NHIA 2022 & THE REALITIES OF UHC

By Munachimso Ayo-Olagunju

Universal Health Coverage (UHC) as defined by the World Health Organization (WHO) means every citizen has access to the full range of quality health services they need, when and where they need them, without financial hardship. In 2015, the Nations of the world recommitted to achieving UHC by 2030 as one of the pillars of the Sustainable Development Goals (SDG).

However, the progress towards achieving this has been uneven across the board. In 2015 at least greater than half of the world’s population was yet to have access to UHC, with middle-andlow income countries bearing the brunt of this. 23 of the 27 countries ranked as low-income countries, which are the poorest in the world, belong to Africa while 21 of the 55 lower-middle-income countries equally belong to Africa (World Population Review, 2022), with Africa being at the epicentre of this underdevelopment, it’s very easy to see how close to home this hits.

Since its establishment in 1999 and operationalization in 2005, the National Health Insurance Scheme (NHIS) has been largely unsuccessful in meeting its aim of 40% Nationwide coverage by 2015, recording a measly 3% coverage which is largely comprised of Federal civil servants, despite provisions being made to target formal and informal sectors and the vulnerable.

The NHIS was internally and externally constrained by factors that greatly limited its capability to deliver on its mandate.

Experts and pundits alike argued in hindsight –which is always a perfect sight, that the scheme and program were bound for failure as it was even constrained from the getgo by the very act that established it. Hence, a brownfield-oriented approach was keenly required to address this, birthing the National Health Insurance Authority (NHIA) Act 2022. The NHIA Act is a landmark piece of legislation that was enacted in May 2022 by President Muhammed Buhari, to repeal the earlier National Health Insurance Scheme Act of 1991. This updated piece of legislation –the New Act is a major step in the right direction towards achieving UHC and was welcomed by all well-meaning Nigerians, industry players, key stakeholders and development partners as it seeks to address the shortcomings of its predecessor – the Old Act in the following regards;

Firstly, Health Insurance is now compulsory for all Nigerian residents! Everyone living in Nigeria is now mandated by law to procure health insurance. Prior to the enactment of this Act, health insurance participation was voluntary. The Act went further to clearly define residents to include; all employers and employees in the public and private sectors with five staff and above, Informal sector employees, and All other residents in Nigeria. If a State setups a mandatory health insurance scheme, then residents in such states would be required to participate in the State’s health insurance scheme. However, nothing precludes residents of such states from participating in a complimentary private health insurance scheme.

The New Act introduces and stipulates the creation of vulnerable group funds, which would be used to cater to the subsidy and payment of health insurance coverage for the vulnerable in society, which are defined to include; children under 5, pregnant women, the aged, the physically and mentally challenged, the indigent and others as may be defined from time to time. The Vulnerable group funds are to be pooled from the Basic Health Care Provision Fund (BHCPF), health insurance levy, special intervention fund allocated by the government, interests from investments and others — grants, donations, gifts and contributions.

The Old Act used the NHIS as a vehicle to provide health insurance – to entitled insured persons and dependents. The New Act creates a regulatory body and umbrella for health insurance schemes and more clearly defines the roles of the body as; Promote, regulate and integrate health insurance schemes; Improve and harness private sector participation in the provision of health care services; and Do such other things that will assist the authority in achieving UHC With the New Act, there’s a clear delineation of the roles and responsibilities of NHIA as a regulator, promoter and enabler of UHC, creating room for other State Health Insurance Schemes.

The New Act introduces ThirdParty Administrators (TPAs), which have been rightly defined to include; Health Maintenance Organizations (HMOs) and Mutual Health Associations (MHAs) while curbing the powers of the HMOs by removing fund management from them and residing it with the State Health Insurance Schemes (SHIS). The Old Act empowered HMOs to collect and implement contributions for premiums, including payment for services to healthcare providers, and investment of pooled funds not in use while the New Act curbs their powers to the collection of contributions for premiums on behalf of SHIS where they are employed to do so but must remit these pooled funds to the SHIS who will then manage, and or invest the funds through the NHIA. The New Act addresses a conflict of interest that existed in the Old Act, where the NHIS council included an HMO, which obstructed proper regulation and monitoring of HMOs, thus clipping the NHIS. The New Act doesn’t include representatives of HMOs as part of its governing council.

The New Act provides for contributions to a State Health Insurance Scheme fund payable by employers and employees in the formal sector, as well as individuals, families and groups within the informal sector, at a rate to be determined by each States council of Health Insurance Scheme. The three tiers of government, nongovernment and development partners are required to contribute to the vulnerable group. The Federal Government’s contribution to the vulnerable group is to be drawn from the BHCPF. The New Act also introduces penalties and punishment upon conviction for failure to; pay contributions on time, remit payments’ after deductions from an employee’s salary, pay healthcare providers after receiving services from them and provide care to an enrollee.

