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ISSUES, PROBLEMS AND PROSPECTS OF CONTROLLING OF NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN THE PUBLIC SECTOR

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CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

          One of the basic needs of the people of any nation is good health. This incorporates physical fitness, adequate nutrition and food security, high life expectancy, absence of epidemic and endemic disease and efficient healthcare service delivery. Mfon (2005:21) expresses that a nation with an effective healthcare system is a wealthy nation and is development –oriented in the social context. In Nigeria, however, the health situation is a manifestation of malnutrition and low life expectancy for the majority, high incidence of epidemics and endemic diseases as well as inefficient healthcare service delivery.

It is in recognition of the significance of good health system that the Nigerian government has been consistent in its quest for an efficient healthcare delivery to be perpetually established in Nigeria.

It has been emphasized that no meaningful development can take place in the country if the greater proportion of the populace have no access to effective healthcare services and live in squalor and disease. The rapidly growing population therefore need adequate healthcare services for effective physical and intelligence development. Lambo (2006:12) observes that there was a sharp contradiction in the nations healthcare services in the periods of 1960s/70s and 1980s/20002. in the former, healthcare delivery was an effective term of cost and coverage with the government catering adequately for the cost of health services. But since the 1980s, the financing of health services has risen so much that the government has found it difficult to bear the burden in much the sand way was it did in the earlier periods.

Ugbanmadu (2003:24) observes that health services have become a matter of concern to the government given the dividing finances of the government which began in the 1980s.

Thus, when the Obsanjo administration came into being on May, 29 1999 the nation’s health sector was near comatose. Hospitals were in bad shape. Community and inter-sectoral collaboration was minimal. Ugbaja (2007:19) remarks that resources devoted to this vital social services were insufficient. Worst still, there was outright inadequacy of drugs and other consumables in most government health facilities. There was also paucity of qualified manpower in the government hospitals. The available ones were not motivated while facilities and equipment were poorly maintained.

Other lapses of the past included inadequate manpower development to meet modern trend and improper monitoring of  services rendered to the public among others. From inception, therefore, it was clear to Obasanjo’s administration that the sector needed an urgent surgical operation.

Consequently, Oduenyi (2002:42) notes that in October 2003, federal Government organized a national conference on Alternative Healthcare financing in Nigeria. Participants were drawn from private and public health institutions and agencies through out Nigeria. They examined the inadequacies of health service, the casual factors as well as remedies for inadequate health services financing in Nigeria. Interalia, the conference ended with a call for improved health services financing.

Thus, in line with economic reforms in the country, health sector reform gained momentum with adequate health  service financing as its cardinal objective, this resulted in the inception of the National  Health Insurance Scheme (NHIS) on June 6, 2003 by  ex-president Olusegun Obasanjo. The scheme had earlier been launched by the then Head Of State, late General Sani Abacha on 15th  October,1997.

  • STATEMENT OF PROBLEM

The  National Health Insurance Scheme (NHIS) is faced with several problem which hampered its effective implementation in the health sector.

First, there are administrative problems which consist in the delay of remittances from government  and government establishments to the National Health Insurance Scheme (Council) and from the NHIS to Health Maintenance Organizations (HMOS) down to Health service providers.

Second, there are inadequacies of health facilities and medical personnel to cover the nation sufficiently under the scheme. This is due to limited number of  HMOs and HSPs registered in the scheme.

Thirdly, many Health Service providers are either withdraw from the scheme or refusing to accept new enrollees.

Again, inadequate Logistic support facilities from the government and donor-agencies limit the coverage of the scheme so far to the public sector thus leaving the larger private sector out of the scheme.

Finally, there is public skeptism and apathy towards insurance in general and widespread ignorance about social health insurance. All these problems militate against effective implementation of the NHIS in Nigeria.

1.3 OBJECTIVES OF THE STUDY

          The objective of this study is to examine the problems and prospects as well as issues involved in the management of the NHIS.

Specifically, the objectives of the study are;

  1. To find out why the national Health Insurance Scheme was established.
  2. To examine the goals of the National Health Insurance Scheme.
  3. To find out how the NHIS is managed.
  4. To find out how the scheme is funded
  5. To establish the benefits of the NHIS
  6. To make recommendations on the problems and prospects of the NHIS in Nigeria.

1.4 RESEARCH QUESTIONS

The research is set to address the following problems;

  1. Why was the National Health Insurance Scheme established?
  2. What are the goals set to be achieved by the National Health Insurance Scheme?
  3. How is the NHIS managed?
  4. How is the NHIS funded
  5. What are the benefits of the NHIS?
  6. What are the problems and prospects of the NHIS in Nigeria?

1.5 FORMULATION OF HYPOTHESES

          The following hypotheses are formulated for the study;

  1. H0: The NHIS is not established because of inefficient and poor state of the nation’s health care system.

H1: The NHIS is established because of inefficient and poor state of the nation’s healthcare system.

  1. H: The NHIS is not armed to achieve improved healthcare service delivery

H1: The NHIS is armed to achieve improved healthcare services delivery

  1. H0: A major problem of the NHIS is not inadequate government commitment.

H1: A major problem of the NHIS is inadequate government commitment.

1.6 SIGNIFICANCE OF THE STUDY

          The study will be useful to the following

  1. National Health Insurance Scheme Council (NHISC) the regulatory body of the NHIS will find study useful. This is because it will identify all the constraints to effective implementation of the scheme especially as it effects HMOs and HSPs. The regulatory aspect of these challenges will be established in this study so that the NHISC will take remedial measures. the recommendation of this study will be useful in this regard.
  2. Health Maintenance Organization (HMOs)

These organizations will also benefit from this study. This is because it will not only highlight the challenges facinf them under the scheme but will also provide useful information on how they can effectively address these challenges especially those arising from their internal constituencies

  1. Health services providers. (HSPs)

These private health institutions will also benefit from this study. Those already operating under the scheme will be provided with useful information on how to brace up with their challenges while those not yet operating under the scheme will find in this study the need to be integrated into the national healthcare delivery system via the NHIS.

1.7 SCOPE AND LIMITATIONS OF THE STUDY

          This study focuses on the management of NHIS in Nigeria. However, the scope covers the scheme as it is administered in the public sector only.

The limitations of the study include:

  1. Difficulty of collecting primary data: this followed from uncooperative attitude of most the staff of the organizations take into the study. Their refusal to complete the questionnaire or too be interviewed limited the volume of data available for this study.

Inadequate finance: The study could have been very extrusive HMOs and HSPs were including in the study. This could have entail making more expenses which the researcher

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