By Agbor N. Ebuta MD
Almost seven months ago, Mr. President signed the National Health Insurance Authority (NHIA) bill into law, and this was a watershed moment in the history of health system repositioning. Indeed, it is expected that this NHIA Act which replaces the now repealed NHIS Act will do for health, what no other framework or policy document could have done potentially.
The National Health Insurance Authority Act 2022 replaces the National Insurance Scheme Act 2004. (18years ago). Originally, it was Act 35 of the 1999 constitution that established the National Health Insurance Scheme (NHIS). However after a fairly limited review in 2004, it became operational in 2005.
To understand how progressive the NHIA Act is, one will need to place it side by side with the NHIS Act. Indeed, the NHIS Act though a fair march forward, failed to provide the predicted giant leaps in the health sector its originators prophesied. While some may consider this a failure to meet set goals, it’s definitely clear that in putting the NHIS to use, the yawning gaps in its operationalisation became apparent. This provided a justification for the birthing of the NHIA Act. Thus, any success envisioned, therefore, in relation to the NHIA Act must share some accolades with its predecessor the NHIS.
Though key stakeholders across the health sector, working hand in hand with the National Assembly clearly did a lot to put together a much-improved bill, Mr. President appending his signature was the defining moment. The NHIA Act may fittingly be called the ‘Buhari health act’ or ‘Buhari Medicare’.
The new Act (NHIA) represents both a qualitative and quantitative improvement on the old Act (NHIS). While the old Act in 1999 had 10 functions, the new authority has 26 functions, clearly a quantitative leap of 160%.
Although the 1999 NHIS Act had good intensions, it was at best a modest effort aimed at establishing the primordial phase of an organised national health insurance sector. It was more on generalisation and less of specifics. It tried to capture the key essence of a national health insurance programme but was unable to speak truth to power as relates integration with sub-national governments, comprehensive population demographics cover, clear documentation/data collection strategy, policy review interval amongst other key performance indices.
Qualitatively the NHIA guaranteed a mandatory cover of ‘All’ residents Nigeria. The National health Act Basic Health Care Provision Fund (BHCPF) provided that 1% of consolidated revenue will be remitted to NHIA guaranteeing steady funding. NHIA Act card to be given to every Nigerian will ensure a trackable eligibility to basic health services. NHIA will thus be supported by an increasing pool of funds available for health projects. Guaranteed funding for primary health care via BHCPF is also a key innovation that has been affirmed.
The new Act ensures that the authority is to be effectively in charge of all matters related to health insurance, regulation, accreditation inclusive, guaranteeing the mandatory availability of health insurance to all Nigerians and legal residents based on a reviewable basic minimum package guideline.
It was explicitly stated that support for state government run insurance which were to also address vulnerable groups was to be active, as opposed to the passive collaborations obtainable in the past.
The BHCPF was to be implemented more effectively. Effective over sight and accreditation of health management organisations was now clearly domiciled with the NHIA, and any ambiguity was discarded. A pathway for policy articulation and improved service coverage of the health sector was also enshrined in the act, strong support for state government run health insurance schemes, impetus for fund drive outside statutorily guaranteed payments, need for the development and maintenance register of insurance schemes and health facilities were also enshrined in the new act. The deployment of research, role of a robust ICT framework, deliberate human development policies, a gazette basis for timely tariff/operational guidelines reviews, including applicable sanctions where necessary was also elaborated on.
The Act is now seven months, effort to quickly update the operational guidelines, immediate and wide spread dissemination, backed up with an interim hotline readied to provide support on its deployment is imperative. No doubt, the review of the old Act took more than awhile. Some of us feel that an earlier revision may have mobilised factors which may have prevented some elements of the current ‘Japa’ phenomenon and other health system challenges we currently experience. The year has ended, but in 2023, all stakeholders must move faster in operationalising the 2022 NHIA Act, for indeed, the best time to plant a tree is yesterday, but the next best time is now.
▪︎ Dr Ebuta is a Family Physician and Vice President Medical Initiative for Africa (MIFA). He writes from MIFA headquarters in Abuja.