The objectives of the New Act are laudable. However, it would take a significant amount of sensitization at all levels and most importantly compliance monitoring, to achieve Eldorado. 10 months later and there has been no noticeable outcome in the health insurance landscape nor the execution of salient aspects of the NHIA. Suffice to say, it has been business as usual. As of the time of this article, even the governing council established in section 4 of the New Act is yet to be constituted and this is the governing council tasked with

THE IMPACT OF DIGITAL TECHNOLOGY ON BRAIN DRAIN IN THE HEALTHCARE SECTOR.

By Amilo UCHECHI Precious

The phenomenon of brain drain refers to the emigration of skilled professionals from their home country to another country, resulting in a loss of valuable human resources for the home country. The healthcare sector is particularly susceptible to brain drain, with nurses being among the most mobile group of healthcare professionals. This article will examine the impact of digital technology on brain drain in the health care sector, including the impact on healthcare delivery, the role of technology in mitigating brain drain, and the need for policy interventions.

Digital technology has facilitated the migration of healthcare professionals by increasing their awareness of job opportunities in other countries. Healthcare professionals can easily access information on job vacancies, salaries, and working conditions in other countries through online job portals and social media platforms.

Additionally, digital technology has made it easier for healthcare professionals to obtain professional licenses and certifications required to work in other countries. The use of digital technology in the healthcare sector has also resulted in the development of telemedicine and telehealth services, which allow healthcare professionals to provide medical services remotely. This has led to a significant increase in the demand for healthcare professionals in developed countries, leading to a brain drain in developing countries. Healthcare professionals are attracted to developed countries due to higher salaries, better working conditions, and the availability of advanced technology. the impact on healthcare data management. Nurses play a crucial role in collecting and analyzing patient data, which is critical to improving patient outcomes and healthcare efficiency. However, with brain drain, healthcare systems in developing countries may lack the expertise needed to effectively manage healthcare data. This lack of expertise can lead to inaccuracies in data collection and analysis, which can negatively affect patient care.

The role of nurses and other healthcare professionals in the healthcare system is crucial and can never be overemphasized because they offer a variety of services that are vital for providing high-quality patient care. Yet, there has been a major brain drain as a result of the global scarcity of nurses, with many nurses moving to industrialized nations in search of better working conditions, higher wages, and better career prospects. The healthcare industry is significantly impacted by this trend, as many nations(Nigeria included) are finding it difficult to keep up with the rising demand for healthcare services due to a lack of qualified nurses. Digital technology has also made it possible to transfer medical expertise and knowledge from industrialized to developing nations. Local healthcare systems have grown as a result, and patient outcomes have also improved.

Yet, as healthcare experts leave developing nations like Nigeria to developed ones in search of better opportunities, this transfer of information and skills has also contributed to brain drain.

One of the technological implications of brain drain among nurses is the loss of skilled professionals who are familiar with the latest technologies and equipment used in healthcare. This loss can have a detrimental effect on the quality of patient care in the home countries, as the remaining nurses may not be adequately trained or familiar with the latest technologies. The shortage of nurses resulting from brain drain has significant technological implications for the healthcare sector. In particular, the use of technology can help mitigate the negative impact of brain drain by improving healthcare delivery and reducing the reliance on human resources. For example, telehealth technologies such as videoconferencing and remote monitoring can enable nurses to provide care to patients in remote locations, reducing the need for physical presence. Artificial intelligence (AI) and machine learning (ML) technologies can also be used to automate routine tasks, freeing up nurses to focus on more complex tasks that require human expertise.

Technology has an important role to play in mitigating brain drain among nurses. By improving working conditions and providing opportunities for career development, technology can help to retain nurses in their home countries. For example, the use of electronic health records (EHRs) can reduce administrative burdens and improve communication between healthcare providers, making it easier for nurses to do their jobs. The use of virtual reality (VR) and gamification techniques can also enhance training and development opportunities, providing nurses with opportunities to learn new skills and improve their clinical knowledge.

Moreover, with the rise of digital health technologies, nurses play a crucial role in implementing and utilizing these technologies. Brain drain can hinder the adoption of these technologies in developing countries, which can affect patient outcomes and the overall quality of care. The lack of skilled nurses may also lead to a shortage of nursing educators, which further compounds the problem by reducing the number of trained nurses available to work in the healthcare system.

Policy interventions are also required to address the problem of brain drain among nurses because of its enormous ramifications. Governments ought to fund education and training initiatives that equip nurses to use technology in the delivery of healthcare. Incentives like tax breaks and money for research and development should be offered to encourage healthcare practitioners to use technology. Retaining nurses in their home nations can also be aided by policies that enhance working conditions and offer chances for career advancement. The government needs to pay attention to healthcare.

