The idea of a National Health Insurance Scheme in Nigeria was first attempted in 1962 under the leadership of the then Minister of Health, Dr M.A Majekodunmi. In the last four decades, the fight to have a health insurance system that works has been an arduous journey of sorts, fraught with plenty complexities and peculiarities.
The overarching idea behind a health insurance scheme is to improve the health of all Nigerians at an affordable cost. In 2016, the Executive Secretary of the National Health Insurance Scheme (NHIS), Professor Usman Yusuf mentioned that in the 12 years of the scheme’s existence, after it was officially signed into law in 2005 by President Olusegun Obasanjo, the scheme covers only about 1% of Nigerians. To say that this is a failure would be stating things mildly. This inability and ineffectiveness as well as the shroud of corruption that has covered the scheme from its inception are major factors that have led to the call for the repeal of the NHIS Act and the enactment of a new Act in its place. One of the major differences now in the Act is the fact that states can now have their own health insurance schemes. This has already resulted in a number of states such as Lagos, Cross River, Kwara, Kano etc signing their state Health Insurance Acts into law. This fragmentation of the pool has both its pros and cons. The pros being that with states being in charge, desired healthcare services will now become a step closer to the people while the cons will be that the pool of funds will have been fragmented, meaning that states have to maneuver whatever financing mechanism possible to get as much money as they can into the funding pool. Some of the strategies that are being employed by some of the states include: making the scheme compulsory for all state residents, compulsory solidarity contributions from residents who are already on private health insurance schemes, sourcing for lump sum contributions from philanthropists etc.
While all of these sound very interesting, one major question that has been on the lips of development enthusiasts is “will these laws and the inherent taxation of the people translate to better health services for the people? Will it lead to the overarching goal of achieving Universal Health Coverage in Nigeria? Will the state governments do a better job of providing the necessary social infrastructure? Will the social contract between the people and the government be strengthened in this new arrangement?”
speaking in a panel session at the event
These are a few of the questions we asked at a recent experience sharing meeting on health insurance for selected states in Nigeria. The meeting which was hosted by Nigeria health Watch and Christian Aid brought together state officials, media personnel, Civil society organisations working in the health space as well as members of the donor community
As much as we may not have answers to some of these questions now because they will only be answered in time as the schemes kick off in the states, we can however make a few postulations:
- The above questions can only be answered with a YES if the state governments beef up the existing health facilities and strengthen the health systems within the states. This should also be accompanied by appropriate accountability mechanisms to ensure that the monies pooled are utilized as they should be and to the fullest benefit of the people.
- The states should not see the Health Insurance scheme as just another method of revenue generation or another political mandate to be checked on a list or as a tool for campaigning in 2019. Rather, the programs and activities of the scheme should have the health of the people at its core.
- The National Health Insurance Agency needs to strengthen its oversight and regulatory responsibility to ensure that the Health Maintenance Organisations (HMOs) do not run amok and appropriate sanctions be put in place and implemented for defaulters.
- Most importantly is the fact that the states need to understand that for the scheme to work, a good part of the state budgets need to be committed to the health sector to beef up capital health infrastructure at both the state and Primary Health care levels and it should be clear that the funds from the health insurance pool are not meant for infrastructural development.
- Finally, the state governments need to understand that the citizens are major stakeholders in this process as such, they must be carried along every step of the way; they should be able to contribute to the entire decision making process, not just making monetary contributions, there should be a system for addressing the inquiries, complaints and grievances of the people as they arise and the state governments must ensure that they are as responsive as they can be in this regard.
Every year since 1950, the world has celebrated April 7th as World Health Day. So, in essence, we have had over sixty decades of this celebration. The question I ask myself however is “has this yearly celebration impacted Nigerian and indeed global health in any way?”
When I think about the fact that in this age and time, Nigeria is still grappling with communicable diseases as cholera, meningitis and malaria, that Nigeria still contributes 10% to global maternal mortality or that we lose over 2,000 under five year olds daily and I am greatly saddened. Only now are we even beginning to consider tackling non-communicable diseases such as cancer, hypertension, mental illness etc. The picture I see daily of our Health system is that we have had and still have governments who do not care much about the health of its people.
From non-functional Primary Healthcare centers to under-equipped or under-staffed ones to teaching hospitals that may not be readily accessible to the majority of citizens or those that even lack the most basic health facilities or instruments… Every day, the picture is that of doom and depression, which brings me to the theme of this year’s World Health day celebration “depression: let’s talk”.
