A lot has gone into the inauguration and sustenance of a Health Insurance Scheme in Nigeria which is quite commendable since most Sub-saharan countries cannot boast of such. Inspite of problems of Cost, Coverage and Transparency, the NHIS has come to stay. However, like every Nigerian Govt policy, it is bound to fail without consistent appraisal and review where necessary..we can all see what's happening with the NHS in the UK, which despite it's sophistication is running into problems today.
As a Doctor who has worked in both high and low resource centers in Nigeria, I deduced some inconsistencies with the scheme which doesn't meet the test of equity.
I have noticed that the Choice of Drugs covered by the NHIS differs from center to center and HMO to HMO which shouldnt be so at all since the Govt premium is fairly output dependent.
while popular assumption is that the NHIS covers basically essential medications which are generally affordable to the bulk of the population,thus leaving out nonessential medications for patients to bear alone (even this model has is own shortcomings because no one chooses the kind of sickness to have). this is often not the case because the center I work now is a high resource one whose HMO provides comprehensive coverage for expensive drugs such as Galvus-Meth, Co-Diovan etc while the General Hospital I served barely covered Rocephin and virtually never stocks it, the most you can get is Unbranded Ceftriaxone. yeah, its easier to just mind your business and move on as a doctor until you realise that the people benefitting mostly from this inconsistencies are those who can afford these expensive drugs-the Rich.
it makes no sense for a Commissioner's Mum to obtain Meropenem for N60( NHIS subsidized) in the Staff clinic( CBN clinic, NNPC clinic, State House Clinic etc) which stocks it, while the Level 6 Civil Servant whose wife just put to bed in the General Hospital is told to go buy it outside for N6000 naira because the Hospital pharmacy or the HMO doesn't stock it on the NHIS list. both are supposed NHIS beneficiaries for Christ's sake.

Many patients with Chronic ailments are suffering, especially in the recession since the prices of routine drugs have quadrupled and a huge chunk of their salaries go into buying drugs that ideally should be stocked by their hospital pharmacies and covered by NHIS
My questions to the board overseeing this scheme are as follows:

1. who oversees the ethical implementation of this scheme in all the hospitals enrolled in the scheme?

2. Are different HMOs allowed to cover what they wish to cover? or there's a harmonized code of conduct ?

3. if there is, why the variations from center to center?

4.Do patients have the right to source drugs covered-by-the -NHIS-but-not-stocked-by-the pharmacy in the open market via NHIS referral?

5. Are some HMOs above the Law?

6.Do some Government Staff Clinics have special insurance Schemes apart from the NHIS that enables them get drugs at NHIS-rates while the converse applies for other public hospitals?

Alot of my pharmacist friends are also complaining about this trend, because they have the unenviable job of having to explain this ethical aberration to Patients.

People are complaining about the price of Foodstuffs, but no one has noticed the silent deaths of not Nigerians due to the Astronomical price of drugs today and a skewed health insurance policy that isn't helping matters.

#TheNHISmustbeReviewedToMeetCurrentTrends