Another technological implication of brain drain among nurses is

In conclusion, digital technology has significantly transformed the healthcare sector by improving healthcare delivery and patient outcomes. However, it has also contributed to brain drain, which is a significant challenge faced by the healthcare sector. Healthcare professionals are attracted to developed countries due to better working conditions, higher salaries, and the availability of advanced technology. To mitigate the impact of brain drain, developing countries should invest in improving their healthcare systems by adopting digital technology, increasing salaries, and improving working conditions. Developed countries should also collaborate with developing countries to transfer knowledge and expertise to improve local healthcare systems. Brain drain among nurses has significant technological implications for the healthcare industry. It can result in a shortage of skilled professionals who are familiar with the latest technologies hindering equipment, hindering the adoption of digital health technologies, and impacting healthcare data management.

Addressing the issue of brain drain requires a multifaceted approach that includes improving working conditions and salaries for nurses, investing in healthcare infrastructure, and developing programs to train and retain skilled nurses. By addressing the brain drain, we can improve the quality of patient care and strengthen healthcare systems globally. I strongly believe that healthy citizens makes a healthy nation.

THE JAPA EFFECT:

A LOOMING CRISES FOR A NIGERIA’S HEALTHCARE SECTOR OR A BLESSING IN DISGUISE

By Adekunle Faderera

Although there has been constant use term of the word Japa it is imperative that we hear the true definition and what it means for us. Japa means to run. It conveys a situation when a Nigerian leaves their country, typically because of socio-economical, financial challenges and the lack of proper infrastructure and resources. The rising question is whether the concept of JAPA is only prevalent on social media and not in real life. People are indeed leaving every day, and with the present state of the country, it is fair that people leave. The embassy has become one of the most crowded places in Nigeria, and both young and old have become accustomed to the word. Most medical practitioners started with the intention of helping people, but with the lack of resources, they have come to a standstill. The clear lack of resources has become alarming, because how can they help people when there are no resources to do so? Another push factor is the fact that Nigeria has become unsafe coupled with no stable healthcare sector. If Nigeria wasn’t where it is, and another opportunity presented itself, some medical practitioners would still pursue their interests.

Nigeria as a country would remain regardless of who runs the country, some might say. Others would leave at the moment to come back later after gaining more experience. But to be honest, who would want to come back after experiencing a better life? From another point of view. Comfort means different things for different people, some medical practitioners don’t feel safe in Nigeria and that alone is an important factor for choosing not to stay in Nigeria. With the import of Medical practitioners leaving, the implication of this decision will lead to a lack of teachers to train and reproduce more doctors. The only steps that we can take to solve this issue are to improve the state of the hospitals, like adequate staffing, more compensation, provision of health insurance, improve the state of our hospitals, and Implement policies that can better the state of the patients and medical practitioners generally. We should also start from the primary healthcare sector, before moving to the secondary and tertiary sectors. The primary healthcare sector should deal with malaria, typhoid, and prenatal issues. There are also restrictions on what medical practitioners are allowed to and not allowed to do, which will cause a stunt in the growth of healthcare workers. There is a lack of adequate laws that protect nurses from assault, there should be laws that protect and make health workers safe. Another bone of contention is whether the Japa system has a negative or positive effect in Nigeria. There is a negative impact because most vulnerable persons cannot be able to access proper healthcare. There is also no value for human life. Nigeria still ranks 9th among the most dangerous places to give birth in. The fact that the Nigerian government travels abroad to seek healthcare has sown low confidence in the minds of other Nigerians. With the lack of competent healthcare workers, there is more chance of quacks filling in the gaps. The healthcare sector also needs more funding, without this, it is impossible to provide quality healthcare. We should extend our focus on the effects of Japa to healthcare workers who move abroad, there is a surge of cultural exploits, it can foster a good relationship with the new country, and there is also a presence of knowledge advancement. Not to dwell on only the good, there is also the presence of racism and loneliness which stems from staying away from family.

After careful consideration, it is clear that there is no specific way to solve this issue, it needs to be targeted on all sides to see a clear change. There should be more value attributed to human life, if our attitude concerning this can change, there will be a mind shift that can produce changes. There should be more funding supporting healthcare workers and their affairs. If government personnel can start using the healthcare centers we use, there will be a significant change in the healthcare infrastructure. After a statistical inquiry, there is an alarming amount of healthcare workers who have decided to leave Nigeria. The nurse to Citizen ratio is scary, there are about 125,000 nurses registered, which is little compared with the number of our populace. There is a need for collaboration among healthcare workers because this will help spark some interest in the general public and generate enlightenment on what is happening in the healthcare system. If this happens, they can carry the public along and make changes.

In summary, since there is no proper infrastructure in Nigeria, these healthcare workers must leave to pursue their dreams and come back when they believe that they have acquired extensive knowledge. If there is educational reform, we can create more healthcare workers. In a year Nigeria loses like 1 billion Naira in medical tourism. There should be an online movement to create more awareness of what is going on in the healthcare system, maybe the government will do something about it