Nasarawa State Health insurance Agency (NASHIA) effectively took off in 2019 with the mandate to facilitate physical and financial access to quality and effective healthcare services to all residents of Nasarawa state. The Agency is the main vehicle for the attainment of Universal Health Coverage (SDG Goal 3, Target 8) for Nasarawa State.
The establishment of NASHIA is in line with the unambiguous determination of Governor Abdullahi Sule’s administration to providing quality and affordable health care delivery services to people of the State. The Governor had clearly stated in his pronouncement upon assumption of office on 29th May 2019 that “we will endeavour to provide affordable healthcare services and infrastructure at tertiary, secondary and primary levels for the well-being of the people of Nasarawa State”’
In view of the enormous financial implication in securing quality healthcare services in the face of ravaging poverty confronting the people, the state government conceived and established the Nasarawa Health Insurance Agency (NASHIA) through a legislation passed by the House Assembly and assented to by the State Governor.
The NASHIA Law No. 10 of 2018 is therefore an effort geared towards providing affordable healthcare services to the people and in a sustainable manner through a contributory funding strategy. This is also in tandem with the decentralization of the National Health Insurance Scheme into the State Social Health Insurance Schemes (SSHIS) in Nigeria.
The Nasarawa Economic Development Strategy (NEDS) document which has become the fulcrum for the transformation of the state and making it better than what the Abdullahi Sule’s administration met it, also captures this position as it stated unequivocally that “the government is committing to intensive action to attain the goal of Universal Healthcare Coverage for all citizens, to help them attain socially and economically productive lives at the highest level”.
Governor Sule reinforced the focus of his administration in the health sector considering that, “the health of the people not only contribute to better quality of lives but is also essential for the sustained economic and social development of the state as a whole
NASHIA has its main objectives as including: “to regulate, supervise and ensure the effective administration of the Nasarawa Health Insurance Scheme, ensuring that every resident of Nasarawa State has access to good health services, families are protected from the financial hardship of huge medical bills, there is equitable distribution of healthcare costs among people of different income groups, and the efficiency in health care delivery is improved”.
Governor Abdullahi Sule appointed Dr. Yahaya Bawa Ubam, an experienced medical doctor and Consultant Obstetrician/Gynaecologist, a very proud son of Uke in Karshi Development Area of Karu Local Government Area of Nasarawa State who had worked with the Federal Medical Centre, Keffi to head the Agency as Executive Secretary in November 2023. He therefore assumed office at the Agency with vast experience in Administration of Medical institutions having served and retired in 2020.
Upon assumption of office, Dr Ubam, a product of the University of Jos imbued with all humility due to his upbringing, acknowledged and paid glowing tribute to his predecessor for the sound foundation laid for the agency. The existence of very capable staff was an added boost for him to work on in order to achieve the Universal Health Coverage by 2030 in line with the United Nations target.
This he has done along with the staff by hitting the ground running, and within a short span of two years, the agency which started with zero enrolment in 2019 had its enrollees numbering 2,000 in 2023 before subsequently increasing astronomically to 357,056 when Dr Ubam took over, representing a approximately 10% of the population to be covered by the scheme.
Dr Ubam succeeded the Agency’s first Chief Executive Officer, Dr. Gaza Gwamna, presently Commissioner for Health who as a pioneer worked together with his crop of dedicated staff to set a sound foundation for the operation of its activities by developing Operational Guidelines and Standard Operating Procedures as well as a 5-year Strategic Plan.
Operations of NASHIA are carried out through three key areas namely:
Resource mobilization across all formal/ organized sector of the state and the informal sector of the economy where more 70% of the residents of the state belong
The mobilized resources are pooled to form a single pool at the center regardless of the source of the fund. This is done to ensure accountability and transparency in the spend for health insurance
With the funds moved to a single pooled, the Agency in collaboration with major stakeholders including community based organizations, civil society organizations, determine what services to purchase with the mobilized funds and for what category of people and at what price and from which healthcare provider
The Agency has digitalized most of its operations, from biometric data capture at enrolment to providing access to care at registered facilities, while referral for Secondary and Tertiary care is through an end to end electronic process that allows for sharing of information between the facilities responsible for the care of the client.
In order to further strengthen the Agency’s resolve to achieve its mandate, NASHIA has successfully established three functional Zonal Offices in Akwanga, Keffi and Obi Local Government Areas to cater for the Northern, Southern and Western Senatorial zones of the State. This move is to bring its services closer to the under-served communities.
Currently, enrolment, on-boarding of clients and resolution of complaints are done at the Zonal offices. This strategy reduces the stress and travel inconveniences for clients.
The Equity Fund provided by the State Government and the Basic Healthcare Provision Fund provided by the Federal Government has enabled the Agency to cover over 100,000 vulnerable persons by paying their premium. In addition, the adoption of this scheme has helped to provide coverage for almost 5,000 vulnerable persons across the state.
In spite of the giant strides made by the Agency, especially in the last two years under the pragmatic leadership of Dr Ubam, its operations are constrained by the following challenges;
Non release or delayed release of statutory funds to subsidize the premium of civil servants in the state by the Government leading to a delay in the reimbursement of health care providers
Inadequate Human resource for quality healthcare delivery across all levels of care. Poor quality of care provided at the point of care due to poorly trained staff
Poor attitude of healthcare providers/facilities towards health insurance clients
Insecurity in some areas of the state making them inaccessible to clients and staff of NASHIA
High inflationary trend, making it difficult to plan and peg capitation and reimbursement of healthcare providers.
Lack of operational vehicles for routine supervision and spot check mentoring of healthcare facilities.
Insufficient office accommodation at the state office and zonal offices.
Non possession of National Identity Number(NIN) by prospective clients making them ineligible for enrolment
Dr Ubam attributes all the strides being made by the NSHIA to Governor Abdullahi Sule’s unwavering support. He recounted that “any time we make a request, he is quick to grant the same because he seriously believes that the way forward health-wise is through insurance because of the expenses involved”.
It is therefore expected that with the support of the Governor, traditional rulers, Non-Governmental Organisations and other stakeholders in the state, NASHIA is poised to attain heights never witnessed. If we continue this way, accessibility to quality healthcare services will be much better in the near future.