Despite the establishment of the health insurance scheme in some states, many residents have continued to pay for health care services from their pockets.
Daily Trust gathered that in some of the states, the scheme is either not working properly, years after it was established, or residents are not even aware that it exists.
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It is estimated that over 70 per cent of Nigerians pay health bills from their little incomes, thereby making it difficult for many to access health care.
According to the Nigerian Demographic and Health Survey (NDHS 2018), about 97 per cent of Nigerians are not using health insurance to access health care services.
Last year, NOIPoll also showed that almost eight out of 10 Nigerians (77 per cent) did not have health insurance cover.
Experts said this slowed Nigeria’s efforts towards achieving Universal Health Coverage (UHC).
The UHC means ensuring that people have access to quality health services without suffering financial hardship.
Prof Mohammed Nasir Sambo, the executive secretary of the National Health Insurance Scheme (NHIS), in an interview with Daily Trust Saturday, said it was retrogressive for over 70 per cent of the money coming into the health system to come from individuals.
He said it was important to ensure that people did not go into poverty as a result of seeking health care services.
A 47-year-old trader in Abuja who identified himself as Tochukwu said it had not been easy paying for health care services for his family of five out of his pocket.
He said that sometimes he had to incur huge debts to pay for his children’s medical bills in public and private hospitals.
He said many people he knew, ranging from colleagues and relatives, also struggled to pay-out-of-pocket for health.
Kogi still struggling
Most people interviewed in Lokoja said they were not aware of the Kogi State Health Insurance Agency (KGSHIA). Others said it existed more on paper than reality.
A civil servant who didn’t want her name mentioned said the scheme had not been working effectively.
“The underlying issue here is funding. The concept is good; at least it will assist the less privileged in the society in addressing their health challenges. But how committed is the state government to this scheme?” she asked.
A Lokoja-based Islamic scholar, Mallam Abubakar Ahmed, said many lives would be saved if the scheme was allowed to see the light of the day, adding that many are dying because of lack of money to pay for treatment.
“I lost an uncle recently to a terminal illness. He had exhausted all his savings in his attempt to save himself from the illness, but he unfortunately died in the process.
“If this scheme was in place and functioning, he would have gotten a better medical care that would have prolonged his life. For now, it is still paperwork,” he said.
Some residents are of the opinion that the scheme is another avenue to defraud them.
“The government has a good policy to assist the masses, but people will always hijack it to serve their interest. They will use it to enrich themselves at the end of the day.
“I will not register for the scheme. I will die when I will die,” a shop owner in Lokoja who wants to be identified as Madam Bukky said, angrily.
The Kogi State Health Insurance Agency (KGSHIA) was established on April 24, 2019 when Governor Yahaya Bello assented to a bill passed by lawmakers setting up the agency on November 14, 2018.
Among other things, the agency was established to assist in providing quality and affordable health care services for the people of the state towards ensuring universal health coverage by 2030.
It is expected to target vulnerable persons, state and local government workers or civil servants, organisations and other interest groups.
Daily Trust gathered that besides the agency’s reported registration of 131 vulnerable persons in each of the 239 wards recently, during a sensitisation tour of the three senatorial districts, nothing tangible seemed to be happening in the agency.
The agency could not register state workers or any other group till now as the move was said to have been stalled by the organised labour and paucity of fund.
It was learnt that the organised labour leaders had insisted that civil servants must be paid all their pending entitlements before keying into the scheme.
Payment of minimum wage, promotion arrears, yearly salary increment and others were thrown up in this direction.
Also, activities at the agency were said to be at the lowest ebb because of lack of funding by the state government. A source said most of the agency’s programmes were not carried out and those being observed were done at a very snail speed.
Efforts to speak with the chief executive officer of the agency, Dr Adekunle Aledare, failed at press time as he moved the interview to the next day due to tight schedules.
In Bayelsa, scheme mandatory for civil servants
Speaking on the charges for the Bayelsa Health Insurance Scheme, a resident, Tare Joseph, said though the yearly subscription of N17,400 was affordable, most residents of the state who are not public servants may not afford such amount for medical fees.
He said though he and his family had subscribed to the scheme and paid the yearly fees, the state government should see how indigent people could subscribe for the health insurance scheme free of charge.
“The scheme is good because sometimes, when you or any family member has health challenge and you are not financially buoyant, you get treatment through the scheme, so it is a nice initiative by the government.
“They should not limit the services of the scheme to Yenagoa, their services should be at least at the local government headquarters so that people at the remote part of the state can also benefit from it. They even need medical attention more than us in the town,” he said.
An elderly woman, Mary Sandy, said although patients are always many, thereby making appointments with doctors difficult, the scheme is doing great work for the people of the state.
She urged the government and operators of the scheme to improve on service delivery so that more persons with medical challenges could be encouraged to subscribe.
The Bayelsa Health Insurance Scheme (BHIS) was established on July 2013 by the administration of former Governor Seriake Dickson.
Checks by Daily Trust indicate that the scheme has, since its establishment, handled over 485,980 cases for patients who enrolled, and out of this number, 9,0148 were secondary medical cases.
Some of those who enrolled into the scheme told our correspondent that its services were less cumbersome for bill payment when compared to that of out-of-pocket.
The enrolment fee is deducted from civil servants’ salaries as the state government has made it mandatory for them to participate.
