Where are all the talks on health insurance leading to?

Adesua Ayomaria
7 min readMay 15, 2022
Marcelo Leal Via Unsplash

We have all made mistakes, but you know some mistakes stick to us. You know those mistakes you are reminded of at every point of the day. All she did was love, but sometimes, love turns sour. She was in love, and one thing led to the other, she got pregnant.

Well, her husband-to-be was buoyant. At least so, she thought until the attitudes started changing after she took in. Then the story changed to “You either find a way to get rid of this baby, or I walk!”. She was struck, and there was no way she was getting rid of her baby. The deed has been done, but she wanted to keep the baby.

She went through those grueling nine months. Some women say they enjoy it, and they always feel beautiful, but hers was different. She was mostly found wandering, muttering, cursing to herself, and waiting for when this would end. Often, she had nothing to eat, and she was always malnourished and dehydrated.

The family was also not supportive; you know that deal when there is the ground rule that no child out of “Wedlock” would be allowed. And then, you can only talk about clinic appointments when there is food to eat. She was basically on her own except for the occasional assistance from friends. But through thick and thin, she managed to carry the baby to term.

On the day of delivery, she could not afford a hospital. So, she settled for “Iya Nurse,” who has been known to deliver many babies successfully. No one knew where “Iya Nurse” trained, but her bragging right was that she had delivered many babies in the past, and hers was not going to be an exception.

The delivery was tough, but she pulled through, and the baby was born. On giving birth to him, she noticed the baby was not breathing well. Under normal circumstances, this was supposed to be the first cue of trouble right? but “Iya Nurse” assured her that everything was fine.

The baby was not suckling as every newborn should, but she was told everything was fine, and it was all fine until the baby turned blue by the next morning. She wailed and wailed, but nothing was bringing back that baby. I could bet she did not get to breastfeed the child. And Just like that, another precious life was lost.

Now, if you scroll back to the title, you might be thinking, “What is the relation to this story”? But this is no story, it is the reality for many of us out there. This truly happened, and I happened to be in the vicinity where it was discussed. Now back to the bone of contention, at this point, health insurance should not be a luxury; it should be a necessity.

Many Nigerians cannot come to the hospital because they are scared. They would have to pay out of shallow pockets every time they do this right? In the context above, we can blame the lack of money and other resources all we want, but what if some form of insurance covered her? Every human has the right to basic healthcare, but that is not the case in Nigeria.

Omotayo Tajudeen Via Unsplash

If you are reading this piece, I bet you would have heard or witnessed something similar. Not with the high maternal mortality indexes in the country. Well, this is not the point for today. In Nigeria today, a lot of things can best be described as a mirage.

Yeah, you know that phenomenon that disappears the more you peer at it, yeah, that is it. The realities of the healthcare sector are so grim, that you can only wonder. Budgetary allocations to the sector are super low, and a lot of public health care interventions are being bankrolled by foreign donor agencies. But again, that is not for today.

Amidst all these realities, there is this glimmer of hope provided by the national health insurance service (NHIS). Established in 2005, the goal of the scheme was to achieve total health coverage for Nigerians by 2015. It is 2022, and we both know where we are with that. Less than 10% of the population are covered by health insurance, and roughly over 70% of the population pays out of their pocket for their health expenditures.

Over 170 million people are still at the mercy of economic forces when it comes to their health. Top among the reasons for this is said to be the delayed passage of the amended health insurance bill, and another is said to be due to the covid-19 pandemic. Access is still another issue we have to contend with, but where are the talks on health insurance really leading to?

If we have over 170 million Nigerians paying out of the pocket for their health, then we are staring the trenchiest of the trenches in the face. You do not need an economist to tell you that poverty will be a direct consequence. Nowadays, it is common to find different “Go Fund Mes” across the social media landscape.

Why on earth is health insurance still a possibility here, when it should, as a matter of fact, be a necessity? The scheme gets allocation from the budget, but as is typical with Nigerian politicians, all we get is core mismanagement and corruption. I can recall, that a former chief of the agency was indicted by the EFCC for embezzlement.

The agency and healthcare management organizations (HMOs) as of the last count only cover employees of core government agencies, and some private firms, and banks, also get to cover their employees under the scheme. But who ensures the vulcanizer, or the main men of our transport sector in the parks? The informal sector is about 65% of the population, and this is a strong bulk. So, why is there no focus on this part of the population?

In addition to this, there is a gap between the health insurance agency, the core healthcare providers, and the HMOs serving as intermediaries. Within this gap, you would find disagreements as to the brands of medications to be given, the medical procedures that are allowed, and those that are no-go areas. If you are in the healthcare industry, you would understand this; everything has been watered down, and the profit remains the only focus.

It is common to hear representatives of the HMOs saying certain prescriptions are examples of “Polypharmacy” when all the physician and pharmacist are after is the wellbeing of the patient. Clear lines are blurred on a daily basis, so what do we do? How do we solve all of these?

Technology which has always been about providing solutions to everyday problems becomes useful here. Young Nigerians are thinking and innovating new ways to improve access to good, quality healthcare, while also providing health insurance. There are so many private health management organizations all offering insurance premiums at low rates.

I recently stumbled upon a platform that makes this even easier. This app provides you with a list of HMOs you can have and makes recommendations for you, all based on how deep your pockets are. While all these are good initiatives, who enrolls the average woman selling food products in the market? how do we ensure Nigerians without an internet-enabled phone, or an email to subscribe to newsletters and promotions get access to good quality healthcare at the best rates possible?

Olumide Bamgbelu Via Unsplash

These are some of the problems. While the country has a vibrant youth population that makes up over 50% of the population, we must not forget that there are those that are being left behind by the latest improvements in technology. How do we bring them to latch on to these premium services?

Some figures even state that less than 5% of the population is covered by insurance. This figure is even smaller when you talk about the informal sector. This figure continues to drop year after year when there is no unified body for all health insurance companies in Nigeria, and the provision of healthcare to those already covered is below par.

It does not also help that a lot of Nigerians do not trust government systems well enough to key into the initiative. The way services have been provided to those already on the system has also made many drop out of it. So, where are we going with all the talks on insurance? We could talk about effective health policies, organize conferences, and release newsletters on the latest summit we would be having, but how about implementation? Who takes up this mantle?

Data is supercritical in ensuring the success of the national health insurance scheme. We cannot know where we are going without having a clear perspective of where we are coming from. We need to have a stable record of Nigerians on the scheme, weigh our options, and then design efficient systems on the best way forward.

I believe a key focus of stakeholders in the NHIS should be to ensure that over 70% of Nigerians latch on to the benefits of the scheme. This would be a lot of hard work coming from less than 5% of the population being on the population already. We can do better. The bill for the amendment of the scheme has been passed by both chambers of the legislative chamber. If it has been assented to by the president, is another call.

But this is a good start. We can do better in the coming years. I look forward to a time when we have a good bulk of Nigerians covered by insurance.