We ‘ll ensure quality health care service
—NHIS Coordinator

Alhaji Isa Ismaila Kaita is the Coordinator, North-West Zone of National Health Insurance Scheme (NHIS). In this interview with our correspondent, John Ewaoche Gabriel, he speaks of the important role of NHIS, and explains that those who registered will live a healthy life because there will be a greater improvement in their health through quality service delivery.

How do you distinguish between Social Health Insurance and National Health Insurance?
Social Health Insurance is a kind of arrangement where people come together to contribute certain amount of money in order to assist themselves through health care delivery system. In this case, the amount contributed will assist them to have access to health care any time they felt sick. Therefore, it is a social activity that takes care of health need when the situation arises. It is borne out of the regular contributions by enrollees. It is usually deducted monthly, yearly, depending on the arrangement. On the other hand, National Health Insurance Scheme is a body or government agency set up to provide Social Health Insurance to the people of Nigeria. Social Health Insurance is a product while the National Health Insurance Scheme is the agency that provides the service to the people of this country.
National Health Insurance Scheme has various programmes and covers different segments of Nigerian society. We have the formal and informal sector, rural community, tertiary institutions, retirees, prison, immigration etc; all these are programmes of National Health Insurance Scheme. So, formal sector is just one of the populations of Nigeria sector that National Health Insurance Scheme covers. So, the formal social insurance is the insurance covered by the members of that formal sector like government employees including parastatals and organized private sector.
For instance, contributions to the National Insurance Scheme if you are talking of the formal sector which we operate now are on “earning base”. This means a fixed percentage is calculated and deducted from the employees’ earning on monthly basis. Presently, the total amount is 15 percent of basic salary. The employer pays 10 percent while the employee pays 5 percent.

What will happen to employee’s medical allowance after joining National Health Insurance Scheme programme (NHIS)?
Employees who have been on the scheme need no other medical allowance because such employees are adequately catered for in terms of medical care. The purpose of medical allowance is for the employee to pay for his medical bill. It will be a duplication of payment if medical allowance is being paid at the same time, the employee gets cover from the NHIS. However, it all depends on the employers. Some employers don’t have this scheme while others do not have medical allowance for her employees. Normally, it is those who were provided medical allowances that often talk of medical allowance. In some government agencies, there are medical allowances while in some state government agencies, they don’t have medical allowance. In some places where there are provisions for medical allowances if the employer chooses, they can cancel the medical allowance and introduce NHIS instead to cover the medical allowance which has been paid. It is a duplication of allowances to have social insurance in place and at the same times, the employer pays medical allowances. Medical allowance is for you to take care of yourself by paying your hospital bills when you are sick, buy drugs etc and when social insurance is in place, there is no need for other to exist. In reality, those who have the medial allowance are those who do not have medical cover. So, if you have medical cover, you don’t have medical allowance.

How many members of a family are covered by employee’s contribution?
Under the National Insurance Scheme which include formal sector, the contributions covers the principal (that is, the person contributing), his spouse, followed by his four biological children. So, the contribution covers six people. Considering the peculiarities of our Nigeria society, some people have more than one wife and produce more children. The same people are surrounded by their relatives, grandparents etc. Since the contributor is covered by six people, he has to make special arrangement for any other extra person. So, if you have more than one wife, more children, you can get them covered by paying some tokens after your normal contributions. This type of contribution is called extra pay for dependants.
However, if you have a child of 18 years and above, such child can not be cover by the scheme because the child is already an adult. The child can not benefit under his/her parent’s contributions because the National Insurance Scheme has designed a programme for every segment of the society to be covered. We felt that a child of 18 years should be in tertiary institution where we have designed a programme that will take care of them independently. Even if such a child is not in tertiary institution, he/she might be an employee of a parastatal or ministry where she can be register into the formal sector programme. Even if she/he is self employed, she can go into informal sector programme. If the child does not belong to any of the above, he can go to the community. So, there are many programmes. I have to mention here that if somebody reaches the age of 18 years, such person is no longer a child. Again, I have to make it clear that if one is single, his/her relation cannot benefit from his contributions because the contribution is for him and his spouse and four biological children. If he wants his relations to be covered, he can do that through extra dependant programme. Also, two spouses contributing can not be rebated but each of them can register separately in their respective places of work. The registration is employer, employees and contribution base. If they are employed separately, they can both register separately but they can not have any rebate because they are all working.
Social Insurance Scheme offers numerous advantages to the contributors as there is nothing that can quantify free access to quality health care service. Before the advent of Social Insurance Scheme, we access health care haphazardly because there was no plan. People gets sick at a time when salaries are not paid, even the little changes can not be enough to buy drugs as little or no amount is saved. In times of sickness, people run helter scepter in search for money to take care of the sick ones. As we all know, ill health does not ring bell as it can occur unexpectedly. Children can fall sick anytime, wife can sick anytime, and complications can come anytime during child birth. People don’t prepare for such a thing before it arises. With social insurance, you keep contributing gradually so that in time of need, you don’t have to crying around begging for help. Apart from that, as you continue to contribute, your brother and spouse may fall sick, you don’t have to look for money. Those contributions will take care of their expenses.

Is there a limit to the medical bills that National Health Insurance Scheme will pay?
There is no limit to the medical bills paid by NHIS. The limit of the medical bill is to take care of the contributor till he gets well. As long as the person remains in the hospital and needs drugs or medical care, NHIS will continue to pay for the bill. The same thing applies to children in primary school, secondary school and tertiary institutions until they reach the age of 18 years. As I have earlier mentioned, if a child reaches the age of 18 years, he will be cover by another programme. If a child is covered while does he need another cover from his parents again?
I have earlier emphasized that the benefit one gets is that he will be contributing to a pool of contributors. If you are not sick, your contributions will be used for those who are sick. The social aspect of the contribution is to use your contribution to treat those who are sick. Likewise, if you are sick, somebody’s contribution will be use to treat you. However, in the treatment of HIV/AIDS, I may suggest that there are some ailments that the Federal government has designed a programme for. Such ailments like tuberculoses, Guinewarm, etc but any opportunity infection under HIV/AIDS is covered. But HIV/AIDS antrovirus can be covered under different programme. The government provides anti-virus free of charge to patients but opportunity infections that come with HIV/AIDS are covered.