Non-civil servants or private residents either pay N1,450 per month or N17,400 per year to enrol in the scheme.
The executive secretary of the BHIS, Dr Zuoboemi Agadah said, “In order to serve enrolees better and curtail prices and abuse of the system, management has constantly reviewed service tariffs and added drugs that were not initially in the list, as well as the approval for an upward review of capitation for hospitals as from March this year.”
Agadah said that in November 2021, the scheme started registration of the vulnerable and the less-privileged under the Basic Health Care Provision Fund.
Many not utilising health insurance scheme in Lagos
Paying out-of-pocket for health care in Lagos State has not been an easy task for many residents.
Despite community sensitisation, radio jingles and other awareness efforts by the government agency in charge of health insurance, many Lagos residents still pay for their health bills as health insurance still appears ‘foreign’ to most of them.
Some of them also visit pharmacies to buy over-the-counter drugs rather than visit hospitals.
The Lagos State Government introduced the Ilera Eko Health Insurance Scheme to ensure universal health coverage. Establishing and sustaining health insurance may be an uneasy task in some states, but the case is different in Lagos, our correspondent learnt.
Under the packages available for the scheme, an individual is required to pay N8, 500 per annum, while a family of six, comprising father, mother and four children of less than 18 years, is to pay N40, 000 per annum.
The fee covers registration and consultation, child sickness, chronic disease, emergency care, care of women and newborn baby, admission for at least 15 days, and drugs, among others. A total of 714 facilities have been registered for the scheme with 142 private and 72 public facilities across the state.
To reduce the financial burden on enrolees of the health scheme, the Lagos State Government recently increased the maximum age of dependants in a family package from 18 years to 23.
The general manager, Lagos State Health Management Agency (LASHMA), Dr Emmanuella Zamba, explained that the decision was because there were still some children above 18 years who still stay with their parents.
She said civil servants paid for only 25 per cent while government paid for the remaining 75 per cent.
“We introduced the Ilera Eko ‘Pay Small Small,’ which allows those who can’t afford to pay once to pay in instalments; and they will still enjoy the packages accrued to someone who paid once.
The number of enrolments done so far, as at the end of January, is 560,000.
Asked why the number is low compared to the over 20million residents in the state, she said health insurance was still ‘alien to our culture.’
The coverage of the state health insurance is not limited to government-owned hospitals. Zamba said the scheme had over 250 hospitals across the state, including secondary health facilities, PHCs, as well as private hospitals.
Mrs Nkechi Ajayi is one out of the over 500,000 Lagos residents who have benefitted from the scheme, which started full operation in 2020.
While others paid cash or with their ATM cards during an antenatal clinic at the Isolo General Hospital, Mrs Ajayi did not pay any money. After delivery through a caesarean section, others were paying over N100,00 before they were discharged, but she did not pay anything because she enrolled in the Ilera Eko family health scheme.
A Lagosian who has benefitted from the health insurance scheme and gave her name as Mrs Olu said the scheme was good because enrolees could get help when it is needed.
“When my child was sick, I rushed him to the hospital close to my house at night and he was treated free of charge. He was given injection and drugs.
“When I was sick, I also went to the hospital. The only challenge I had at that time was that my enrolment number was not seen on time in the computer, which kept us waiting before I was attended to.
“Also, because the scheme does not cover all ailments, I was referred to a general hospital for further treatment because my condition required expertise,” she said.
She stressed the need for government to ensure continuous monitoring of the accredited hospitals to ensure that they do the right thing and maintain the standard.
A civil servant who did not want his name mentioned said he had been enjoying the scheme as he doesn’t incur any additional cost any time any of his kids is sick and needs medical attention.
Beneficiaries of the scheme have, however, urged the state government to expand the scheme to cover more ailments, as well as give access to retirees and their families.
Kano
In Kano, the contributory health care system was established in 2006.
Various programmes run by the agency include the formal, informal and the equity health care sector programme having broad category and sub categories.
There’s an organised private sector for private companies who register their staff for the provision of the health care services.
There’s a programme for students of tertiary institutions, as well as a programme for retirees, covering civil servants.
The informal sector has a vital contributory health care programme designed for individuals that are not under any formal or equity health care programme meant for businessmen who pay a minimum of N12, 000 per head yearly.
There’s a community health care programme the agency is yet to start.
The deputy director, programme, Kano State Contributory Health Care Management Agency, (KSCHMA) Abdullahi Sa’ad Ahmed, who spoke on behalf of the agency’s executive secretary, Dr Halima Muhammad Mijinyawa, said the agency had enrolled 79,000 beneficiaries.
The agency has also covered 20,000 pregnant women and children under five across the 44 local government areas of the state.
“Apart from the vulnerable and basic health care programme, the agency also has a source of funding from the Kano Health Trust Fund to assist and boost the health sector in the state.
“KetFund spared some percentage from its total income, whereby it is covering individuals from internally displaced persons camps, Torrey home, rehabilitation centres across the state and remand homes.
“The children home in Nassarawa are solely provided by the state government through KetFund,” Ahmed said.
Ojoma Akor (Abuja), Tijani Labaran (Lokoja), Bassey Willie (Yenagoa), Risikat Ramoni & Christiana T. Alabi (Lagos) & Salim Umar Ibrahim (Kano)
