The Nigerian Social Health Insurance System and the Challenges of Access to Health Care: An Antidote or a White Elephant?

Abstract

This paper is an excursion into the operation of the recently launched National Health Insurance Scheme of Nigeria. Its primary task is to determine whether social health insurance in Nigeria, as expressed in the statute establishing the scheme, has prospects for actualizing its promise of, inter alia, ensuring access to affordable health care for every Nigerian. To make this determination, the paper critically analyzes key components of the scheme, focusing on the different actors and issues, the interplay of which is crucial to the scheme's successful implementation. Regrettably, the depth and breadth of the analysis are somewhat constrained by the fact that the scheme is still at embryonic stages of implementation, barely two years in operation and covering a very small segment of the population. Assessing such a complex and multifaceted system, especially one bereft of a solid operational history, is not at all a simple enterprise, as limited practical experience invariably limits knowledge about its successes, challenges and failures. Nonetheless, despite the dangers of adopting a one-size-fits-all approach, there has evolved an adequate corpus of literature and international experience on the dynamics of social health insurance that could justifiably be relied upon as evaluative resources, especially with respect to the deficiencies of the Nigerian system.

Given the centrality of these deficiencies to the task aforementioned, considerable attention is devoted to their impact upon the scheme, particularly within the context of the National Health Policy and related programmatic and legal instruments. The analysis ultimately leads to and justifies the claim that in its present configuration, the scheme evokes an image of a white elephant, in that while on the surface it seems sufficiently sanative of the current access crisis, it is, upon proper scrutiny, fraught with serious weaknesses, so debilitating as to render naught many of its salient goals. More succinctly, the scheme lacks the requisite policy and legal frameworks for realizing many of the goals it sets out to accomplish. But, the status quo need not remain unchanged. Despite its flaws, it is possible - and this is the conclusion - for the scheme to be recalibrated and repositioned as an antidote by adopting remedial measures targeting the problematic elements animated by this discourse.

Keywords: governance, health care, human rights, income, law, Nigeria, social health insurance, solidarity, poverty

JEL Classification: H41, H51, I12, I18, I131, J71, J78, K19, N47