MANAGEMENT OF NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN NIGERIA ISSUES PROBLEM AND PROSPECTS

ABSTRACT

The aim of this study is to find out how the National Health Insurance Scheme is managed. This is against the background of  the  need to  highlight its strengths and identify sources of its shortcomings. Data were then collected from both primary and secondary sources. The main instrument used in collecting the data is questionnaire.

The data were then presented in tables as frequency distribution. The techniques of frequency and percentage were applied in analysing the data. The following are the major findings of the study: The NHIS was introduced against the background of poor state of the national healthcare   system.   The   scheme   aims   at   giving   all Nigerians access to good healthcare services, ensure equitable distribution of healthcare costs and facilities and high standard of Healthcare services.

The scheme is funded through joint contributions by government and workers. The NHIS regulates the scheme while the managers are the HMOS. Clinical and laboratory services are provided by HSPs.

CHAPTER ONE INTRODUCTION

One of the cardinal objectives of good government is to have effective healthcare delivery system put in place for  the  entire  citizenry. A  healthy nation is  a  wealthy nation because of the absence of debilitating diseases and epidemics in such a country, which, along with hunger and squalor, impoverishes the citizenry (Nwatu, 2000:12). Ensuring adequate nutrition, high life expectancy, and very low incidence of epidemics and diseases has been acknowledged as most important duty of any government.

Unfortunately, in most developing countries (including Nigeria) poor state of the nations’ healthcare system reinforces poverty and squalor to further deteriorate living conditions (Nwosu, 2002:8).

The  indispensability of  good  healthcare system  in national development underlies the governments commitment to providing adequate healthcare services since  Nigeria  attained  political  independence  in  1960

(Ugbaja,  2003:6).  in  terms  of  cost  and  delivery,  the Nigerian healthcare system  was  adjudged effective and efficient in the periods of the 1960s and up to the late

1970s, by the early 1980s shortage of  health facilities including drugs and personnel had set in  resulting in rising cost of healthcare services.

The situation seemed to favour private sector health institutions which were enjoying relative boost in patronage as the general poor state public healthcare system continued deteriorating.

According to Abacha (1985:3), the public hospitals had   become   (consulting   clinics”   Given   the   rapid population growth rate, what the nation needed was a commensurate increasing level of are services. But the decreasing finance of the government oil left the government with no other choice than reducing budgetary allocation to the health sector (Ozuh, 2004:30) prior to the government  almost  solely  financed  health  services  in public health institutions. But by the turn of the 1980s, it had become joint responsibility of the government and the

citizens (Ughamadu, 2003:23). In other words both the government   and   the   citizens   shared   the   costs   of healthcare services in public health institutions with the greater burden weighing heavily on the government. Subsidization of  healthcare services was paramount in healthcare budgetary allocation.

As a panecea to the increasing depending on the government for social services, the international monetary fund (IMF) packaged some economic reforms among which was removal of subsides in the oil and health sectors. This is a precondition for the granting of a $2.5 million loan to Nigeria. The rejection of the loan led the government to implement some aspects of the conditionalities including reduction  of  healthcare  financing  (Olaghere,  2000:42). This was also in response to the call by participants in a conference organized by the federal government to deliberate on alternative ways of funding the health sector. The participants, among other things; called for joint healthcare services financing (Obadan, 2002:10),

Thus,  in  line  with  the  public  sector  reforms, the health sector reform became paramount with adequate financing as its cardinal objective. The culminated with the introduction ^r launching of the National Healthcare insurance Scheme (NHIS) on June 6, 2005 by the Federal Government.  According  to  Umar  (2005:13)  the  NHIS

represents a milestone in the quest for adequate financing of healthcare services in the country.

From both internal and external sources, Nigeria’s health sector expenditure amounted to 1.95% of the GNP in  2003 or  $4.8  per  capital External sources financed

50.2% while internal sources accounted for 49.8% Direct financing method was increasingly advocated for as a source of additional resources for healthcare services.

The methods includes user – fees and pre-payment schemes. User- fees and drug sales are the methods most frequently used because of  their greater administrative simplicity (Oduenyi, 2003:21). Topically, the revenues generated by  user-fees in  the  public  sector  are  rather modest, thus,  increasing government burden  in  health financing. This gives justification for the National Health Insurance Scheme.

According to Obasanjo(2005:2) the basis for the establishment of the Nation Health Insurance Scheme (NHIS) include;

 The  general  poor  state  of  the  nation’s  healthcare system.

 The    excessive    dependence    and    pressure    on government

 Dwindling funding of healthcare in the face of rising costs, and

 Poor  integration  of  private  health  facilities  in  the nation’s

healthcare delivery system.

This study is therefore set to examine the management of the scheme with a view to determining its benefits, problems and prospects.

