The National Health Insurance Scheme (NHIS) was instituted to enable Nigerians to acquire quality healthcare without stress or the ability to pay hospital bills. It was introduced in 2005 to provide universal health coverage (UHC). This is to say that all Nigerians, regardless of income level or geographic location, are supposed to receive the medical attention they require without financial difficulty.
However several issues have hampered its success. Today, less than 5% of Nigerians are covered under the NHIS, while 70% still pay for healthcare out-of-pocket. This means millions of Nigerians do not have access to quality healthcare, especially women, children, and rural residents.
This guidebook will explain how the NHIS works, its issues, and how it can be enhanced.
How the National Health Insurance Scheme Works
The NHIS is supposed to cover medical costs for Nigerians through health insurance plans. People contribute a small amount of money before they need medical care so that when they get sick, they do not have to pay high hospital fees.
There are different insurance programs under the NHIS:
- Formal Sector Health Insurance – For government workers and private employees
- Informal Sector Health Insurance – For traders, farmers, and self-employed people
- Vulnerable Group Insurance – For pregnant women, children, and the elderly
- Community-Based Health Insurance – For rural communities
Despite these programs, most Nigerians are still not enrolled. Many do not even know how the NHIS works or how to register.
Challenges Facing the NHIS
1. Low Enrollment Rates
The NHIS has been running for over 15 years, and yet it has only 5% of Nigerians enrolled. Many people do not have faith in the system or do not understand how it works. Others, especially those in the informal sector, find it too expensive or time-consuming to enroll.
2. Poor Healthcare Services
The majority of Nigerians are unhappy with the quality of NHIS services. There are not enough doctors, nurses, or medicines in some hospitals. Others refuse to treat NHIS patients adequately because they claim the government does not pay them on time.
3. High Out-of-Pocket Costs
While the NHIS is designed to lower the cost of healthcare, the majority of Nigerians continue to cough up enormous amounts from their pockets. More than 70% of health spending in Nigeria is straight from individuals’ pockets, making it beyond the affordability of low-income earners.
4. Weak Infrastructure and Staff Shortages
Nigeria does not have adequate hospitals, clinics, and medical personnel. The country only had 24,640 doctors serving over 200 million people in 2019. That is far less than the World Health Organization (WHO) recommended ratio of one doctor per 600 people.
5. Corruption and Mismanagement
There have been many cases of misappropriation of NHIS funds. Some hospitals and officials embezzle funds, while others fail to provide proper health services. This has resulted in the loss of trust for most Nigerians in the system.
How to Improve the NHIS in Nigeria
To make the National Health Insurance Scheme work better, the government, health organizations, and the private sector must work together to fix these problems.
1. Increase Public Awareness
Many Nigerians do not know about NHIS or how to enroll. The government should:
- Educate people about the benefits of NHIS
- Use radio, TV, and social media to spread information
- Set up registration centers in local communities
2. Improve Service Quality
People will trust NHIS more if hospitals provide better services. The government should:
- Train more doctors and nurses
- Ensure hospitals always have enough medicine
- Monitor hospitals to prevent poor treatment of NHIS patients
3. Reduce Out-of-Pocket Payments
The NHIS must fully cover healthcare services so people do not have to pay extra fees. The government should:
- Increase funding to support NHIS services
- Make sure insurance covers all essential treatments
4. Expand NHIS to More People
More Nigerians, especially those in the informal sector, should be included in NHIS. The government should:
- Offer subsidized plans for low-income earners
- Provide free coverage for pregnant women and children
- Make enrollment simpler and more accessible
5. Strengthen Healthcare Infrastructure
Without good hospitals and clinics, NHIS cannot function well. The government should:
- Build more healthcare centers, especially in rural areas
- Provide modern equipment to improve healthcare quality
- Ensure hospitals have enough staff to handle patients
6. Prevent Corruption and Mismanagement
To restore trust in NHIS, the government must:
- Ensure transparency in fund management
- Monitor NHIS operations regularly
- Punish hospitals or officials who misuse funds
Why the NHIS is Important for Nigeria’s Future
If properly implemented, NHIS can transform healthcare in Nigeria. A strong health insurance system will:
- Reduce maternal and child deaths
- Help families save money on healthcare
- Improve workforce productivity
- Reduce poverty caused by high medical bills
Many countries have successfully implemented universal health coverage. Nigeria must learn from them and make NHIS work for every citizen.
Conclusion
The National Health Insurance Scheme has the potential to change healthcare in Nigeria. However, it must be expanded, properly managed, and made more accessible to all Nigerians.
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