It will take another rigorous legislative process if President Muhammadu Buhari does not assent to the bill repealing the National Health Insurance Scheme (NHIS) Act on or before midnight of May 29.

This was the major concern raised when some lawmakers and experts in the health sector on Friday gathered in Abuja.

The meeting was organised by the Ministry of Health in collaboration with the Health Sector Reform Coalition (HRSC) and the Legislative Network for Universal Health Coverage (UHC).

Discussions centered on how to fast-track the passage of the bill by urging the president to give a nod before the transition into a new administration.

Mr Buhari will be starting his second tenure on May 29.

Importance of Act

Ben Anyene, chairman of the HRSC, said the most important about the new act is that it makes health insurance mandatory for all Nigerians.

But chairman Senate Committee on Health, Lanre Tejuoso, said without presidential assent before May 29, the bill will suffer a setback.

“If by May 29, the president did not give assent to the bill, we will have to start the process all over again,” he said.

“It will be another long journey for the incoming 9th assembly that might even want to do something new. Besides, most of us advocating for this bill are not returning to the new assembly,” said Mr Tejuoso, the outgoing senator representing Ogun Central.

Conundrum

There has been repeated calls for a repeal of the NHIS Act and the enactment of a new one.

The NHIS was created 13 years ago to reduce out-of-pocket spending on health services but the scheme has been stifled by a leadership crisis, corruption, legal, political and technical encumbrances.

Today, only about five per cent of Nigerians are covered. It is believed that the major limitation to any progress is the state of the Act establishing the scheme.

The Act is also said to be the foundation of the challenges and crisis rocking the scheme.

With a new act, practitioners in the health sector believe functions of the scheme will be clearly stated.

Titled “National Health Insurance Act (Repeal and Re-enactment) Bill 2019”, the new bill, when made law is expected to invalidate some aspects of the old law (2004).

The bill passed third reading at the Senate two weeks ago. It now needs presidential assent to fully become law.

‘Long road’

Participants of Friday’s meeting outlined a plan of action towards getting a presidential assent between now and May 29.

Some of the plan include: organising a road show to draw public attention on the need for the bill to be passed urgently.

Gafar Alawode, the anchor of the meeting, urged participants to use their various platforms to make advocacy calls for the presidential assent.

It was also agreed that the Senate committee on health will lead the advocacy in the parliament.

Mr Tejuoso said, “owners of HMOs (Health Management Organisations) are kicking against the bill because the new act says states can run their health insurance with the services of HMOs.”

Dissecting the New Act

In a press statement issued before commencement of the meeting, Mr Tejuoso outlined many of the challenges in the NHIS Act to be revoked with the new bill.

They include:

I) Making Health Insurance Mandatory.

II) Subsidising Premium Payments for those who cannot afford it.

III) Stating roles of states which were not clearly stated in current NHIS Act.

IV) The enforcement of the NHIS Act through the implementation of the Basic Healthcare Provision Fund (BHCPF).

V) Limited Regulatory Powers of the NHIS to effectively carry out its functions.

The senator said “the NHIS act does not empower the Governing Council with sufficient powers to effectively regulate the health insurance industry in Nigeria in its dual roles as both a regulator and promoter of health insurance for the poor and vulnerable.

“The current composition of the Governing Council renders it incompetent to enforce the provision of the NHIS Act on the organisations not covered by the Act.

“The interest of States and local governments is not accommodated by the Act, considering the fact that they have no representation in the Governing Council conferred with the powers to manage the scheme. This is not inclusive.”

Mr Tejuoso said the new act would lay down the framework for a universal healthcare system “where everyone pays into the insurance scheme and everyone gets quality healthcare delivery, regardless of their employment status or personal wealth.”

The bill is also geared towards effectively regulating private health insurance providers in Nigeria to ensure that they deliver, not just for the well-to-do, but also the poor and people in rural areas.

Components

The Bill comprises of nine parts and 80 sections.

Part one deals with the establishment of the National Health Insurance Commission, governing council and its functions/conduct of meeting by the council.

Part two provides for the types of health insurance schemes, registration and license of the various schemes.