1.2 STATEMENT OF PROBLEM.

Three years after its inception, the NHIS has not effectively taken off and operated as initially conceived. This is as a result of challenges facing the scheme. First, the scheme is still limited to the public sector and has not been extended to the private sector due to apparent lack of

political will and commitment. The scheme suffers from restricted coverage.

Second,      there      is      continuous      delay      in remittance    from government establishment to the NHIS council,! which also delays remittance to Health Maintenance Organization (HMOS) Providers (HSPS). This makes the  scheme to  suffer  from  ineffective financing. Third, the scheme lacks adequate facilities and personnel to cover the nation sufficiently.

This arises from the limited number of the Health Maintenance Organization (HMOS) and Health Service Providers (HSPS) registered to operate in the scheme. Besides, most of the HSPs lack adequate medical equipments and  dedicated personnel to  implement the scheme.

Fourth, many of the Health Service Providers (HSPs) are withdrawing from the scheme and some functional ones  are  refusing  to  register  new  clients  or  public servants.

Finally, inadequate logistic support or support facilities from the government and donor-agencies affects the scheme adversely. Furthermore, adequate publicity or enlightenment has not been given to the people on the scheme.

1.3  OBJECTIVE OF THE STUDY

The objectives of the study are;

1. To examine the rational for the NHIS

2. To examine the goals of the scheme

3. To find out the funding strategies for the scheme

4. To examine the roles of the operators of the scheme.

5. To establish the benefits and problems of the scheme

1.4  RESEARCH QUESTION

The following questions with are addressed;

1. What is the rationale for the NHIS?

2. What are the goals ofthe scheme?

3. What is the funding strategy for the scheme?

4. What are the roles of the operator of the scheme?

5. What are the benefits and problems of the scheme?

1.5  FORMULATIONS OF HYPOTHESES

The following hypotheses are formulated for the study;

1.     Ho: The rationale for the NHIS is not general poor state of the nation’s healthcare system.

Hj: The rationale for the NHIS is the general poor, state of the nation’s healthcare system.

2.  Ho: The goal of the NHIS is not efficient healthcare services delivery.

Hj: The goal of the NHIS is not efficient healthcare services delivery.

3.    H0:  The problems of  the NHIS are not  essentially administrative.

Hj:   The   problems   of   the   NHIS   are   not   essentially administrative.

1.6  SIGNIFICANCE OF THE STUDY

The study will be useful to the following;

1.      National Health Insurance Scheme Council (NHISC)

This regulatory body of the NHIS will find this study useful. This is because it will identify all the constraints to effective implementation of the scheme especially as it effects HMOs and HSPs. The regulatory aspect of these challenges will be established in this study so that the NHISC will take remedial measures. The recommendation of this study will be useful in this regard.

2.     Health Maintenance Organization (HMOs)

These organizations will also benefit from; this study. This is because it will not only highlight the challenges facing them under the scheme but will also provide useful information on how they can effectively address these challenges especially those arising from their internal constituencies.

3.     Health Services Providers. (HSPs)

These  private  health  institutions  will  also  benefit from this study. Those already operating under the scheme will be provided with useful information on how to brace up with their challenges while those not

yet operating under the scheme will find in this study the need to be integrated into the national healthcare delivery system via the NHIS.

4.     The Government

The government will also see the need to solicit for foreign assistance to effective implementation of the programme as well as to ensure prompt remittance to the NHISC and HMOs from its establishments. The  recommendations  in  this  study  will  also  be useful for its policy review in respect of the scheme.

5.     Students

Definitely, the study will add to the little literature on the NHIS and can also serve as reference material to those who will carry out related studies in the future.

6.     The Society

The study will also be useful to the society at large. This is because it will give a full exposition to NHIS and how they can benefit from the scheme.

1.7  SCOPE OF THE STUDY

This study focuses on the rationale, goal, management, finding, benefits, problems and prospects of the NHIS.

1.8  LIMITATION OF THE STUDY

The limitations of the study are;

1.      Limited information.

The NHIS is relatively new in Nigeria. Consequently, not much work has been done on it or primary information for the evaluation of its performance.

2       Inadequate finance

This prevented the researcher from gojng to the headquarters of NHIS for information.

1.9   DEFINITION OF TERM AND ACRONYMS

1.     National   health   insurance   scheme:-   This   is a      security programme under which employers and employees finance health services through contribution (Lambs, 2006:16).

2.     Health Service Providers:- This refers to any health institution (hospital,    health  centers  clinics,    etc) authorized to provide healthcare service under the NHIS (Ozuh, 2004:30)

3.     Health Maintenance organizations (HMOs):- This refers to any authorized body or organization to administer the NHIS by liaising between the NHISC and HSPs (Ozuh, 2004:30).

4.     Healthcare Delivery System: – This refers to the provision of health service to. The people (Ughanmadu, 2003:23).

5.     HMOs    an    acronym   for   Health    maintenance organizations (Uduma, 2005:3)

6.     HSPs  an  acronym  for  Health  Service  Providers

(Uduma, 2005:3).

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