Kaduna Health Bill: CSOs Want Sub-Section Exempting Vulnerable Persons From Contributing
By Alex Uangbaoje, Kaduna
Following a Bill currently before the Kaduna State House of Assembly, establishing the State Contributory Health Management Authority (2017), group, Concerned Civil Society Organisations (CSOs) in Kaduna State, has recommended, through a memo, a sub-section exempting vulnerable persons from contributing under the scheme.
“There should be a sub-section added in section 22 of the bill, exempting vulnerable persons form contributing under the scheme, which is proposed to be as follows: “All vulnerable persons are exempted from paying contributions under the scheme.” This is to prevent any lacuna that could exclude vulnerable persons from accessing health care services as a result of non-contribution into the scheme.
“The payment of contribution under the scheme, as provided in section 22 (2) of the bill stated that “An employer who has a minimum of five employees shall, together with every person in his employment, pay contributions, at such rate and in such manner as may be determined, from time to time, in the operational guidelines of the authority.” It was observed that there was no provision anywhere in the bill, exempting vulnerable persons in contributing under the scheme.” the said.
The memo, which was signed by Malam Lawal Abubakar and Mr. Iliya Kure, Chairman, HERFON and Asst. Secretary, Family Health Kaduna State Advocates in Nigeria Initiative (FHANI), also noted that section 23 (1) of the bill has made provision for the establishment of the contributory health scheme, which stated that “There is established the Kaduna State Contributory Health Scheme (in this law referred to as, the “Scheme”) which shall be for all residents of the State.
“However, the bill did not specify the categories of contributory health scheme to be regulated by the Authority. Without categorization, the Authority may end up in providing the scheme to only government employees, as was seen in the NHIS. With this gap, the Authority may not be held accountable, and large segment of the citizens who are not government workers will not be given priority, as seen in the NHIS.”
The memi was presented to the Chairman, House Committee on Health, Dr. Isaac Zainkhai. by Mallam Lawal Abubakar on behalf of the Concerned CSOs
They observed that vulnerable persons were well captured by the interpretation in Section 3 of the bill, which stated that “Vulnerable persons” “include pregnant women, children under 5 years of age, the aged, mentally challenged, disabled, poor and others persons with disabilities as may be recognized by the Authority.”
The CSOs therefore recommended that “Children under 5years of age” should be replaced with “children under 18 years of age”, in the interpretation of vulnerable persons.
“Accident and rape victims”, should be included in the interpretation of vulnerable persons”.
Similarly, the CSOs also observed that Section 17(2b) of the bill made provision of “equity contribution of not less than 1 % per annum of the Consolidated Revenue of the State on behalf of vulnerable persons” is among the source of funding the contributory health fund, which is well acknowledged and appreciated.
In view of the above, the Concerned CSOs stated that in order to achieve universal coverage, especially to the vulnerable persons, with affordable and quality health care services, we suggest that a bigger and additional pool of resources is needed by the Authority to manage the scheme, which are as follows: The “equity contribution of not less than 1% per annum of the Consolidated Revenue of the State on behalf of vulnerable persons” should be increased to “not less than 2%”; a 2.5% contributory health management levy should be added to VAT.
On the Third Party Administrators (TPAs), the Concerned CSOs stated that “It is clear that the bill expects collaboration between the Authority as a regulator and TPAs as the purchaser of the health services from the actual health care providers in health facilities.
“This was in tandem with what the National Health Insurance Scheme (NHIS) had been using in managing its scheme. However, based on the poor coverage of less than 5% of Nigerians by the NHIS since its establishment, the Centre for Social Justice (CSJ) has reviewed the provisions of the NHIS and its implementation over the years, and identified specific challenges on the use of Health Management Organizations (HMOs).
“Based on the bitter experience of using the HMOs by the NHIS, the State should learn a lesson, by not allowing history to repeat itself. It is therefore recommended that health care facilities registered in section 25 of the bill should replace the TPAs. Hence, all the functions of the TPAs specified in section 29 of the bill should be made to be the functions of the accredited health care facilities.
“The issues and challenges of TPAs serving as contractors or middlemen between the Authority and health care providers will virtually be eliminated. When this proposal is accepted, wherever TPAs appears in the bill should be replaced with accredited health care facilities.”
Receiving the bill, the Chairman, House Committee on Health, Dr Zainkhai commended the Concerned CSOs for their observations and recommendations which will guide the House in the cause of deliberations on the proposed Health Insurance Bill.
He appreciated the role of CSOs in supporting the Assembly in its work, adding that the points raised by the CSOs are key in moving forward.
He promised to study the Memo with other committee members, and urged CSOs to always take interest and participate in the legislative process.
Dr. Isaac appreciated the role of CSOs in supporting the Assembly in its work, adding that the points raised by the CSOs are key in moving forward.
He promised to study the Memo with other committee members, and urged CSOs to always take interest and participate in the legislative process.
