The provisions of the federal government’s 2023 budgetary proposal on health, would determine the extent of its commitments towards the realization of the mandatory health insurance scheme as provided in the National Health Insurance Authority Act.
Recall, the National Health Insurance Act 2022, was signed on the 24th of May 2022, by the Buhari-led federal government. The functions of the NHIAA are to (a) promote, integrate and regulate all health insurance schemes that operate in Nigeria (b) ensure that health insurance is mandatory for every Nigerian and legal resident (c) enforce the basic minimum package of health services for all Nigerians across all health insurance schemes operating within the country, including federal, states, and the Federal Capital Territory (FCT) as well as private health insurance schemes.
The 2023 health budget has a total provision of N1.097trn which is also inclusive of N46.7bn being one per cent of the Consolidated Revenue Fund for Basic Health Care Provision Fund. The breakdown of the budget is as follows; personnel is N612bn, overhead, is N16.37bn, and 404bn was budgeted for capital expenditure. The sum of N62.6bn was earmarked as retained revenue, while N2.5bn is for aids and grants. Despite the increase of the health budget in the 2023 proposal, it still falls short of the 15 per cent Abuja declaration with a funding gap of N1.98trn.
The 2023 proposed budget did not also make any provision for the Vulnerable Group Fund as captured in Section 25 of the National Health Insurance Authority Act. According to the Act, the VGF is to provide finance to subsidize the cost of the provision of health care services to vulnerable persons in Nigeria. The money from the fund shall be expended to provide (a) subsidy for health insurance coverage of vulnerable persons as determined by the Council, and (b) for the payment of health insurance premiums for indigents. Apart from the N46.7bn Basic Health Care Provision Funds disbursed to the primary health care centers in the states, there is no other allocation for health insurance in the budget.
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Meanwhile, the BHCPF has a breakdown as follows; (a) 50% of the funds shall be used to provide a minimum service package of health services to the citizens, in eligible primary or secondary health facilities through the National Health Insurance Scheme (NHIS) (b) 20 per cent of the fund shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities; (c) 15 percent of the fund shall be used for the provision and maintenance of facilities, equipment and transport for eligible primary health care facilities and (d) 10 per cent of the fund shall be used for the development of human resources for primary health care; (e) five per cent of the fund shall be used for emergency medical treatment to be administered by a committee appointed by the National Council on health. This breakdown shows that the N46.7bn is too meager to provide universal health coverage for a country of over 200 million citizens whose out-of-pocket health expenditure is around 90 per cent.
The 2023 proposed budget has the government’s own shared contribution of N105.7bn for National Health Insurance Scheme funds of employees of government in the Ministries Departments and Agencies. This sum is different from the health budget. Government employees represent less than five per cent of the population covered under the formal sector. The ambition of the NHIAA is to expand the coverage of citizens under one form of an insurance policy or the other to at least 90 percent. To achieve this, Section 25 of the NHIAA provides that beyond the 46.7bn for BHCPF, the government needs to set a fund aside called a special intervention fund which is to be appropriated for the vulnerable group insurance.
Unfortunately, none of such funds was earmarked in the 2023 budget. The section also provides that the Governing Council appropriates investments from money accrued to the VGF to the fund. Others include imposing health insurance levies and funds received from grants, donations, gifts and any other voluntary contribution made to the Vulnerable Group Fund.
Based on the above, the national assembly should mandate the federal government through the honorable minister of health to set aside a take-off grant for the implementation of the BHCPF.
Meanwhile, the minister should commence the production of policy guidelines for the registration of citizens under the informal sector as partakers of health insurance in Nigeria. Beyond the mobilization of resources for health insurance, the absorptive capacity of the stakeholders amongst the health care providers and the health facilities needs to be strengthened. There is a need for awareness creation and moral suasion for citizens to partake in health insurance. The underlining benefits to the citizens must be clearly spelt out. The federal government should also set realistic targets for responsible agents of the government to mobilize resources in line with provisions of the Act for its due enforcement
Emejuiwe Victor is the Program Manager, Good Governance Centre for Social Justice, and wrote from Abuja
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