The National Health Insurance Scheme (NHIS) said it is poised to keep working on a seamless service delivery mechanism that would enable the scheme deliver satisfactory services to enrollees and deepen healthcare insurance in Nigeria’s economic hub — Lagos.
NHIS State Coordinator, Ikeja-Lagos, Mrs Aisha Abubakar Haruna disclosed this at an Interactive Stakeholders’ Forum in Lagos, Tuesday.
She said the scheme can only attain its Universal Health Coverage goals by continuing to engage all stakeholders, including the Health Maintenance Organizations (HMOs), Healthcare Service Providers and the Enrollees who are the beneficiaries of the Scheme
The NHIS is strategically positioned towards ensuring that all Nigerians have financial access to quality healthcare service delivery and to only make 10% of Co-Payment for cost of drugs at the point of accessing care within the limit of coverage otherwise known as Benefit Package
Haruna said NHIS is aiming at this strategic goals by ensuring each of the stakeholders in the scheme understands its role and also get the right feedback needed to strengthen the initiatives and give enrollees the maximum satisfaction they desire.
“The reason for bringing all the major stakeholders together is to strategize on how to improve service delivery to the enrollees. Through this awareness all the stakeholders hope to address the challenges encountered by the enrollees especially in the areas of the indiscriminate charges by some of the heathcare providers, the delays in granting referrals and payments of Capitation and Fee for Service (FFS) to the providers by the HMOs.”
The State Coordinator, NHIS, Ikeja continued: “The NHIS under the leadership of Professor Muhammed Nasir Sambo, is striving to ensure the health system in Nigeria is taken to a level to which the attainment of universal health coverage can be achieved in Nigeria. How do you get to achieve universal health coverage, it’s for you to provide quality services, making the enrollees satisfied and to ensure that there’s sustainability of the programme.
“Recently the scheme carried out a reconciliation exercise on HMOs indebtedness to Facilities. The purpose of the exercise was to ensure prompt settlement of claims by the HMOs to the Healthcare Facilities towards improving the Scheme’s overall efficiency.”
The Coordinator further stated that the theme for the Forum was centered on three thematic areas of scheme with presentations from speakers namely:
The New NHIS Operational Modalities/Programmes (GIFSHIP) Group, Individual & Family Social Health Insurance Programme which was presented by an Assistant General Manager of the Ikeja State Office, Mrs Chika Amahalu;
Ensuring Enrollees Satisfaction in accessing Healthcare Service Delivery Under NHIS Programmes in time of Pandemic delivered by Dr Umar Oluwole Sanda, immediate past President Health Care Providers Association of Nigeria (HCPAN);
And Efficient Referral/Payment Mechanism to Ease the Challenges of Enrollees Access to Healthcare Services, by Mrs Amaka Anyaegbunam, Southwest Coordinator of the Police HMO.
In his remarks, the Zonal Coordinator, NHIS Lagos, Mr. Olufemi Akingbade said the pandemic has exposed the Nigeria’s healthcare system, hence the need to interrogate various issues affecting healthcare service delivery in the country. He added that deepening the NHIS coverage in Lagos is crucial to the scheme’s success as the state accounts for about 10% of the population to be covered in the country.
According to Anyaegbunam, who spoke on behalf of the HMOs, the major challenges facing healthcare managers in the country include wrong referral timing due to lack of adequate communication between healthcare service providers and the HMOs; issues on capitation and lack of prompt payment of claims by HMOs to providers; late submission of bills and absence of evidence of diagnosis on which payment is based.
“To ensure that enrollees have access to good healthcare services at all times, availability of funds and swift response to referrals is a must,” she stated.
In his presentation, Dr. Umar Oluwole Sanda, a former HCPAN President who chaired the event urged healthcare providers to put in place all the necessary internal processes that would engender prompt service delivery without any discrimination against NHIS enrollees who seek care at their facilities.
Tasking the NHIS to up the ante in its supervisory role of the scheme, he identified communication gaps and inadequate feedback mechanism between healthcare providers and enrollees as one of the bottlenecks the scheme must address to boost confidence and better deliver on its mandate.
Sanda during a media chat with The New Diplomat said: “Health Insurance started in 2005 and this is about 16 years down the drain, we are yet to get it right, we still have a lot of bottlenecks. For instance, the regulators need to up their game, the health managers are not doing what they suppose to do. The providers who are the gatekeepers are annoyed that they’re not being paid the right amount and that they’re not being paid on time as well.
“All these go along to affect the enrollees who we all want to serve and for whom this health insurance is meant for. Right now, it’s only about 7.5% of Nigerians that are insured and we want to achieve Universal Health Coverage. The states have been given the go-ahead to start their health insurance, for instance Lagos state, but majority of the healthcare providers are not happy with the capitation the State is offering to pay. they’re working out for them.”
Dr. Sanda, while lauding the role played by the Scheme during the last total lockdown in the country occasioned by the pandemic, said the implementation of the NHIS ACT which is still awaiting presidential assent would make health insurance compulsory for all Nigerians, noting it would go a long way towards boosting health insurance in the country.