National Health Insurance Scheme (NHIS), Universal health coverage and the Nigerian Optometrist Part 2.

On the 31st of August 2014, a Political Action Committee (PAC) was inaugurated by the NOA President Dr Damien Echendu. The chairman of the committee, Dr. Joe Owie, was to perform the following functions, among other things:

Ensure that optometrists are included in National health insurance scheme (NHIS) 
Ensure that National Health Insurance Scheme (NHIS) Act is amended to include optometry as Primary Care Provider (PCP).

 COST in health care- eye care inclusive- is the much needed impetus driving Optometry to explore the National Health Insurance Scheme (NHIS) option. In a sequel blog, I rhetorically raised the following questions:

1) How does eye health care service benefit from NHIS scheme in Nigeria?

The Nigerian NHIS established in 1999 by act 35 of the Federal Government of Nigeria has the overall goal of enhancing access to quality and affordable health care to all Nigerian citizens. The eye care system, a microcosm of health care service, would actualize the goal of quality  and affordability service in it's practice by keying into the NHIS till.

2) Of what effect is the National Health Bill of 2014 to the rising cost of eye care services in Nigeria today? How will NHIS affect the direct and indirect cost of visual impairment and  blindness in the country?

To ameliorate the sufferings of the average Nigerian citizen on the burden of astronomical rise in cost of health care services, the Basic Health Care Provision Fund was introduced into the Nigerian Health care system. (National Health Bill[ Section 11 (1). 2014]).

 The purpose of this fund is elaborated in subsection (3) and summarized such:

(a) 50% of the fund will be used to provide basic minimum package of health services to eligible citizens.
(b) 20% of the fund will be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities.
(c) 15% of the fund goes for maintenance of facilities, equipments and transportation for primary health care facilities.
(d) 10% of the fund goes for Human Resources development.
(e) 5% of the fund will go to Emergency Medical Treatment.

3) Legislatively, can the eye care business be said to have a good representation in the National Health Insurance Scheme?

The National Health Insurance Scheme Operational Guidelines (2012) identifies the Optometrist thus:

2.2.13.1 Possession of Doctor of Optometry degree, or equivalent qualification recognized by optometrist and dispensing optician registration board of Nigeria (ODORBN)
2.2.13.2 Registration with ODORBN
2.2.13.3 Possession of current license to practice issued by ODORBN.

Remember this? [laws of the Federation (1989) Chap. 09, No. 34. Part VI. {29}]

 “Optometry” means a health-care profession specializing in the art and science of
vision care and whose scope of practice includes—

(a) eye examinations to determine refractive errors and other departures
from the optimally healthy and visually efficient eye;
(b) correction of refractive errors using spectacles, contact lenses, low
vision aids and other devices;
(c) correction of errors of binocularity by means of vision training
(orthoptics);
(d) diagnosis and management of minor ocular infections which do not
pose a threat to the integrity of the ocular or visual system; and
(e) ocular first aid;

 NHIS Operational Guidelines (2012) [Section  1.1.3.1.x] highlights our Primary health Care functions thus:

 Treatment of minor eye ailments including:

* Conjunctivitis.

* Simple contusion, abrasions, foreign bodies etc.

* Other illnesses as may be listed from time to time by the NHIS.

 NHIS Operational Guidelines (2012) [Section 1.1.3.2.xvi.]  highlights our Secondary Health Care functions thus:

* Refraction, including provision of low priced spectacles and excluding contact lenses,

*All Ophthalmological cases that cannot be handled at the primary level except those requiring tertiary care or on the exclusion list.

NHIS Operational Guidelines (2012) [Section 1.1.3.3.vi.] highlights our Tertiary Health Care functions thus:

*All Ophthalmological cases that cannot be handled at the primary and secondary levels of care except those on the exclusion list.

It is obvious that Optometry is not only represented in the operational guidelines of the National Health Insurance Scheme (NHIS), clauses in the guidelines predicate the legislative nuances that we (Nigerian Optometrists) fail to explore. I always remain of the opinion that we should focus on the real substance than to shadowbox mirages or ask irrelevant questions.

 For instance, is it more important to request that frames are put on the exclusion list of NHIS than to explore areas our profession appropriately fits into the Nigerian version of universal health coverage?

To be continued...