By JOHN NWOKOCHA

The Acting Zonal Coordinator, North Central Zone, comprising Kwara, Niger, and Kogi, Alhaji Adamu Abdullahi, has disclosed in a recent media chat that the National Health Insurance Authority (NHIA) has enrolled over 20 million Nigerians in the health insurance scheme across Nigeria, targeting 44 million enrollees from Nigeria’s growing population by 2030.

In the drive for optimal healthcare delivery in a country with over 300 million population, 20 million appears like a drop in an ocean. But the NHIA is not relenting in its drive for more Nigerian families to enroll in the scheme, as the new leadership of the Authority is focused on increasing the enrollment rate. The NHIA unfolded a strategy for an enhanced scheme, indicating the deployment of dynamic and time-tested technologies for capturing a greater number of the population. Low enrolment experienced over the past years stems from apathy and disincentives by a healthcare system that offered its primary and secondary health services with nearly zero satisfaction or relief.

So, with 20 million registered enrollees in the meantime, the NHIA has significantly changed the narrative, underscoring the commitment of the management to decisively erase the old records, even though the work is ongoing. Nothing illustrates the fresh determination to improve the nation’s healthcare system clearly than the re-engineering at the NHIA, aiming to serve the citizens better. The interventions could be described as the most significant step ever seen in the history of NHIA, even if you put together previous efforts by the past managements to make Nigeria’s health insurance scheme a reality. The citizens have not had it good.

Nigerians have dreamt of an NHIA ruled by good governance and in line with best practices that would translate into better health for the people. Their dreams swirled and waited for full translation into reality. And yet, progress was slow.

Also, the highly anticipated impact of the health insurance scheme on the health of the citizens could not be felt for several years. The NHIS was officially launched in 2005 with the goal of achieving universal coverage for all Nigerians. The journey started in 1962, and since then, it has raised hope for better health for all people through access to a full spectrum of high-quality health services delivery across the country, without independent financing.

The people deserve a better health system. They expect a health insurance management that is shaped by accountability, transparency, and improved service delivery.

Their hope for a better healthcare delivery system follows complaints about shoddy services often rendered by officials who lack the basic courtesies that healthcare professionals ought to possess, aligning with the care and hospitality industry standards. As a key requirement for promoting wellness-enhanced services, it also makes the enrollees look forward to their next visits. But the unprofessional conduct by care workers is affecting enrolment growth, despite the orchestrated drive.

Additionally, obsolete resource management contributes to the low enrolment rate and failure. These undermine the efforts to change the narrative.

Nigerians would be willing to enroll in any programme that offers them efficient and affordable healthcare delivery services from primary to secondary levels, rather than financing their healthcare independently.

But with services that remain unimproved and clearly undermine the system, the enrolment rates will continue to decline. Besides, the current economic hardship in the country can affect enrolment. And this raises concerns about attaining the 2030 target, by first addressing the low enrolment rate.

Nigerians are grappling with the high cost of living occasioned by rising inflation. The severe economic situation has also created problems for many households, as the purchasing power of many families has dropped drastically. Consequently, access to quality healthcare is now unaffordable to them.

Hundreds of thousands of Nigerian households have been pushed into extreme poverty as the price inflation continues to rise.

With prices skyrocketing, medicines and medications in particular have become out of reach for millions of Nigerians, leaving them starkly vulnerable to health risks, including preventable public health diseases. And yet, amid the galloping prices, the citizens face a threat of fake and substandard drugs, double trouble for them.

All these gaps combined are significantly frustrating the objective of the out-of-pocket expenditures for citizens, on the one hand, and push back efforts aiming to improve the health sector, on the other.

The NHIA’s Intervention is therefore welcome news because is an all-inclusive lifesaving. The intervention could be the need elixir for achieving the intended goals of the NHIS at this crucial time when Nigeria is working to move closer to the universal health coverage target. The package, eloquent of Ohiri’s determination to transform the NHIA for the better, should not just be hailed but encourage intending enrollees to take this moment as very precious and key in.

The NHIS has been successfully implemented not only in high-income countries but also in low- and middle-income countries, like Nigeria.

The Dr Kelechi Ohiri-led management is already taking steps in the right direction, quietly transforming the entire system.

The revised capitation fee as part of the reform initiated by the Ohiri-led management will address the issues around enrollees’ fears.

In the reform, the management ensures that waiting time is reduced for enrollees when they need referrals from primary to secondary healthcare.

Strengthening capacity for efficient healthcare service delivery is equally a commendable move by the management.

Said the zonal coordinator, Abdullahi, “We are working towards ensuring a drug-free society, under the NHIA medicine initiative”, adding: “We are going to have NHIA-branded drugs that our enrollees can easily access”.

The Federal Government has introduced the ‘One-Hour Referral Authorisation Code’ to reduce the bottlenecks encountered by enrollees when accessing services.

In the reform, maternal health is given deserving and adequate attention. How? Under the new intervention programmes, a carefully designed care package will address the five leading causes of maternal mortality in Nigeria. These include: haemorrhage, preeclampsia, sepsis, post-abortion complications, and obstructed labour. They have posed a high risk to maternal health and caused countless deaths.

Another health threat the intervention programme is targeting to curb is infant and newborn mortality, and scale up obstetrics delivery in Nigeria to save and protect infants.

A Comprehensive Emergency Obstetric and Newborn Care programme, designed to tackle the five leading causes of maternal mortality in Nigeria, is mentioned in the plan.

When put into full action, underlying risks such as haemorrhage, preeclampsia, sepsis, post-abortion complications, and obstructed labour would be reduced.

There is also the NHIA Free Fistula Programme and the Global Fund HIV-AIDS Drug-Resistant Tuberculosis

These programmes are crucial in scaling up the Universal Health Coverage and aligning with President Bola Tinubu’s Renewed Hope Agenda in the health sector.

A monitoring and evaluation exercise to be conducted by NHIA officials, tagged “Mystery Shopping,” will commence soon.

Enrollees deserve uninterrupted access to healthcare and flexible operational guidelines, and they should not have to suffer at the point of accessing services. The NHIA requires the cooperation and support of management from all public healthcare facilities across the country to provide the right treatment to all enrollees.

However, for the enrollees to have the benefits of quality assurance, which should be a defining mark of the reform, a courteous workforce of healthcare workers will make the expected difference. But should the workers turn themselves into principalities, then the reform is dead from the outset.

•Nwokocha, seasoned newspaper Editor, is also a healthcare development analyst writes this feature from Abuja.

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