It is all too important for us to talk about depression in Nigeria because even our health system causes one to be depressed most times! Imagine if you live in a community of over 5,000 inhabitants and there is no functional Primary Healthcare facility in that community, so people in the community have to either recourse to private health facilities where they will have to pay through their noses, further pushing them into poverty or travel long distances to the nearest public health institution (imagine if there was an emergency!).
On another hand, let us even say you do not live in a rural community; you live in a city where all the public health facilities are functional with top line facilities. Alas! A patient is rushed into the hospital on an emergency and is left unattended to until he/she dies or even that there is no doctor to attend to the patient because all doctors are on strike for unpaid salaries or the patient is in need of oxygen and there is no oxygen in the entire hospital. I am certain there are many who can relate to most or all of these scenarios (I can because I have been in some of these situations myself).
women waiting to receive medical care outside a Primary Healthcare Center photo credit: Nigerianeye.com
Beyond all of these instances and storytelling is the fact that there is an urgent need for a revamping of the Nigerian Health system which a lot of health advocates (me included) will argue should begin with putting more money into the health sector. Unarguably, it is true that the Nigerian health sector is largely underfunded but beyond increased funding, there should also be increased transparency in how the funds are being utilized. It is pertinent that before we insist that more money be put in, we demand for explanations and visible proof of how current funds are being expended so that we do not end up funding that same corruption we are claiming to fight by giving it more money in the end.
As citizens, one of the key roles we have to play is in holding our government accountable to its responsibilities. By voting them into power, we sign a social contract with them where we as citizens get to play our part and they as government get to play their part. So, do not just sit back and complain, get involved, get interested in the issues and arm yourself with adequate information, join a community of like-minded people and ACT now!
To join our growing community of activists who are working tirelessly to ensure transparency and accountability in how public funds are being expended, go to www.ifollowthemoney.org and request an invite. Let us work together to change the face of governance and healthcare administration in our beloved country.
Over the last two decades, the issue of climate change and the need for individuals and countries to become more environmental conscious has become a recurring topic with plenty of activities and talks to bring this discussion to the global fore.
One of such activities is the global yearly Earth Hour celebration which is an hourly celebration to ignite the idea of environmental awareness into the minds of people. The celebrations usually consist of various independent activities within an hour when the lights are turned off.
interacting with one of the participants at the event
This year, I had my first experience of Earth Hour celebrations at the CODE event organized at and in partnership with the Hilton hotel, Abuja. This year’s event focused on interacting with the younger generation to get their perspective on the theme as well as ignite their passion towards environmental sustainability. I found this particularly interesting and inspiring as this goes to disrupt the popular cliché that “youths are the leaders of tomorrow”. As a fan of disruptive thinking, I personally think that “youths are the leaders of today” and we are not reminded of this fact often enough. So it was an awesome time, getting to listen to some of the brilliant things the young people had to say.
the students during the panel discussion
Highlights of the event included a panel discussion where students of The Hillside School and The American International school shared some very interesting perspectives into what they thought about Nigeria’s current energy crisis, her role in contributing to climate change via carbon emissions from being unilaterally energy dependent and a heavy user of carbon energy sources such as crude oil and some key recommendations on ways to diversify Nigeria’s energy sources by harnessing the resources abundant in the various regions such as solar and wind energies in the North and hydro power in the South and West. The students also talked about interesting ways they as individuals and their schools were contributing to raise environmental sustainability awareness and changing climate change such as reducing, reusing and recycling materials such as papers, not powering the generator for whole days and researching into generating energy from biological wastes such as urine i.e. biofuel production.
The whole event for me was particularly significant because even though I am very much aware of the fact that climate change is a real issue that affects almost every socio-economic aspect of human life including health, economy and agriculture (which I will talk about in a later post), I really would not consider myself an environmental sustainability activist but after the event, I am positively inspired to be more of an advocate for mother Earth as we should all be. After all, if we do not take care of our Earth, who will?
Until recently, I really had no idea there was an act called the Freedom of Information (FOI) Act talk much less of knowing what it was all about.This, I am pretty sure is also the reality for majority of Nigerians. In the little time I have been working in the transparency and accountability and open government scene, some facts have become clear and this article really is about sharing some of my experiences in invoking the powers that the FOI Act affords me as a Nigerian citizen.
