By Chioma Obinna
Yemi had never really been to able to afford hospital treatment. A young widow, she and her family wallowed in abject poverty for years. Already a mother, she was pregnant and jobless when her husband died years ago. Life became difficult.

Things went from bad to worse. At five months gestation, Yemi had not registered for ante natal, nor visited the nearby Primary Health Centre in her locality. The reason was basic – there was no money to pay the hospital bill and other essentials.

*Centre is the Executive Director NHIS, Dr. Waziri Dogo-Mohammed and some of the beneficiaries of the Maternal and Child project of NHIS/MDGs

Luckily, she resides in Ondo State, one of the States benefiting from the National Health Insurance Scheme/Millennium Development Goals Maternal and Child Health, NHIS/MDGs/MCH, Project.

Free medical treatment

Fortunately, her Local Government was chosen for the pilot project.  Under the project, select primary health care centres offer free medical treatment to pregnant women and children under the age of five years once they enroll for the scheme. This was the saving grace for Yemi.

She had her baby in a safe and healthy environment. Today, she and her baby are hale and hearty thanks to the NHIS/MDGs' MCH project. Kelechi, a 20-year-old orphan who hails from Imo state was unable to finish school. Since her parents died, she became pregnant in the process of making ends meet.

Unfortunately, her supposed partner had no regular source of income and was unable to support her. No one could readily support her and her guardians actually sent her away. Seven months into her pregnancy, she fell ill in the middle of nowhere.

A good Samaritan who turned out to be a nurse in a health centre in that local government area, got her enrolled on the free NHIS/MDGs project on in the state.  Kelechi and Yemi are beneficiaries courtesy of the NHIS/ MDGS project under the NHIS benefit package.

Ali Egba, would not have lived to tell his story if he was not covered under the NHIS. A government employee, he suddenly passed out in front of his house. Although he had no money on him at that time, Ali is an enrollee under the scheme. He was quickly rushed to the hospital where he presented his card and was treated free of charge.

Many have lost their lives due to their inability to meet their health needs. Statistics have shown that about 70 per cent of Nigerians pay out of pocket for their healthcare needs. A situation, many countries have eliminated through healthcare financing.

This and many more health watchers say justifies the reason for the NHIS to function effectively.  It is not surprising that agitation for an efficient and sustainable health insurance scheme in Nigeria has engaged government at all levels since the promulgation of the National Health Insurance Scheme, NHIS, Act.

Nigeria continues to fare badly in global development indicators as it was ranked 156 out of 187 surveyed by the 2011 United Nations Development Programme (UNDP) report released in 2011. With a life expectancy of 51.9 years and under-five mortality out of 1000 births put at 138, Nigeria has a low Human Development Index.

The reason may not be unconnected with the fact that the country is plagued with many health challenges ranging from health financing, excessive dependence and pressure on government provided health facilities, dwindling funding of healthcare in the face of rising costs, poor integration of private health facilities in the nation's healthcare delivery system and overwhelming dependence on out-of-pocket expenses to purchase health.

Global maternal mortality

The country accounts for 10 per cent of global maternal mortality and 59,000 women dying annually from pregnancy related problems.

No doubt establishment of a health insurance scheme became imminent. All over the world, the establishment of a health insurance scheme has continued to tackle out-of -pocket payment by enrollees. It also ensures access to basic healthcare services to all residents of in most countries of the world and Nigeria is not exceptional.

Critical observers have maintained that without a focused scheme in place many Nigerians will continue to struggle to pay medical expenses on their own. And the country's health indices will continue to drop from bad to worse.

Research shows that four out of five people who go bankrupt in the developing world are pushed over the edge by mounting medical bills. When the NHIS was established under Act 35 of 1999 by the Federal Government of Nigeria, its aim was to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.

The desire for a well performing health insurance scheme was premised on two major platforms –– a reliable financing option and an acceptable legal framework.

Participants register with a Health Maintenance Organisation (HMO), and pay a premium to the same. The employer pays 10 per cent of the employees' basic salary while the employee contributes five per cent of his basic salary.

The HMO would then link them up with a number of service providers (clinics) in their neighbourhood out of which they will choose their preferred clinic. The participant may decide to change the chosen clinic if at any point he is not satisfied with its services.

Whenever, there is any health issue, the participant or his dependants will just report at the clinic and they are treated without having to pay any fee, apart from the initial premium paid to the HMO. A policy usually covers a couple and four children under the age of 18.

The NHIS  was adopted to achieve the Millennium Development Goals, MDGs, which is to reduce child and maternal mortality rates by 2015. Today, there are thousands of testimonies from beneficiaries like Yemi and Kelechi, in areas where the Maternal and Child Care Project has been launched.

Some of the states include; Imo, Bauchi Oyo, Sokoto, Niger, Bayelsa, Gombe, Ondo, Kastina, Cross River and Kano amongst others. The Scheme has had teething problems, but the real challenge is to amend the law establishing it.

In six years, the NHIS, no doubt has recorded some expected achievements under the leadership of the current Executive Secretary, Dr Waziri Dogo-Mohammed. The scheme has enrolled several millions in Bauchi and Cross River states that joined the scheme, and more are at various stages of joining.

The regulatory body has developed operational tools, guidelines, protocols etc., accredited 7,850 health facilities and 61 HMOs to run the scheme, developed blueprints for implementing the informal sector programme, community — based and Tertiary Institution Social Health Insurance programmes.

Subsidy funding

It has also secured approval to implement MDG subsidy funding for pregnant women and under-five children.  Employment generation from activities of new HMOs and expanded capacity of providers, Near completion of a robust IT platform (e-NHIS) to drive operation and regulation of the scheme, Establishment of a vibrant National Call Centre, Establishment of central data centre, Draft of new NHIS Act, re-organisation and restructuring of the NHIS to meet future challenges, monitoring and evaluation system in place for HMOs and providers, enhanced funding to providers (public and private) and improvement of quality of care.

One major achievement of the NHIS is the transformation of the psyche of the Nigerian people from skepticism, resistance to acceptance and expectation.  Now NHIS is a household name. People's expectations are, when will it touch my life? And that has made NHIS develop many programmes to address the different segments of the Nigerian population.

The NHIS Executive Secretary once noted: "We have been able to prove that it can work in Nigeria. We have been able to transplant the idea of social insurance into Nigeria and we have seen that, yes, our people can actually harmonise the ideas. But the real challenge that we have, is the law establishing the organisation, which needs amendment. It needs to be made compulsory, made mandatory, and then everything will roll out."