The affordability of healthcare for citizens for a long time has been a huge challenge in Nigeria, until the Federal government decided to subsidise the sector through the National Health Insurance Scheme (NHIS), which was established in 1999 but became operational in 2005, with its agency launched in 2006.
After many years, NHIS metamorphosed to the National Health Insurance Authority (NHIA) with the enactment of the NHIA Act on May 19, 2022.
The aim is to facilitate a coordinated scheme where beneficiaries can have easy access to healthcare. Successfully, NHIA has brought healthcare services close to the people, as applicants and dependents are able to access healthcare more easily in Nigeria. However, whether the healthcare is of quality is another issue, as reports abound of complaints by beneficiaries on shortcomings of the service.
These include lack of adequate attention and quality drugs, the long wait for a code to be generated for an enrolee and alleged use of inexperienced medical doctors, among others.
These often lead to the severity of a patient’s health condition, which may end up in complications and sometimes death.
Some months back, the NHIA announced the introduction of a strict one-hour deadline for the authorisation of care and issuance of treatment codes by Health Maintenance Organisations (HMOs).
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The directive, which took effect on 1st April, 2025, mandates all HMOs to respond to authorisation requests within one hour of submission by healthcare providers. NHIA instructed that where delays exceed the one-hour limit, healthcare providers should go ahead with treatment and inform the NHIA immediately.
For emergency cases, the NHIA directed that treatment may commence without prior authorisation; however, authorisation codes must be obtained within 48 hours of commencing care, as stipulated in the operational guidelines.
Enrollees who encounter delays or obstacles in accessing services due to late authorisation are encouraged to report such incidents independently to the NHIA for redress and monitoring, as the authority warned that sanctions would be imposed on any stakeholder found deliberately delaying authorisation.
As applaudable as this may sound, there are still complaints of delays in code generation by HMOs and the snail’s pace of response by NHIA. Reducing delays in healthcare service delivery and improving patient outcomes demand attention, monitoring and enforcement by NHIA.
The HMOs, on their part, need a lot of improvement in code generation to save lives. The alleged hoarding of drugs by hospitals for NHIA enrollees must be checked effectively. This has led to the regular lack of quality drugs at the pharmacy for enrollees.
Also, the use of Corps members and medical students as housemen to examine patients should be avoided. Regular interaction and engagement of enrolees by the stakeholders is another way of boosting the scheme.
Undoubtedly, the NHIA health scheme would improve, and more lives would be saved, when all the stakeholders show commitment and empathy in the service they render.
