Juliet Akoje in Abuja

The House of Representatives yesterday announced its intention to investigate implementation of the National Health Insurance Scheme (NHIS) across Nigeria.

This resolution followed the adoption of a motion of urgent public importance moved by Hon. Billy Osawaru at plenary on Tuesday.

He expressed serious concern about widespread public dissatisfaction with the scheme and highlighted the various operational issues confronting Health Maintenance Organizations (HMOs).

During the debate, Hon. Osawaru reminded the House that the NHIS, originally set up in 1999, was designed to give Nigerians access to quality healthcare services and shield families from financial strain caused by high medical costs.

He also pointed out that the 1999 NHIS Act has since been replaced by the National Health Insurance Authority (NHIA) Act of 2022.

“This new law mandates health insurance for all Nigerians and legal residents, aiming to achieve universal health coverage nationwide. The updated legislation lays out a framework for a healthcare system that is affordable, accessible, and comprehensive.

“Its primary goals are to promote and regulate health insurance programs, integrate various schemes, and guarantee access to quality healthcare for everyone.”

He further noted that “NHIS collaborates with HMOs to deliver healthcare services to beneficiaries, including federal and state government employees, private sector workers, and other Nigerians. In turn, these HMOs contract hospitals and clinics to provide care.”

Despite the program’s potential, the lawmakers observed that the NHIS and HMOs have encountered persistent problems such as low enrollment rates, limited funding, and inefficiencies in service delivery and that as a result, many Nigerians still struggle to access quality care, hampered by both financial limitations and inadequate health infrastructure.

He expressed concern that only around 5% of Nigerians are currently enrolled in the NHIS. “Even those enrolled report serious issues, including substandard care, limited drug availability, frequent stockouts, and ongoing out-of-pocket expenses despite having insurance.”

The lawmaker also highlighted that: “government’s efforts to fund NHIS adequately have fallen short. Insufficient funding often delays payments from HMOs to hospitals and clinics, which in turn impacts the quality of care patients receive.

“Delays in payments to healthcare providers lead some facilities to compromise patient care. In extreme cases, this has even resulted in avoidable deaths.

“Other alarming practices include restricted drug options, assignment of only general practitioners even when specialists are needed, limited diagnostic tests, and refusal to cover essential surgeries like Cesarean sections or appendectomies under the NHIS.

“If these challenges are not urgently addressed, NHIS beneficiaries will continue to face obstacles in accessing healthcare. This will worsen existing health inequalities and force more Nigerians to pay for services out-of-pocket, increasing their financial burden.”

Consequently, the House has directed the Director-General and CEO of the NHIA to appear before the House Committee on Healthcare Services to assess the NHIS’s effectiveness in healthcare delivery, identify the challenges it faces, and explore potential solutions.

Furthermore, the House also instructed the joint Committees on Healthcare Services and Health Institutions to carry out a comprehensive investigation into the reasons behind NHIS’s underperformance.

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