Payment for healthcare in Nigeria is predominantly out-of-pocket but a new player believes in spite of the numerous odds stacked against it, an already familiar approach could make a lot of difference in expanding access to health insurance.
In Nigeria, achieving most health goals has been greatly limited by access and cost, with payment for health services predominantly out-of-pocket. The country has a large population of uninsured people, and even those who have insurance often find it difficult to afford the high cost of care. Several years after it began operation, Nigeria’s National Health Insurance Scheme (NHIS) is yet to achieve its loftily set target of significantly reducing the number of uninsured citizens, necessitating the need for other approaches at different levels including solutions from the private sector, including new players like Helt.
Helt is a new health technology company that is trying to make healthcare more accessible and affordable in Nigeria. The company offers a subscription-based health care service as well as a healthcare marketplace where users can choose services at clinics or pharmacies as well as wellness services. Helt’s proposition is to provide a more affordable and convenient way to access healthcare. The company’s subscription-based service allows users to pay a monthly fee for access to a network of healthcare providers. Users can also use the Helt marketplace to book appointments, order prescriptions, and find wellness services. However, there are some limitations to Helt’s solution.
But there are number of concerns. The company is still in its early stages, and it is not yet clear how successful it will be in the long run. Additionally, Helt’s services are only available in a limited number of cities in Nigeria making its impacts on the national outlook potentially limited except there is a massive expansion. But despite these limitations, Helt’s leadership described the solution as a promising new development that could help to make healthcare more accessible and affordable in Nigeria. Furthermore, the company believes that has the potential to make a real difference in the lives of many people.
A national issue impacting lives individually
Young Nigerian couples, John and Mary, were both excited and nervous about the upcoming birth of their first baby. They were also worried about the cost of healthcare. John works as a mechanic and Mary is a stay-at-home mom. They did not have health insurance, and were not sure how they will afford the cost of delivery and any complications that may arise.
“Three months before the baby was due, I started telling my colleagues together with whom we organised a monthly contribution scheme to let me collect mine around the time of delivery. I also informed by uncle that I would need his support to foot the hospital bill when my wife delivers,” John said.
He is not the only one who had to worry about how to foot hospital bills when the time comes. For individuals living with health conditions like cancer, being able to afford early diagnosis and treatment often determine the prognosis (likely outcome) — whether the individual can survive, fully recover or die — from the condition.
It took Michael, a pensioner, and his family eleven months to gather enough money for tests and the news of his third stage prostate cancer diagnosis was devastating as his determination to fight the disease was not well matched by the ability of health insurance coverage to cover the cost of treatment.
“We were told that my insurance does not cover it and so we have to find millions of Naira. I don’t even get my pension on time. It was this same financial situation that led to my wife’s death after she suffered a massive stroke but they had to discharge her from the hospital because we were unable to afford the cost of her care.”
In addition to caring for their patients, health workers in Nigeria often have to pool resources together to support the care of some patients under their care whose chances of survival often hinge on what the workers can squeeze out of their own pocket. Stakeholders believe an effective health insurance system can help prevent this.
Several attempts at different levels have been introduced to address this is issue and make health insurance to be more inclusive, extensive, accessible and reliable in Nigeria but they have all had limited successes. Nigeria’s president recently signed the country’s latest National Health Insurance Act into law.
The new national health insurance law aims to make healthcare more accessible and affordable for all Nigerians. The law makes health insurance mandatory for all citizens and legal residents, and it establishes a Vulnerable Group Fund to provide health insurance coverage to poor and vulnerable people. The law also creates a National Health Insurance Authority to oversee the implementation of the law. The new law has been described as a major step forward for Nigeria’s healthcare system. It has the potential to improve the health and well-being of millions of people by making healthcare more affordable and accessible.
“The new law will make health insurance mandatory for all Nigerians and legal residents, and it will also establish a Vulnerable Group Fund to provide health insurance coverage to poor and vulnerable people. This is a major step forward for Nigeria, and it will help to ensure that everyone has access to quality healthcare, regardless of their income.” – Senator Ibrahim Oloriegbe, Chairman of the Nigerian Senate Committee on Health.
