Operationalizing universal health coverage in Nigeria through social health insurance

Abstract

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.

Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania

“…In Nigeria, health care resources are skewed toward secondary and tertiary health care which are run by the state and federal governments, respectively. Availability of higher cadre health workforce (doctors, nurses) is also skewed in favor of secondary and tertiary health facilities which are usually in urban areas . Similarly, in Tanzania there is a severe shortage of human resources in the health sector at all levels, which is higher in rural areas…”

Health Insurance and Healthcare Quality: A Comparative Study between Insured and Uninsured Patients at a Teaching Hospital in Northeast Nigeria

“…The drug administration policy of the NHIS stipulates the use of generic drugs [1], in line with its objectives of healthcare affordability and quality. Generic drugs are often low-priced than the branded ones while still maintaining quality and effectiveness, thus lowering healthcare costs without compromising efficacy [25][26][27][28][29].…”

Distribution of health facilities in Nigeria: Implications and options for Universal Health Coverage

“…The uptake of health insurance in Nigeria has been slow limiting the public sector's capacity to leverage the private sector among other issues. By 1995, fewer than 0.03% of the population were enrolled in any health insurance program, which has only reached about 5% . Legislative challenges, resistance by unions, poor political will, and voluntariness of health insurance participation have been highlighted as limiting the adoption of health insurance by subnational governments in the country …”