IS NHIMA BROKE?

Under ordinary circumstances, ‘broke’ and ‘NHIMA’ should not be used in the same sentence. The National Health Insurance Management Authority (NHIMA) runs a contributory scheme aggregating monies from all workers in both the formal and informal sectors. NHIMA is one of the best things that has ever happened in Zambia’s history. The scheme has facilitated access to quality health care and health commodities to all citizens regardless of social economic status. It has proved to be truly inclusive and dynamic in responding to the huge gap in access to quality health between the rich and the poor.

My family has benefited from NHIMA greatly. My wife and I have accessed certain medicines, medical procedures and lab tests that our private health insurance scheme refuses to cover.  This has saved us resources that we have channelled to improve the welfare of our family. My ageing parents have been managing to access quality care and undergo periodic health checks through the scheme.

I have seen many poor expectant mothers coming from poor neighbourhoods  and even from rural communities access quality services and deliver healthy babies at private health facilities which were previously only a preserve for the well to do. NHIMA was a game changer.

We are all seriously concerned with the performance of our beloved scheme recently. Why is the scheme struggling to settle accounts with private health providers, pharmacies, and other suppliers? We have seen some private entities dumping NHIMA, we have seen increased difficulties by members to access NHIMA supported facilities. Sometimes you have to go back and forth between a private lab and the hospital colleting codes and all manner of cumbersome and frustrating procedures before a service can be accessed.

Recently NHIMA stopped admitting members using the buy back option where you pay for a few months and instantly access its services, instead you have to wait for atleast 4 months. This is another indicator that the scheme is overwhelmed.

The failures of NHIMA have continued to manifest in recent times. Most recently government made a decision to move NHIMA back to Ministry of Health a decision which I fully support because I never agreed with the decision to move the scheme to Ministry of Labour. In my view NHIMA is not an ordinary social security institution like NAPSA, it has a broader mandate to actualise universal health coverage and though workers’ contributions are its heartbeat, it is fundamentally a health concern.

However the biggest red light came on when NHIMA made a drastic decision to curtail private facilities from accrediting to the scheme, they also offloaded certain services and commodities such as spectacles and dental services.

Thankfully the Minister of Health has stepped in to reverse this decision. However the damage is already done and we now demand that the government comes clean on the status of NHIMA. Is NHIMA on the verge of insolvency? Is NHIMA broke? How did we get here? What shall we do to ensure NHIMA gets back on track?

I have sat in meetings and heard from certain quarters for sometime now that NHIMA was having serious operational and liquidity problems. We all know that health insurance is generally abused in terms of pricing and when NHIMA got private facilities on the scheme the invoices they were churning out for services and health commodities were seriously inflated in terms of price. Could those running NHIMA at the time recklessly run down the facility through syphoning of funds through private providers?

The inflated invoices to health insurance schemes is not a unique feature to NHIMA accredited facilities, it is the case for almost all medical cover charged to health insurance. My wife and I have often wondered why drugs we buy at K10 over the counter would cost K85 – K120 when paid for using our health insurance.  

I have also heard of extraordinary efforts to try and have NHIMA access funding under the global fund basket for HIV and AIDS, if true, could this be another desperate effort to inject life into an institution on the verge of insolvency? We have also heard of efforts to link social protection beneficiaries such as households on social cash transfer to NHIMA. This is actually one of the measures in the eighth national development plan were government scored zero in the last performance review. Critics however argue that it could be another attempt to inject funds into the scheme.

The majority poor and struggling Zambians need NHIMA, it is their lifeline. With the cost of living reaching unbearable levels for many of us, our plea is PLEASE SAVE OUR NHIMA FROM COLLAPSE.