe in a pre-paid system where they have to contribute in advance of a catastrophe. They believe once the catastrophe is averted, then money has been wasted.

The tendency of pooling risk to ensure that the vulnerable Nigerians tend to benefit from the pool of the non-vulnerables who will hardly use the service is too difficult to comprehend by majority.

3. Abuse is another huge challenge facing the Scheme. Abuse by all players in the industry; NHIS itself, HMOs, Health care facilities and enrollees.

The NHIS allocate lives to friends and cronies and those with huge financial lobbying abilities. It isn’t merit based.

Health care facilities are the worst. All of them suddenly want insurance because they now have unlimited ability to capitalize on unsuspecting patients to perform all routine tests both necessary and unnecessary to conjure claims and make monies.

They claim services and procedures not done and they inflate figures for services rendered. One wonders how they claim humans have two thyroid glands sometimes when they claim to have done full thyroidectomy twice in a space of 2 years…

So many other sharp unwholesome and unethical practices abound by these facilities. Little wonder all HCFs operating under Health insurance have suddenly witnessed tremendous increase and growth.

The enrollees themselves are not left out. They invite friends, Neighbour’s, colleagues to use one single NHIS number for all activities while they can encourage them instead to do a registration of their own.

They want to obtain expensive antibiotics to re-sell or you see non hypertensive patients obtaining anti-hypertensive drugs to their sick parents or in-laws.

Then comes the administrators who believe monies abound and shamelessly demand for kickbacks in the name of CSR from all players in the Health Insurance industry without fear. They believe it is their right and refusal leads to threat to invite another player.

All stakeholders have turned the charade to a joke and the very essence establishing the Scheme has long been defeated.

I fear for the future of the Scheme as all the above factors will kill the Scheme even before it takes off.

I hope we understand the all our long grammar about Universal Health Coverage will be fruitless if we allow the NHIS continue to function abysmally.

I hope one day we can call experts to sit down and review the Scheme.

Source: Aderibigbe Adedayo


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