However, there are still some challenges that need to be addressed before the law can be fully implemented. These challenges include: The need to increase awareness of the law and its benefits; improving the capacity of the National Health Insurance Authority to implement the law; increasing the availability of healthcare providers who accept health insurance, and several others.
Helt’s approach
The low uptake and the skew towards workers in the formal sector across those who are currently registered to the NHIS mean that there are millions of Nigeria who continue to be vulnerable to catastrophic health spending because they are not covered under any health insurance plan. To fill this gap, multiple health tech organizations have sprung up to address the various challenges that result in the poor uptake of healthcare. Many offer lowered rates and leaner packages that make the subscriptions more affordable as well as micro health plans.
While these varied solutions address address the access and financing problem within the health insurance space, there are companies like Helt that seek to operate outside of health insurance and their reasoning seems based on some fundamental issues that impact the ability of many Nigerians to buy health insurance.
With a poverty rate higher than 60% and a high unemployment rate, the Founder of Helt, Tonye Harry, reasons that many Nigerians would be unable to purchase health insurance even at lowered rates. Also deterring poor Nigerians from purchasing health insurance is the young population who Tonye and colleagues find most young people experience minor illnesses infrequently in a year and thus are more averse to spending on health insurance that they may infrequently use.
Helt’s leadership said the entity’s mission is to these uninsured and insurance-averse people who pay for healthcare at clinics and pharmacies out of pocket by providing subscription-based health care as well as a healthcare marketplace where they can choose services at clinics or pharmacies as well as wellness services.
It believes that this would appeal to the younger population who are working and earning and would help them money aside for health care and wellness but in a way that gives them more control over the funds they have set aside for health. “Potentially, this would give cost savings, convenience, and transparency to young healthcare users who rarely need healthcare, and by putting money aside towards healthcare and wellness, are able to procure the services they want in the marketplace on Helt in a way they can control and personalize,” Harry added.
The Helt’s model is based on the nascent but popular prepaid electricity model in Nigeria where individuals, households and organizations estimate their consumption based on previous patterns and buy electricity credit based only what they use. Tonye and his colleagues said they hope that by bypassing health insurance packages where services are services are bundled in a package, clients get a freedom to choose what services they want.
As a marketplace, the Helt app will provide access to hospitals, pharmacies, wellness education, and wellness services to users. There will also be discounts on services purchased through the app. By putting these services together and offering them to customers who are systematically putting money aside for healthcare, Harry said the Helt app offer increased visibility, access to new customers, and a reduced marketing cost to the healthcare providers.
Odd stacked against Helt and others
Notwithstanding the benefits the app offers, however, there are challenges the app must surmount to gain a foothold in Nigeria. Given the continued economic circumstances, there are more than half of the Nigerian population below the poverty line and health economists argued that the Helt team will fight a uphill battle to help consumers understand the value proposition of setting aside some funds for healthcare and wellness. There is also the challenge of raising enough awareness to get more individuals to sign up. This has been a major challenge for even the NHIS itself.
“The biggest challenge with health insurance in Nigeria is the low level of awareness. Many people don’t know about it, and even those who do often don’t understand how it works. This is a major barrier to enrollment, and it’s something that needs to be addressed if we want to make health insurance more accessible to Nigerians,” said Dr. Olufemi Olugbile, CEO of the National Health Insurance Scheme (NHIS)
Even as the Helt team targets the section of the population with higher income, it may also find the market choked with a wide array of personal health financing products with their own competitive edge. Moreover, as the team seeks to attract healthcare providers to its marketplace platform, the team may recognize the difficult task of ensuring all its registered providers provide quality healthcare to the Helt app users.
At the launch of the Helt app in March 2023 however, Harry and his colleagues said they remain very optimistic as they roll out the app in Abuja with a plan to spread to the rest of the country as they grow.
This story has been supported by Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems, solutionsjournalism.org