The Chairman of the Health and Management Care Association of Nigeria, the umbrella body of Health Maintenance Organisations, HMOs, Kolawole Owoka, on Tuesday pushed the bulk of blame of poor coverage of Nigerians under the Health Insurance Scheme, NHIS on the regulators.
According to Mr. Owoka, a medical doctor, “the regulators that are supposed to regulate and monitor the scheme now want to be the operators. That is the problem”.
This was his remark at a summit on improved healthcare financing model for a sustained investment in the health sector. The summit was organised by THISDAY newspaper in conjunction with the World Bank Group.
Mr. Owoka also absolved the HMOs of corruption.
He said the structure of NHIS was not followed the way it was constructed since inception in 2005 because, ”the regulators did not do a good job in monitoring the scheme.”
The newly reinstated Executive Secretary of the NHIS, Yusuf Usman, recently said 90 per cent of Nigerians eligible for the scheme have not been covered.
This means that about 10 per cent of a country with a population of 180 million has been covered so far since the inception of the scheme 13 years ago.
“99 per cent of federal civil servants are covered under the scheme currently”, Mr. Owoka said Tuesday at the summit.
“What would have followed is that all states and local governments should have covered its (their) own civil servants under the scheme. When you add the three together, we should be talking of 20 to 30 per cent coverage.
“Then we now focus on the informal and private sector which is hugely under-covered.
“If we had followed it this way, it would have worked but we didn’t. The current structure is wrong. It is not the question of HMOs not delivering but the fact that the regulators that are supposed to regulate now wants to be the operators”, he added.
NHIS deals with two major components: Health Maintenance Organisations, HMOs and Health Service Providers, HSPs.
The HMOs are the go-betweens in the scheme. They sit between the beneficiaries of NHIS and the service providers (hospitals). By this description, they are better known as managers of the scheme’s funds.
The scheme which is the regulatory body now monitors and regulates the activities of the HMOs and the service providers.
The HMOs were established in 2005 and had operated freely for 13 years without any form of probe.
“When the scheme was established in 2005, we had only eight HMO’s in the country and we are doing fine but now there so many HMOs mostly established for political reasons that I don’t even know.
“The problem is from the regulators (NHIS), they have not been able to monitor the running of the scheme well”, the HMO union chairman said.
He further urged the National Assembly to hasten steps in reviewing the act establishing the NHIS.
There is an ongoing amendment of the National Health Insurance Scheme.
Central to this bill, which seeks to repeal the NHIS Act and enact the National Health Insurance Commission Bill, is the need to ensure a more effective implementation of a health insurance policy that enhances greater access to health care services for all Nigerians.
This means that the bill would lay down the framework for a universal health care system where everyone pays into the insurance scheme and everyone gets quality health care 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.