No fewer than 19 States of the federation are at various stages of implementing universal health coverage through establishment of their respective health insurance schemes

However, Anambra, Delta and Lagos states have particularly made significant progress in enrollment of people on this scheme.

Health Insurance is one of the mechanisms for providing financial protection from the costs of using healthcare services, which is a key pillar of universal healthcare. The protection it affords is extremely important as research from the World Bank and WHO showed that 100 million people are pushed into extreme poverty on an annual basis due to healthcare expenses. While health insurance has been operational in Nigeria for over 15 years, the uptake has remained low.

Speaking at a virtual Leadway Assurance Media training for insurance journalists in Lagos recently, the head, Medical Services, Leadway Health, Dr. Temitope Falaiye, stated that Nigeria spends a relatively small proportion of national income, translating to about 4 per cent of Gross Domestic Product(GDP) on health against the agreed 15 per cent  at the 2001 Abuja Declaration.

Stressing that Out-of-pocket expenditure on health is amongst the highest in the world put at  77.23% of total health expenditure and the highest in Africa, he added that a voluntary National Health Insurance Scheme(NHIS) exists in Nigeria but covers less than 5% of the population, saying, Nigeria’s informal economy, which accounts for more than 60 per cent  of its total GDP is still largely uncovered.

“To bridge the coverage gap, several states have commenced the establishment of State Health Insurance Schemes. Presently, about 19 states are at various stages of their implementation journey. Anambra, Delta and Lagos state have particularly made significant progress in enrollment. Private Health insurance accounts for less than 3% of the Nigerian population,” he pointed out.

Explaining that there is no one-size-fits-all approach to achieving Universal Health Coverage(UHC) as strategies will depend on local circumstances, he said, improving Universal Health Coverage requires addressing building blocks of health systems with a proper roadmap from policy, implementation and monitoring.

Highlighting the  challenges of universal health coverage in Nigeria,he listed underfunding and skewed funding allocation in favour of secondary and tertiary care as against primary healthcare, as well as poor public financial management
Others , he listed include; ” limited political commitment to health and primary healthcare, poor policy formulation, lack of clarity on roles and responsibilities at different levels of the system, lack of measures to assess quality of care, lack of confidence in healthcare systems and human resource shortages (workforce)”

On recommendation, he advocated for diversification of sources of funding, increased funding for primary healthcare services through public-private partnership, even as he suggested State funded private health insurance in collaboration with private Health Management Organisations(HMOs)

Calling for better funding/incentives for health providers in rural communities, he stated that there must be fraud prevention and systems to check corruption.

Stating that improved government commitment to health especially at the state and local level is germane, he called for research based policies, formulation of a national UHC roadmap involving national, state and international partners, better collaboration between the public and private sector, among others.

Governments, he advised, should create an enabling environment to promote Corporate Social Responsibility(CSR) support towards UHC initiatives, while advocating implementation of a monitoring and evaluation framework with data from key UHC indicators.