Comparing the Nigeria National Health Insurance Scheme Act, 2004 and the National Health Insurance Authority Act, 2022 - What is New and its Implications for the Health System

BACKGROUND

Currently, <10% of Nigerians are insured by the National Health Insurance Scheme (NHIS) and this among other things has led to the signing of the National Health Insurance Authority (NHIA) Act in May 2022, which aims at ensuring the effective implementation of a national health insurance policy and attainment of Universal Health Coverage (UHC) in Nigeria.

OBJECTIVE

To highlight the new features of the NHIA Act and its policy implications for the Nigerian health system.

METHODS

A modified Delphi method was used for extracting the differences in the two Acts. A total of three rounds of reviews were carried out among 5 reviewers within three weeks. Differences were tabulated and also presented in prose.

FINDINGS

The NHIA Act makes health insurance mandatory for all residents of Nigeria with the introduction of the vulnerable group fund and implementation of the Basic Health Care Provision Fund through the established State Health Insurance Schemes. Unlike the NHIS which is a Scheme, the NHIA is an Authority and has an expanded function to regulate, promote, manage and integrate all health insurance schemes and practices in Nigeria. Also, funds management has been transferred from Health Maintenance Organizations to the State Health Insurance Schemes and the Health Maintenance Organizations are now excluded from the Governing Council.

CONCLUSION

Certainly, the journey towards UHC could be safer and more equitable with health insurance now mandatory for all Nigerians and the introduction of vulnerable group funds in the new Act. This will eliminate the catastrophic expenses of poor Nigerians if the Act is correctly implemented.

Medication adherence and blood pressure control: A preliminary assessment of the role of health insurance in Nigeria and Ghana

Objectives

This study sought to assess the current impact of health insurance coverage on medication adherence and blood pressure control of patients being managed for hypertension in Ghana and Nigeria.

Methods

The study was a prospective study among 109 patients with hypertension in two health facilities with similar population dynamics in Ghana and Nigeria. Patients were systematically selected, categorized as having health insurance coverage or not, and followed up monthly for 6 months. The outcome variables (medication adherence and blood pressure control) were then measured and compared at 6 months. Analysis was done using Stata with level of significance set at p ⩽ 0.05.

Results

There was a 90% insurance coverage among participants from Ghana compared to 15% from Nigeria. National Health Insurance Authority enrolees in both countries had better blood pressure control and medication adherence compared to non-enrolees (adjusted odds ratio = 2.6 and 4.5, respectively).

Conclusion

National Health Insurance Authority enrolment was found to be poor among respondents in Nigeria compared to Ghana. Enrolment into the National health financing schemes in both countries led to better blood pressure control and medication adherence among patients with hypertension at primary health facilities. There is therefore the need for system strengthening to improve their sustainability.