Adewole D A
Department of Health Policy and Management, College of Medicine, University of Ibadan, Nigeria.
Ann Ib Postgrad Med. 2024 Dec 31;22(3):107-111.
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 Very recently, the National Health Insurance Authority (NHIA) of Nigeria was enacted, which concomitantly repealed the NHIS Act.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.
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.
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.
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.
尼日利亚国家健康保险计划（NHIS）于2005年设立。该计划的总体目标是让所有人都能更方便地获得优质医疗保健，并尽量减少灾难性医疗支出。然而，自成立以来，其人口覆盖率一直低于总人口的10%。最近，尼日利亚国家健康保险管理局（NHIA）成立，同时废除了NHIS法案。本文将NHIA的设计以及尼日利亚卫生系统中该计划之外的其他因素与其他地区的类似计划进行了比较。最后，研究了新实施的NHIA及其试图填补的差距。
对从PubMed、谷歌学术和普通谷歌网站等数据库中提取的相关文献进行了综述。对这些来源的研究结果进行了综合分析，并用于撰写本文。
与其他地区的社会健康保险计划相比，尼日利亚NHIA目前的人口覆盖率较低。导致NHIA表现不佳的一些因素包括该计划的设计特点，这与其他国家大多数社会健康保险计划的设计背道而驰。除此之外，在许多国家广泛存在且在其他社会健康保险计划中作为服务提供者的初级医疗保健层面，在NHIA下并未得到利用。此外，与其他地区不同的是，直到最近NHIA的成员资格一直是自愿的，之后才变为强制性的。
目前，NHIA的人口覆盖率非常低。非正规部门，尤其是农村地区的非正规部门，大多处于不利地位。这与大多数其他国家不同，其他国家鼓励正规和非正规部门的人口参保。鼓励健康保险行业的利益相关者使该计划具有强制性并加以执行。初级卫生保健设施也应作为NHIA下的服务提供者参与进来。
