This month’s discussion topic: The new Nigerian health insurance bill – reimagining the Nigerian health system for healthier lives and social justice?

The Federal Government of Nigeria has expressed commitment for Universal Health Coverage (UHC) and is seeking to attain financial protection for all citizens. Healthcare in Nigeria is financed through government budgetary allocation, donor funding, the National Health Insurance Scheme (NHIS), and private funding. The Government launched NHIS in 2005 to reduce huge out-of-pocket spending for health services, which often leaves average and vulnerable Nigerians in penury. Despite billions being pumped into the scheme since its inception 17 years ago, about eight out of ten Nigerians (still) do not have health insurance covered in Africa’s largest economy, according to a 2021 survey. The Nigerian health insurance system is a paradox. A lot of donor funding has been received from the Bill and Melinda Gates Foundation, and World Bank (e.g. the Saving One Million Lives programme), yet there was no corresponding improvement in the health indices.

These shortcomings have led to Nigeria’s President signing into law the health insurance bill, in May 2022. According to the bill, NHIS has a mandate to cover all Nigerians by 2025. To achieve this, NHIS has decentralized health insurance implementation to the states, while ensuring that the “mandatory clause for enrollment” is passed into the various state health insurance laws. Furthermore, the new National Health Insurance Authority will collaborate with state government health insurance schemes to accredit primary and secondary healthcare facilities; ensure the enrollment of Nigerians; and undertake quality assurance visits to ensure equitable access and quality of care are maintained.

Before the signing of the new Act, the only incremental progress for UHC we saw in the states, though slow, was most notably through the Basic Healthcare Provision Fund (BHCPF). The BHCPF serves to fund a Basic Minimum Package of Health Services (BMPHS); increase the fiscal space for health; strengthen the national health system particularly at the primary health care (PHC) level by making provisions for routine daily operation cost of PHCs; and ensure access to health care for all, particularly the poor, thus contributing to overall national productivity. Health data at times are skewed to just attract more funding while the health system is not at all strengthened.

The new act has a governance and accountability framework seeking to create and enforce the “rules of the road to UHC.” I believe Nigeria will make progress towards UHC with this Act, but only if it ensures the enforcement of strict oversight of Health Management Organizations and strategic purchasing arrangements. Until that happens, the new Act would be akin to putting new wine in old wineskins.