First of all, let us examine the Act and summarize just a little bit. For Nigerians who are still where I was up until a few months ago, here are a few things you need to know about the FOI Act:
- It was signed into law by former president Goodluck Jonathan in 2011
- It gives every Nigerian citizen the right to request for information from any public institution from all arms of government; executive (presidency), legislature (lawmakers), judiciary (courts) or any other parastatal supported by public funds () or private organisations that provide public services or utilize public funds
- You can present your request in a written form but this is not compulsory. Verbal requests are also in line with what the law says and in the case of a verbal request, it is the duty of the institution to put the request in a written form on your behalf. However, given that the implementation of this Act is still in its nascent phase, it may be advisable to do a written request (for evidentiary purposes mainly)
- ANYBODY- regardless of age, race, sex, religious, cultural or socioeconomic status CAN request information under the Act
- You do not need to give reasons or explain why you need the information you are requesting for; you just need to ask!
- A mandatory reply is expected from the institution not later than 7 days from the date of the request and a failure to provide information within this time is seen as a no response which is cause for the requester to file a complaint in any Nigerian court of law
- Under certain clauses in the Act, the institution MAY decide to decline your request and they are mandated to state why they have refused.
- If you feel that the institution’s refusal is not covered in any of the clauses, you can file a complaint against them in any Nigerian court of law
- You do not need to pay any processing or other fee with regards to your request. The only fee that may be required is in cases where there will be extra costs in reproduction (such as photocopying) of information requested for
- You can download a copy of the Act here
Now that we know some of the basic stuff about the FOI Act, let me now go on to share some of my most recent experiences in invoking the powers of the Act as a Nigerian citizen:
At Connected Development, some of my major duties involve writing FOI letters to institutions, liaising with and following up with these institutions to get information on some of the projects we undertake when we Follow The Money in the areas of health, education and environment.
In my interactions, I have found that there is still a lot of non-information or misinformation of the general public about what the Act really is about. This may be in part due to the general lackadaisical attitude of Nigerians when it comes to issues we generally consider to be technical and that we perceive may bear little or no effect on our present or future personal standing. To tackle this, it may become expedient that the Act be gazetted, translated into local languages and widely circulated so that Nigerians can easily access and become acquainted with it.
Another finding is that there is still some level of reluctance in the manner and timing that institutions respond to requests. They either do not see the need to reply or even acknowledge the requests and even when they do respond, they never comply with the mandatory 7-day response timing or see the need to ask for and give reasons for an extension period. This problem may have persisted as a result of the fact that no precedents have been set. The law is very clear about what should happen in the case of non-compliance but how many examples can we cite of cases where institutions have actually been held to account?
Now to the issue of who exactly is responsible for handling FOI requests in these institutions: most times, it takes a longer period to get a response because the requests have to be passed around multiple offices before it becomes clear who exactly should handle the requests. This is a very laborious and painstaking process which stalls productivity and response and can be clearly avoided if institutions designate a particular department or officer to the handling of FOI requests and these contacts should be made publicly available on the institutions’ public spaces for easy access.
Finally, it would be really great if public institutions can become proactive in the sharing of public information. We really do not need to wait for individuals or civil society to send so many letters and requests for information that should ordinarily be publicly available to citizens. This can be a very good way for Nigerian government to reiterate its commitment to the Open Government Partnership and show greater responsiveness to its citizens by making data open.
Now, as to whether the ACT is working or not…you decide.
I have had a couple of friends ask me “what is this Open Data day about sef?”. Well, to answer them and anybody else out there who may be asking the same question:
Open Data Day is an annual celebration of open data all over the world. It is a day set aside for open data enthusiasts and indeed everyone to bring light to the importance of open data. It is a day to show the benefits of open data and encourage the adoption and implementation of open data policies in the public and private sector as well as in civil society.
What is Open Data?
According to the Open Data handbook; Open data is data that can be freely used, re-used and redistributed by anyone – subject only, at most, to the requirement to attribute and sharealike. In summary, Open Data is data that anyone can access, use and share
How can Open Data aid development?
Whether we realise it now or in the future, Open Data really is the cornerstone of good governance and development. If citizens are able to access, understand and use information pertaining to public life, they are encouraged to become much more active citizens, keeping the government accountable and fulfilling their own part of the social contract. Government in turn, knowing that they can and are being held to account by the citizens they serve will have no choice than to act in the best interest of the citizens at all time- also fulfilling their own part of the social contract.
In short, Open Data is a demonstration of an Open government.
You can join in the open data discussion for this year by joining our Data Thorn on Skype by registering at Open Data Day
See you there!