Nigeria National Health Insurance Scheme: A Highly Subsidized Health Care Program for a Privileged Few

Abstract

The National Health Insurance Scheme (NHIS) of Nigeria was established over a decade ago with the aim of achieving universal health coverage within ten years of inception. Currently the population coverage is less than 10%. Beneficiaries are primarily the formal sector employees. An assessment of the three dimensions of universal health coverage in the South West geo-political zone of Nigeria is essential to determine the gaps in these areas. These will be of assistance for policy makers in efforts to expand the scheme. Methods: Secondary data on health indices such as life expectancy at birth, infant and under - 5 mortality rates, maternal mortality ratio and infectious diseases prevalence, were accessed from the World Bank website. The premium paid per enrollee was obtained from the Strategic Review of Nigeria’s National Health Insurance Scheme Population figures was obtained from the Nigerian population census from the National Population Commission website, while data on the number of enrollees, accredited facilities and the distribution of these by State in the South West geo-political zone was obtained from the NHIS South West Zonal Office in Ibadan, Oyo State Nigeria. The available data were manually analyzed with the aid of the MicroSoft – Excel. Appropriate tables to align with the study objectives were generated. Ethical approval to use some of the data was obtained from the NHIS southwest zonal office, Ibadan Nigeria. Results: Poor health indices exemplified by low life expectancy at 54 years, high infant and under 5 mortality rates of 88 and 143 per 1000 live births respectively. Maternal mortality ratio was 630 per 100,000 live births. Estimated percentage of enrollees of the population was 1.7. At an annual growth rate of 2.7%, the estimated population of the southwest zone in 2016 is over 35 million people of which only 1.7% were enrollees under the scheme. Seventy-five per cent or above of enrollees in the zone were registered with just over 10% of all the accredited health facilities. Funding of the scheme was solely limited to contributions from the federal government while beneficiaries contribution was nil, with a resultant shortfall of about one-third of the expected total fund. The population coverage of the scheme in the southwest zone was poor, the, distribution of the enrollees across accredited health facilities was grossly skewed, and funding of the scheme was inadequate. These findings have negative implications on efficiency of service delivery, and equitable access to quality health care services. Stakeholders must address these gaps if universal health coverage is to be achieved.