THE NATIONAL HEALTH INSURANCE AUTHORITY OF NIGERIA AND IMPLICATIONS FOR UNIVERSAL HEALTH COVERAGE.

Background: The National Health Insurance Scheme (NHIS) of Nigeria was established in the year 2005. The overall objective of the scheme was to enhance access to quality healthcare for all and minimize catastrophic health expenditures. However, since inception, the population coverage has been less than ten percent of the total. Very recently, the National Health Insurance Authority (NHIA) of Nigeria was enacted, which concomitantly repealed the NHIS Act. This article examined the design of the NHIA and other factors outside of the scheme but in the health system of Nigeria, in comparison to similar schemes in other settings. Finally, the newly implemented NHIA and the gaps it seeks to fill were examined.

Methods: Relevant literature extracted from databases such as PubMed, Google Scholar, and the ordinary Google website was reviewed. Findings from these sources were triangulated and used to write the manuscript.

Results: Compared with social health insurance schemes in other settings, the current population coverage under the NHIA of Nigeria is poor. Some of the factors that contributed to the poor performance of the NHIA were the features of the design of the scheme, which run contrary to the design of the majority of social health insurance schemes in other countries. In addition to this, the primary healthcare level that is most widespread in many countries and that was made use of as service providers in other social health insurance schemes was not made use of under the NHIA. In addition to these, and unlike in other settings, membership in the NHIA has been on a voluntary basis until very recently, when it was made mandatory.

Conclusion: Presently, population coverage under the NHIA is very poor. The informal sector, especially in rural settings, is mostly at a disadvantage. This is unlike in the majority of other countries, which encourage population coverage across both the formal and informal sectors. Stakeholders in the health insurance industry are encouraged to make the scheme mandatory and enforce it. The PHC facilities should also be engaged as service providers under the NHIA.