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NHIS and service delivery: What impact so far?

They say that a productive workforce must necessarily be strong, fit, and mentally stable. No doubt, Nigeria’s commitment to the Millennium Development Goals (MDGs), and…

They say that a productive workforce must necessarily be strong, fit, and mentally stable. No doubt, Nigeria’s commitment to the Millennium Development Goals (MDGs), and Vision 20:2020 are strong indications of efforts to reposition the country for greater heights.

Barely five years to the targets of the MDGs and 10 years to that of Vision 20:2020, health and development experts agree that much still needs to be done to make the impact of both programmes felt by the citizens. “Much still needs to be done to meet the objective of both programmes, which are fundamental to true development of the nation,” says Mr Ibe Nwankwo, a federal civil servant.

Nwankwo points to some health-related issues, which are cardinal components of the programmes, describing them as noble. These components, he says, include the envisaged reduction of child mortality by two-thirds and maternal mortality by three quarter.

UNICEF records show that Nigeria ranks as the eighth nation of the world, which has the highest rate of children who die before they are five years, while as many women also die from complications of pregnancy. Notwithstanding these unsettling statistics, health experts say that the Nigerian government has undertaken some major reforms in the health sector, which are expected to redress these problems in course of time.

They point to the development of a national policy on reproductive health and the successful take-off of the National Health Insurance Scheme (NHIS).  In spite of the reservations by some citizens on the scope and effectiveness of the reforms, government officials often reassure the citizenry that all loopholes in the programmes will be plugged.

Mr Dogo Muhammad, Executive Secretary of NHIS, says that the scheme remains the most effective health financing option that guarantees easy access to health care for all. According to him, stakeholders in the public and private sectors must work together in a multi-lateral approach, to enable maximum benefit to all citizens, who subscribe to the scheme.

So far, he says, the NHIS has enrolled about 40 million persons made up of public sector employees and their dependants, adding that over 800,000 beneficiaries are currently enjoying the NHIS-MDG Maternal and Child Health Project in 12 selected states.

Muhammad says he desires more states in the federation to join the scheme for the benefit of their citizens, stressing that he has taken a lot of pains to go round the country in order to persuade the state governments.

“We want the chief executives of the various states to partner with us, so that their people will benefit from this scheme,” he says. While noting that only Cross River and Bauchi states have so far keyed into the NHIS, he expresses regret that many Nigerians are still ignorant of the scheme and as such have not embraced it.

Muhammad emphasizes that the financing mechanism of the NHIS is such that ensures sustainability, stressing that it is important that such mechanism is backed by the force of law, to enable health service providers to upgrade their facilities.

“The regular payment to service providers will encourage health professionals and private investors to establish more health facilities in the rural areas, while government will also get more funds to address other competing problems.

“Each state should strive to set up at least two schools of Midwifery/Nursing, to produce the manpower needed to handle a significant number of vulnerable patients, who are mostly women and children,” he says. The Abia Government is one of the states of the federation, which says it will rise to the challenge of partnering with the NHIS, to boost the health of its people.

Orji told Muhammad at a recent visit that his government placed priority on the health needs of its citizens, especially as it relates to child and maternal health.

“We are building about 200 health centres, spread across all the 17 local government areas of the state; and so far, 165 have been completed and equipped.

“Our government is determined to provide a `safe-landing’ for all newly born babies, while their mothers would also be made comfortable,” Orji assures. According to Orji, the state’s College of Health Technology and other Nursing schools are not relenting in the production of manpower for the health sector, stressing that an Indian firm – MeCure Group, is soon to build an ultra-modern Specialist Hospital and Diagnostic Centre in Umuahia.

“These are just part of efforts to support the NHIS and other programmes, which are aimed at boosting reproductive health in the state,” he says. Observers note that the NHIS is not without some teething problems, which some enrollees have highlighted across the federation.

Mrs Gloria Abiakam, who resides in Abia, says that “most enrollees of the scheme are disenchanted due to unresponsive services of some NHIS care providers, which result in grossly under-utilized services and facilities”.  She claims that many of the care providers operate with poorly trained staff, while drugs are hardly available after diagnoses are made.

“Poorly trained staff, long waiting hours, uncomfortable clinic spaces and inadequate supply of drugs are the bane of the scheme and this dissuades people from patronising the scheme.

“We usually have problems getting drugs from the accredited hospitals and they even insist on treating patients with some drugs I think are sub-standard.

These fears may not be totally unfounded as an official of a Federal Medical Centre in one of the south-eastern states, who pleaded anonymity, admitted that “certain fundamental problems” do exist that can only be decisively addressed by NHIS officials.

“The drugs dispensed to enrollees by the healthcare providers are based on the drug list specified and given by NHIS. The NHIS does not take responsibility for any drugs sourced outside that list.

“Most of the drugs on the list are cheaper and that perhaps explains the omission of other drugs that are more potent and relevant, but expensive,” the official says.

He stresses that “in the circumstance, enrollees are compelled to buy drugs outside and this they feel, offends the spirit of NHIS”.

Notwithstanding these complaints, there are others who applaud the NHIS, describing it as a programme that will improve with time. Mr Sam Oditah, a federal civil servant in Abia, says that the NHIS is laudable but expects improvement in its implementation, as some problems are very evident.

“NHIS absorbs the cost implication of healthcare and medical treatment for civil servants, but the service providers must show more commitment to the success of the scheme. “Most of the service providers are government hospitals and their attitude is as bad as has always been – the usual lazy attitude to work,” he laments.

Another enrollee, Mr Emma Ugwu, says he has not experienced any problems with the scheme, though he wants the government to extend the services to all Nigerians, whether in the public service or not.


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