Unending wait for NHIS enrolment

Few weeks ago, as I was sitting in a hospital reception waiting for my turn to see a doctor, I overheard two ladies lamenting over the frustration they’ve had to go through trying to enroll for the National Health Insurance Scheme NHIS.

The first one was pregnant and her pregnancy was at the advanced stage. She said her husband applied when she was only two months gone. She had wanted to start antenatal classes under the health scheme because antenatal is expensive at the hospital. She waited and got tired of waiting so she decided to go to a government hospital and paid what she could afford.

At this stage, I got curious and joined the conversation. She told me the NHIS enrolment was eventually done two weeks to her estimated delivery date. She was disappointed because she wasn’t able to access the benefits of the scheme when she needed it most.

The other woman said she was diagnosed with ovarian cyst and fibroid, and the surgery would cost about N800, 000. She was told that she would be paying only ten percent of the total amount if she was under NHIS, so she quickly applied. Despite the need for the surgery to be done urgently, she was yet to be enrolled after six months. Unfortunately, when she was examined again, her condition had worsened because six month ago, she had just one cyst but now she has two more.

What could she have done? She couldn’t go early for the surgery because she could not afford the cost of operation at that time and the health insurance scheme had delayed her treatment.

As the conversation progressed, I was shocked to notice that almost everyone in the reception joined in reeling out their experiences – some scary and pathetic, while condemning the procedure of enrolling for the NHIS. They decried the obvious lapses and cumbersome processes people have to go through in order to be enrolled. This got me wondering exactly why the sick would have to be made to put up with such difficulty.

So when I left the hospital, I decided to find out firsthand what the process entails; what should be done and how it was supposed to be done. I learnt that the first thing was to go to the Health Management Office to register and be captured. You must make sure the hospital you choose is registered with the NHIS and then the HMO will give your details to NHIS. I also discovered that the reason for the delay in issuing cards was because their production is done quarterly, hence you would have to wait for three months or more, irrespective of how serious your health condition is.

Unfortunately, a lot of sick people today are sitting at home while their health condition is worsening, waiting to be enrolled in the NHIS before they can commence treatment. Most of the ailments they suffer from may require advanced treatment which the average income earning man cannot afford. And then I wondered why the production or capturing should be quarterly while people are dying every other minute. After all, the scheme was established to improve the health of Nigerians through an affordable arrangement using various prepayment systems.

This, however, brings me to the case of the category of Nigerians whose work place of type of work doesn’t have the NHIS arrangement. The plight of the artisans and most self-employed Nigerians in accessing affordable health care is better imagined.

In one of the national dailies, I read about the family of one Mr. Jimoh seeking financial assistance of about N2m for plastic surgery for his 35-year-old daughter Afuzat Jimoh whose face, hands, neck and chest were burnt after falling into boiling oil in Lagos State. They have no health insurance that can subsidize the cost of the surgery.

These types of cases are very common in Nigeria where citizens beg for money to offset medical expenses. Today, sick people are advertised in the media with a call to support them financially to be able to do surgery or pay medical bills after being detained in the hospital ward. Sometimes, most sick people resort to begging on the street in order to get donations to cater for their ailment.

In developed countries, health insurance scheme is a priority in government agenda and manifestoes of politicians. For instance, the Patient Protection and Affordable Care Act popularly called Obamacare, which was signed into law by former United States President Barak Obama in 2010, made provision to greatly expand access to health insurance, protect patients against arbitrary actions by insurance companies, and reduce costs. The law provided numerous rights and protections that make health coverage more fair and easy to understand, along with subsidies to make it more affordable.

I hope that Nigeria would emulate this policy to improve the health of its citizens because despite the existence of general hospitals for the less privileged, provision of adequate health care is not guaranteed. People are just given what is available in the hospital.

However, those that are already part of the health insurance scheme should be properly attended to by issuing their cards on time so they can start treatment before their health condition degenerates. The government should not look at the few rich people but the larger society which are the poor and uneducated because if the health insurance is well structured, it will reduce mortality rate.

My inquisitive mind still led me to ask a few Nigerians about their experiences with the NHIS. A middle-aged man named Yakubu said “I was so glad and relieved when I learnt that with my new job, I was entitled to NHIS because I was previously working for a private housing company and we were not entitled to NHIS there. I have kids and I always have problems when any of them is sick because I don’t like taking them to general hospitals, and going to private hospitals is very expensive.

“I immediately went to my HMO and applied. I was so excited because finally medical expenses would be off my neck, although I know I would still be paying a little percentage, which is okay. I was told that my card will be ready after three months, which is only when I would be attended to. I waited patiently for three months but to my dismay, the card was not ready when I went to the NHIS office. I went back home disappointed because I really looked forward to using it. After another three months, my card was still not ready. I had to wait for another month, making it seven months before receiving a text message that my card was ready.”

According to Malam Aminu Mansur, “NHIS has become an issue in Nigeria because every worker is dependent on it. The number of people who applied is much, which is why it is usually delayed. It took five months to get my card ready for use. I had problem with my sight and my treatment costs a lot. I had to wait for those five months before going back to the optician. I had to endure waiting that long despite my condition.

Halima Idris, who is pregnant, said “When I applied for NHIS, I knew it takes time before you can get your card, except you know somebody who works there who can help you. So, I went to Federal Staff Hospital Gwarinpa where I registered and paid N35,000 for antenatal. I still go there for antenatal classes every two weeks on Wednesdays. I pray that I will be able to get my card because I don’t want to deliver there. I want a more conducive environment. It’s six weeks to my delivery date and I pray I will be able to deliver where I want.

It is rather unfortunate that one has to wait for months after applying for NHIS, and more disheartening that you have to wait for those couple of months while your health condition worsens. My little advise for NHIS is that they should fashion a way of allowing people access medical care while waiting. For instance, like how people are given temporary drivers licenses while waiting for the permanent one to be ready.

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