NHIS: Expert sets agenda for implementation of NHIA

The take-off law of the National Health Insurance Scheme, NHIS, was promulgated in 1999 and cited as the NHIS Decree 35 of 1999. In 2004, NHIS Act, Cap N42, LFN was established. However, the Law was perceived by all stakeholders in the Health Sector as a weak legal framework because it made participation in health insurance voluntary, rather than mandatory.

However, to make up for the inadequacies of the law establishing the NHIS, on the 19th of May, 2022, President Muhammadu Buhari signed into law the National Health Insurance Authority, NHIA, Act 2022, making the Insurance Scheme compulsory for all. 

The Scheme transformed from the NHIS to the Nigeria Health Insurance Authority, NHIA. The new law also provided for establishment of state/FCT health schemes, the scheme for MDAs, the establishment of a vulnerable group fund, ensures Basic Health Care Provision Fund, BHCPF, implementation and powers to sanction in the Act among others. 

The signing into law of the NHIA Act 2022, has legally repealed the NHIS Act Cap N42 Laws of the Federation of Nigeria, 2004.

Chioma Obinna spoke to the immediate past President of the HealthCare Providers Association of Nigeria, HCPAN, Dr. Jimmy Arigbabuwo on the performance of Nigeria’s Health Insurance sector in 2022 and expectations in 2023.  

Arigbabuwo, who is also a prominent member of the National Executive Council and Chairman, of the Lagos State NMA Committee Chairman on Health Insurance, revealed new hopes and grounds with NHIA. Excerpts:

New NHIA

A quick review of the new NHIA shows new hopes and the breaking of new grounds, and better structured. The journey to Universal Health Coverage, UHC, commenced with the signing of a mandatory health insurance bill into law on the 19th of May 2022. Innovative Health Insurance like the Groups Individuals Families Social Health Insurance Programme, GIFSHIP, became better entrenched.

Health Insurance for the elderly and retirees was given more attention in the new scheme; also branded medicines for NHIA were commenced as a pilot project in some states of the federation has been on the table since mid-2020. The greatest benefit is that Health insurance is now compulsory for everyone in Nigeria.

Setbacks

However, there have been some setbacks. And essentially that was on implementation of the Act. Part of the implementation process was National Health Insurance Summit. It had been postponed twice, first in October and December 2022. 

Perhaps, due to a clash of programmes with the presidential duty schedule. The Basic Health Care Provision Fund seems to be diverted mainly into restructuring, renovations and revamping the various Public Primary Health Care centres across the States and country.

Finally, we expect a robust. acceptable and operational guidelines for all the stakeholders.

Latest on HCPAN

Tariffs mandate

This was a key area. It all began when HCPAN set up a 30-Man Tariffs Review Committee in 2020 to review the 10-year-old areas of tariff complaints and inadequacies as it affected healthcare goods and services. The group had again met for seven months and submitted her reports to HCPAN leadership in November 2020. This was hinted at the HCPAN AGM of December 2020 that was held in Lagos. 

I was President of HCPAN and addressed a large house as well as the media that HMOs will be given another year to consider the reviewed tariffs overdue for implementation. And that was how we waited till December 2021, with yet another national reminder that by 31st January 2022 all the old and ineffective tariffs that had been overtaken by the economic realities would be immediately jettisoned while the new tariffs would be implemented starting 1st February 2022.

One thing leading to the other, the matter was reported to the leadership of the NHIS then, Professor Nasir Sambo, by the HMOs to play an interventional role as the Regulator (albeit as at that time the NHIS had not really been empowered by any known Nigerian law to regulate with such a fiat as spelt out now in the NHIA law) But being a mediator, the NHIS leadership then advised an in-house give and take arrangements between the HMOs and HCPAN for mutual agreement. One meeting after the other, NECA was also invited into the case by the HMOs.

While NECA was not prepared to review what she was presently paying to the HMOs and advised that both the HMOs and HCPAN should do a joint appraisal of their market situation and forces to formulate a way forward.

Indeed, in October 2021, the joint negotiation crack team of the HMOs and HCPAN was able to secure a 25 per cent increment in the NHIS Fee- for -Service Tariffs for Social Health Insurance Programme for the Formal sector etc and another 5 per cent was approved then as an additional top-up for the HMOs to service as an administrative adjustment on Fee-for-services on tariffs of the NHIS only. 

You will also recall that the HCPAN industrial redress was to affect the Private Health Insurance Programme & Business in February 2022.

Hope

It is hoped that the new team of HCPAN as emerged on 13th December 2022, working with the Ex-Officio Capacity of the Immediate Past President, myself, in synergy, will be able to pursue this course to a logical conclusion for a better experience of Health Insurance for the majority of Nigerians.

All should note that the new law has empowered Private Health insurance to be a top-up for Social Health Insurance by groups, individuals, families, as well as corporate organisations.

Projections for sector in 2023

It is expected that the group which is the private health sector that provides about 70 per cent of the Total Health Care delivery of the country will be better incorporated and involved in the planning and execution of the various Health plans and projects.

However, it is important to mention that since Prof Mohammed Sambo came on board there has been greater and better participation from the Private sector. But there is enough room for improvement. It is also expected that implementation processes will be aggressively pursued within the first quarter of 2023 despite the fact that general elections will be taking place.

It is also expected that there will be much more solid institutionalisation of some of these policies and programmes to forestall divergent political will once a government in power is changed.

Kudos to the Executives, Legislators and Judiciary for the signage of the mandatory/ compulsory health Insurance law. It is equally expected that states that are yet to key into the State Social Health Insurance Programme/ Scheme will endeavour to do that so that they can be part of the Basic Health Care Provision Fund.

It is also expected that appropriate and better pricing of healthcare services will be required and implemented. All critical stakeholders should be involved in price/cost determination so that there will be seamless operations, especially with the nose-diving economy.