SIMON KOLAWOLE: 2015 is Knocking on the Door

Simon Kolawole

I woke up Friday morning to some good news: the Federal Government has decided to offer free treatment to diabetic children. It may not make much sense to you – especially if you are one of those preoccupied with the latest gossip from the Nigeria Governors Forum (NGF). In real life, however, a large population of children are suffering from diabetes. Those from poor homes have no one to help them get good treatment. Another sad fact is that an increasing number of teenagers are experiencing kidney failure. A session of dialysis, I understand, costs N40, 000. Three sessions are required per week. That is N120, 000 – minus other bills. How many Nigerians earn N120, 000 per week? What then is the fate of the poor in a country choking with emissions from private jets?

Every day, many Nigerians die because they cannot afford medical treatment. I count myself highly favoured that I can pay for private treatment, but what about mechanics, farmers, tomato sellers, truck pushers and cap washers? Even those who can afford to pay cash for treatment may find themselves in emergency situations when they are out of cash – and ATM can fail at crucial moments. The National Health Insurance Scheme (NHIS) was conceived primarily to avoid a situation where patients cannot get treatment because there is no raw cash in their pockets. The scheme was first mooted in 1962 when the late Dr. Moses Majekodunmi was Minister of Health, but it did not become reality until General Abdulsalami Abubakar signed NHIS into law in 1999 and former President Olusegun Obasanjo finally gave it teeth years later.

Federal Government’s offer of free treatment to diabetic children is, however, dependent on their parents being enrolled with the NHIS. This should ordinarily not be a problem, since registration is relatively cheap. More so, the NHIS has a vision of covering every Nigerian by 2015. The economy will benefit tremendously from this. Without a healthy workforce, productivity will be hampered. If this 2015 vision is realised, every Nigerian, rich or poor, will be covered. But there are several obstacles. One of them, according to the Acting Executive Secretary of NHIS, Dr. Abdulrahman Sambo, is how to persuade the people to enrol. We are normally suspicious of anything insurance, but the less privileged do not even think they are in a financial position to enrol, no matter how cheap. They would rather buy noodles or groundnuts.

Yet, it will take a very large pool of contributions from enrolees to guarantee the success of the scheme. The more people sign up, the bigger the pool. The bigger the pool, the better for the scheme. Federal Government workers have been enrolled by fiat, but since Nigeria is practising federalism, state and council employees cannot be compelled. They are, therefore, not part of the scheme. As for the private sector, the law says companies with 10 or more employees should enrol – and this again leaves out a large chunk of the population. Perhaps most businesses have fewer than 10 employees. There is even no punishment for employers who fail to enrol their workers.

For those not mandated to register by law, the Voluntary Contributors Social Health Insurance Scheme (VCSHIP) allows them to partake for a contribution of just N15, 000 a year. There is also the Community Based Social Health Insurance Scheme (CBSHIP) for organised groups, most of them in the rural areas. However, by far the biggest headache is the informal sector, where most of the poor and lowly Nigerians belong. Bringing them into the scheme is vital to achieving universal coverage. Without insurance cover, our people will continue to be vulnerable to the high costs of consultation and treatment at the hospitals. They may resort to self-help, which leaves them further vulnerable. That is how poverty reinforces itself, hampers productivity and keeps the nation down.

What is the way out? How can we ease their pain? How can we make sure our people stop dying cheaply because of a system that disdains and punishes the underprivileged? How can we expand the insurance to cover all Nigerians, poor or not? How can the scheme be financially secure to meet the 2015 target? In my view, these are the issues that should give sleepless nights to the president, governors, council chairmen, legislators and all other politicians. I am highly interested in 2015 – but a different kind of 2015, the one that will make life more comfortable for the majority of Nigerians. We are already missing the 2015 targets of the Millennium Development Goals, but there are things we can still salvage.

I would suggest that the issue of non-enrolment of state and council workers should be of utmost interest to the NGF. Nearly 100 per cent of Federal Government workers are now covered because of decrees and directives. There is nothing that says the governors cannot bring their workers into the scheme, even if they have to create their own agencies locally. As for the poor in the informal sector, somebody will have to help them pay their contributions. Indeed, according to Dr. Sambo (who, by the way, has impressed me with his stewardship at NHIS so far), no nation has ever achieved universal coverage without the twin instruments of compulsion and subsidy: compulsion for those who can afford to enrol; subsidy for those who cannot. Politicians can pay for their constituents.

I call on President Goodluck Jonathan to take this as a personal project and leave it as a legacy. He should launch and drive an initiative to bring every Nigerian into the social health insurance scheme to meet the 2015 universal coverage target. Ghana started the scheme after Nigeria. Today, every Ghanaian is covered through creative means, including funding from VAT. Giving directives for diabetic children to be treated free of charge at Federal Government hospitals is commendable – I will readily admit that – but there is a lot more to be done to build something bigger and broader that will endure for generations. This requires joint effort by the three tiers of government and the legislature. The ultimate beneficiaries will be Nigerians. I repeat: 2015 is just around the corner. Every Nigerian must be covered.