Dr ‘Femi Thomas FICS Executive Secretary, National Health Insurance Scheme

1. Dr ‘Femi Thomas FICS Executive Secretary, National Health Insurance Scheme Raising Healthcare Coverage Levels in Nigeria.

2. Presentation Outline • Introduction • Situation Analysis • Review of NHIS • Mandate • Core objectives • Portfolios for coverage • Issues with Expanding Coverage in Nigeria • NHIS Key strategies to raise coverage levels

3. Driving Health Policy Objective Improving population coverage, a core objective of the health system • Health systems exist to improve the health of their populations. • Well managed and properly funded systems contribute to social cohesion and stability. • Good population health: a prerequisite for economic development . • Health Systems globally seek ways to improve health outcomes. • The more the coverage, the better for the health system. • Population’s coverage has become an indicator of health system performance. • The NHIS is a policy tool for enhancing population coverage

4. Situation Analysis Coverage still lagging behind target • Poor access to health care by hard to reach persons in Nigeria • Financial barriers to access • High incidence of poverty • No social protection policy for vulnerable persons in Nigeria • Poor persons have no access to income • Population coverage still very low • 2.8% population coverage so far. • More than 70% of population in the informal sector and lives in rural areas • Total Expenditure still not optimal • Total Expenditure on Health (THE) is estimated to be about 5.8% of GDP (HERFON, 2012). • Very high Out Of Pocket Expenditure on health (60 -70%).

5. Raising Coverage: Key issues For coverage to be improved, key issues need to be addressed • How to mobilize adequate and sustainable financial resources. • Type of risk/resource pooling that should be used in view of our political structure • Pluralistic pathway • What mechanisms to cover the different population groups, especially the poor and vulnerable persons. • A coherent and clear enabling law to guide resource mobilization and pooling and pro poor coverage. • NHIS Act • National Health Bill

6. Pooling Risks and Resources A pooling system that optimizes cross subsidies within the political structure is needed at least in the interim • A single pool system remains the ideal. • However, the Nigerian political structure makes this difficult. • A multiple pool system remains the only way for Nigeria given our political development. • Builds trust among the federating units (States). • States can have their health insurance Agencies • Pooling will be done at the state level for strength • An equalization system needs to be put in place • A national fund required to provide coverage for the poor and vulnerable persons

7. Overviewof NHIS NHIS key mandate is to secure Universal Health coverage Social Inclusiveness Key Strenghts Equity NHIS Efficiency Quality

8. NHIS Portfolios for raising coverage NHIS has developed programmestargetting the various segments of the population Formal Sector Programs Informal Sector Programs Universal Coverage Vulnerable Groups Program

9. Formal Sector This is a group with ease of be enrollment Formal Sector

10. Informal Sector Majority of the population is in this group and need coverage

11. Vulnerable Groups More than 60% of the population lives below the poverty line and requires subsidy for coverage

12. Extending Coverage ( Financing) Pluralistic approach required to finance UHC in Nigerian.

13. Extending Coverage (2014-2015) NHIS short term strategy to raise coverage is enroll 40% of Nigerians by 2015

14. Thank You