What does the contributor who falls sick do, if the prescribed drugs are out of stock?
National Insurance Scheme can never be out of stock because the contributors have paid in advance to the Health care providers in order to buy the drugs and keep. It is our responsibility to source for quality drugs in order to get the best treatment. There is no way our provider will tell enrollees that drugs are out of stock. If that happens, such enrollee should immediately alert the National Health Insurance Scheme or HMO for immediate action and I think such a situation will never happen. However, an enrollee who is not satisfied with the service provider can change provider because changing provider is the right of an enrollees. Sometimes, government employees can be on transfer and in that case, he can change a provider to get access to better treatment wherever he may be transferred to. There is a form designed for that purpose where enrollees are expected to fill, and return to the NHIS. Even people who are not satisfied with the provider can change their provider. But it is not right for contributor to select provider outside the health provider accredited by NHIS because the list of NHIS health providers are those selected and found worthy to provide service to the registered contributors. NHIS providers are those screened, tested and were licensed to operated under the confinement of NHIS who supervise them regularly.
These people are different from Health maintenance organisation. To be a health maintenance there are many requirement for one to be eligible to qualify as a health organization. You have to register by the Cooperate Affairs Commission; there are also requirement for office location, personnel, share capital and insurance bond requirement etc.
Every provider under the NHIS is always advised to take the Malpractice Insurance. The purpose is that malpractice insurance enables the enrollees to sue the health provider if he is found wanting or being negligence towards his duty. Such health provider can be changed or made to pay compensation. That is why we forced them to take malpractice insurance.
We have programmes with different segments of the Nigeria society. As a child graduates into adulthood, so also, a worker graduate into retirement. So, there is a programme for the retirees. National Insurance Scheme is collaborating with the National Insurance Commission and is designing a programme for the retirees who after retirement, get covered. NHIS programmes are new and we are rolling them out gradually.

There are other compulsory contributions by workers; would it not be overwhelming with the inclusion of NHIS?
Though as a worker, you may contribute to different programme for different reasons, but contributions varies. You may contribute for Housing fund, union dues, etc but is there any contribution that can quantify your contribution towards your health? I don’t think there is anything that can quantify that. For instance, all the programmes designed by NHIS, the Federal government pays certain percentages, state government also pays some percentages, employees only pay little of the amount. Nobody is asked to pay all the expenses, and even if they are asked to pay, is the money too much to access health care? No amount is too much for any one to access good and quality health care services for himself and members of his immediate families.
Government is the major contributors at ensuring quality health service to the people and I think there is no way a government that ensures peoples’ health will ever default. Since government is not defaulting to pay peoples’ salary, it will never default in providing quality health services to the people. Any reasonable employer will not play with the health of its workers and I am assuring you that government is committed towards providing good health care services to the people. Those who traveled outside their duty post are strongly advised to carry their NHIS card in order to have access to health care anywhere they are whenever they fall sick. With the NHIS card, they may walk directly into NHIS health provider and get the best treatment they deserve.
We don’t chose providers because they are medical personnel. We conduct proper investigation about anyone coming to register with us. We found out if such person meets our standard requirement. We found out if the Clinic he is operating is of standard. Such health provider will be allowed to fill a form after which we inspect the facilities on ground. Apart from that, we have our own criteria to determine the quality of the health provider. If the designated health provider does not meet our standard, he will not be allowed to register.
Presently, we have two states (Bauchi and Cross River) that are functioning properly. However, we have 19 states ready for operation. Our mandate is to provide health insurance cover, to provide health care needs for Nigerians. By the time we roll out all our programmes, we would have covered everybody in Nigeria. By the time all the programmes are released to the public, health care will never be a problem again as everybody will be covered. There will be a qualitative health care and the health indices of the country will also rise. All the enrollees are enjoying free health care under the NHIS. Immediately you registered, you will be given a card and automatically you are qualified to access for quality health care. If you visit any hospital operating under the NHIS you will see the level of improvement in every aspect. This is because they get regular funding. With this fund, they can plan and improve on Medicare since they can buy drugs, employ and so there is no basis for comparison.

As an enrollee, how do you see your colleagues in state yet to join the scheme?
As an enrollee, I pity my colleague in other state who is yet to join the scheme. This because they are missing something that is of paramount benefit for them and their families. In the light of this, I urge all the state government to as a matter of urgency provide this basic service to the people of their respective state. It is a great lose to people who are not enjoying the quality service.
Our aim is to see that these services are provided to the people at the right time. Also, the providers provide these services according to our guide line. Presently, there are programmes we introduced which are of great benefit to the Nigeria society. The programme is called child maternal health care which is going on in some states. By the grace of God, it will cover the entire states of the federation and because of that, I am proud to be associated with this programme. The programme torches the lives of the people of this country.
One of the challenges we face is sensitization. People need to be educated on the need to enroll with the NHIS because it is one scheme that torches the lives of the people. It is one scheme that improves people live. Because people are not well informed, they don’t know the important role NHIS plays in this diverse economy and it is important for people to seek knowledge of what they don’t know. By the time people are well informed on what we do, I think health wise; they can get the best treatment. So, I advise people to seek knowledge, they should know their right at any given time. People should learn to know what is best for them.