INEFFICIENT ENROLMENT AND POOR ACCESS TO SERVICES PLAGUE NIGERIA’S HEALTH INSURANCE SYSTEM

Panelists have identified Inefficient Enrolment and Poor Access to Services as the hallmarks of Nigeria’s Health Insurance System. Speaking during a ‘Conversations on Health Insurance and Managed Care in Nigeria and the Developing World’ organized by the Dr Uzo Adirieje Foundation (DUZAFOUND) and Afrihealth Optonet Association (AHOA), participants discussed the importance of health insurance and managed care in Nigeria, highlighting the challenges in achieving universal health coverage and the need for increased awareness and capacity building. The team also shared their experiences with health insurance systems in various countries, including Nigeria, India, Kenya, Senegal, and Cameroon, highlighting inefficiencies, disparities, and the need for improvements.

The Event, which was organized on 25^th February 2025 to commemorate the 61^st birthday of a prominent global civil society actor, Dr. Uzodinma Adirieje, also highlighted the following that:

• Nigerian government should increase health budget allocation to at least 15% of the national budget;

• Nigerian Health Insurance Authority is expected to improve claim processing and reimbursement systems for healthcare facilities;

• Nigerian health insurance providers should streamline registration and access processes for beneficiaries to stop the hardships and additional costs in transport and logistics encountered by enrollees before accessing services;

• Kenyan government should urgently to address challenges in the transition from NHIF to Social Health Authority;

• Senegalese health insurance system should implement AI and digitalization to control fraud and improve monitoring;

• African governments are requested to develop strategies for including the informal sector in health insurance schemes;

• Health insurance providers across African countries should establish a minimum guaranteed healthcare package for all citizens;

• Civil society organizations in Cameroon should assist in registering citizens for the universal health coverage program; and

• Stakeholders must mobilize to ensure that achieving UHC and Health Financial Protection for ALL remains a priority for the African Union, G7, and G20 Leaders.

HEALTH INSURANCE IN NIGERIA AND THE CHALLENGES

Dr. Uzodinma Adirieje from Afrihealth Optonet Association (AHOA) discussed the importance of health insurance and managed care in ensuring financial protection and access to quality healthcare, particularly in developing countries like Nigeria. He highlighted the National Health Insurance Authority Act of 2023, which aims to make health insurance mandatory for all Nigerians, but implementation and enforcement are ongoing. Dr. Adirieje also pointed out the challenges in achieving universal health coverage, such as low public health financing and reliance on external support. He emphasized the need for increased awareness and capacity building about health insurance and the benefits of prepaid health systems in Nigeria. He also discussed the role of the National Health Insurance Authority in regulating and integrating health insurance and the importance of the Basic Health Care Commission Fund and State Equity Fund in achieving universal health coverage.

NATIONAL HEALTH INSURANCE SCHEME DISCUSSION

Participants discussed the potential benefits of a national health insurance scheme in Nigeria, highlighting the need for public awareness and trust and the possibility of greater healthcare affordability. A participant, Mr. Emmanuel Eso, shared his experience with approaching the Leadership to bridge gaps in the Scheme, while Okon emphasized the scheme’s limitations to registered individuals and the issue of deliverables.

HEALTH INSURANCE SYSTEM FAILURES DISCUSSED

In the meeting, a participant discussed his experience with the Nigerian health insurance system, highlighting its abysmal performance and lack of effectiveness over the years. He shared his experience of registering for health insurance in 2024, the lessons learned from a training trip to Brazil to understudy their health insurance system, and the ongoing struggles with accessing healthcare services in Nigeria. Ms Gift Agu added her perspective from a hospital setting, describing the disparities between those with and without insurance coverage and a disturbing incident where a patient with insurance was denied treatment due to an insurance policy change that denied patients healthcare services if their HMOs are owing the health facility. Speakers expressed dissatisfaction with the current system, calling for improvements and ensuring the reliability of health insurance coverage.

NIGERIA HEALTH INSURANCE POLICIES COMPARED

The team discussed the current state of health insurance in Nigeria and other countries. Dr. Uzodinma shared his experiences with health insurance service in Nigeria. Dr. Anima Sharma from India explained the popular medical insurance in her country, which is provided by both government and private companies to various sections of society. She noted that the corruption in the insurance sector in India is low, and the government is vigilant about malpractices. The team also discussed the reasons why some participants may not be benefiting from health insurance in Nigeria.

HEALTHCARE FINANCING CHALLENGES IN KENYA AND NIGERIA

A participant from Kenya discussed the challenges faced by Kenya’s healthcare financing system, particularly the transition from the National Health Insurance (NHIF) to the Social Health Authority. She highlighted that the new system was not yielding the desired results, with many Kenyans preferring to return to the former system. Rachelle also pointed out that the payment system was not inclusive, as it was based on income, and the claim system was not streamlined, leading to difficulties in accessing healthcare services. Dr. Adirieje shared similar experiences from Nigeria, where the health insurance system was not effective for private individuals and was mainly beneficial to those in the public sector. Hon. Mrs. Aniedi Inyang shared her personal experience of paying for private health insurance in Nigeria, only to find it ineffective when she needed emergency care.

NIGERIA’S UNFULFILLED HEALTH BUDGET COMMITMENTS

Dr. Uzodinma Adirieje discussed the inefficiency of the health insurance scheme in Nigeria, highlighting that the country has not budgeted up to 15% for health, despite the Abuja Declaration in 2001 that required African countries to allocate at least 15% of their national budget to health. He expressed concerns that the Nigerian government was not implementing the agreed-upon resolutions and emphasized the importance of investing in health insurance to improve the lives of citizens and increase productivity. Adirieje also pointed out that Nigeria’s budget for health is significantly lower than the agreed-upon 15%, and that the country’s national budget is not being utilized effectively. Aniedi shared that in her state, the elderly (65 years and above) and children under 5 years are provided with medical care, but only once a year and only in government hospitals.

HEALTH INSURANCE SYSTEMS IN CAMEROON

The group also discussed health insurance systems in Senegal and Cameroon. Mr. Bocar Mamadou Daff, a former Director General in Senegal, explains that their system covers about 53% of the population, focusing on children under 5, pregnant women, and the elderly. He highlighted challenges with the informal sector and fraud prevention. From Cameroon, NWABUFO Francoise Ngnedjou reported progress in universal health coverage, particularly for dialysis patients, pregnant women, and young children. The meeting concluded with participants sharing experiences and expressing interest in continued discussions on health coverage across different countries.

PARTICIPANTS INCLUDED:

1. Dr. Uzodinma Adirieje, Speaker – Nigeria
2. Dr. Anima Sharma – India
3. Abimbola Daramola – Nigeria
4. Hajia Binta Adamu – Nigeria
5. Seth Tsongo – DR Congo
6. Elder Dr Okon Enemi – Nigeria
7. Emmanuel Esio – Nigeria
8. NWABUFO Francoise – Cameroon
9. Agu Ogonna – Nigeria
10. Ms Nicole Serrij – UK
11. Engr Ibrahim MD Sule – Nigeria
12. Balkhisa Bashir – Kenya
13. MR BADOIT Guillaume – Burkina Faso
14. Olumide Kemi Esther – Nigeria
15. Molly Sobola – UK
16. Aniedi Inyang – Nigeria
17. Yemisi Salami – Nigeria
18. Stella Ohanusi – Nigeria
19. Bocar Mamadou Daff – Senegal