On May 19, President Muhammadu Buhari signed the National Health Insurance Authority bill 2021 into law. The new Act repeals the National Health Insurance Scheme Act (Laws of the Federation of Nigeria 2004). It establishes the National Health Insurance Authority to promote, regulate and integrate health insurance schemes; harness private sector participation in health care services and work towards achieving Universal Health Coverage for all Nigerians.
Among several functions, the new Authority is to:
- Enforce the Basic Minimum Care package of health services for all Nigerians across all health insurance schemes in the country, including private health insurance schemes.
- Work with State health insurance schemes to ensure that Nigerians have access to quality health care that meets national health regulatory standards.
- Ensure the implementation and utilisation of the Basic Health Care Provision Fund under the National Health Act 2014.
- Devise a mechanism in conjunction with States, to ensure that the basic health care needs of vulnerable persons are provided.
- Provide and maintain information and communication technology (ICT) infrastructure and capability for integration of all data on health schemes in Nigeria.
The National Health Authority is to be headed by a Governing Council comprising a Chairman and members who shall include the Director General of the Authority, representatives of government ministries, the Armed Forces, organised labour unions, a Civil Society Organisation in the health sector, representatives of each of the geo-political zones. The Director General of the Authority shall be appointed for a term of 5 years which is renewable once.
The Act makes it mandatory for every person resident in Nigeria to obtain health insurance. Residents include employers and employees in private and public sectors employing five or more staff, informal sector employees and all other residents of Nigeria. It also provides that a person who participates in a State mandated health scheme may also obtain private health insurance.
States are expected to provide basic minimum package of care to all residents of Nigeria. In furtherance to this, the National Health Insurance Authority will implement the Basic Health Care Provision Fund under the National Health Act 2014 and any guidelines developed in that regard. State health schemes will be responsible for the management of the Fund and monitoring its implementation. Where a State has not established a health scheme, it may use the services of a Third Party Administrator pending the establishment of its health scheme.
The Act establishes a Vulnerable Group Fund, from which subsidies shall be paid to State health insurance schemes for the health care of the vulnerable and indigent in Nigeria. The Governing Council of the National Health Insurance Authority shall be responsible for the management of the Fund. Vulnerable Group as defined in the Act include children under 5 years of age, the aged, physically and mentally challenged and the indigent, as may be defined from time to time.
The Act makes other provisions as it relates to contributions under health insurance schemes, including for vulnerable persons; accreditation of health maintenance organisations, mutual health associations, third party administrators and healthcare providers. It also establishes offices for the National Health Insurance Authority in the States and Federal Capital Territory, and provides for their administration, finances and functions.
The National Health Insurance Authority Act defines several offences in relation to its provisions, which are mostly financial in nature, and states that an offender is liable to prosecution under the relevant laws guiding such financial transactions.
In general, the Act appears to be an improvement on the repealed National Health Insurance Scheme Act, 2004 and aims to provide health insurance coverage for all Nigerian residents in order to attain Universal Health Coverage in Nigeria.