For a long time, affordability of healthcare by the citizens has been a huge challenge in Nigeria, until the federal government decided to subsidize the sector through the National Health Insurance Scheme NHIS which was established in 1999 but became operational in 2005 with its agency launched in 2006.
After many years, NHIS metamorphosed to the National Health Insurance Authority NHIA with the enactment of the NHIA Act on May 19, 2022.
The aim is to facilitate a coordinated scheme where a beneficiary can have easy access to healthcare. Successfully, the NHIA has brought healthcare services close to the people as applicants and dependants are able to access healthcare more easily in Nigeria. However, whether the healthcare is of quality is another issue as reports abound of complaints by beneficiaries on shortcomings of the service.
These include lack of adequate attention and quality drugs, the long wait for a code to be generated for an enrollees and alleged use of inexperienced medical doctors, among others.
These often lead to severity of a patient’s health condition which may end up in complications and sometimes death.
Some months back, the NHIA announced the introduction of a strict one-hour deadline for the authorization of care and issuance of treatment codes by Health Maintenance Organizations (HMOs).
The directive, which took effect on 1st April, 2025 mandates all HMOs to respond to authorization requests within one hour of submission by healthcare providers. NHIA instructed that where delays exceed the one-hour limit, healthcare providers should to go ahead with treatment and inform the NHIA immediately.
For emergency cases, the NHIA directed that treatment may commence without prior authorization, however, authorization codes must be obtained within 48 hours of commencing care, as stipulated in the operational guidelines.
Enrollees who encounter delays or obstacles in accessing services due to late authorization are encouraged to report such incident independently to the NHIA for redress and monitoring as the authority warned that sanctions would be imposed on any stakeholder found deliberately delaying authorization.
As applaudable as this may sound, there are still complaints of delay in code generation by HMOs and the snail speed of response by NHIA. Reducing delays in healthcare service delivery and improving patient outcomes demand attention, monitoring and enforcement by NHIA.
The HMOs, on their part need a lot of improvement in code generating to save lives. The alleged hoarding of drugs by hospitals to NHIA enrollees must be checked effectively. This has led to the regular lack of quality drugs at the pharmacy for enrollees.
Also the use of Corps members and medical students on houseman-ship to examine patients should be avoided. Regular interactive and engagement of enrollees by the stakeholders is another way of boosting the scheme.
Undoubtedly, the NHIA health scheme would improve and more lives saved, when all the stakeholders show commitment and empathy in the service they render.
Written by:Blessings Ituma
