Improving Pharmacy Services within National Health Insurance Scheme for better performance

Background: Following many attempts at implementing policy strategy on health insurance since 1960, NHIS was eventually launched in 2005. It has a mandate for universal health coverage for Nigeria. The important roles of pharmacies are discernible in NHIS statutory objectives, though the NHIS operation is largely to the exclusion of Pharmacists Council of Nigeria (PCN)-licensed pharmacies.

Objectives: This review was carried out to create an awareness about the exclusion of pharmacists and the pharmacy profession in NHIS operations, and to recommend practical solutions.

Method: We conducted a review of relevant literature on health financing and provider payment mechanisms, in addition to NHIS and PCN documents relevant to NHIS operations.

Results: The healthcare financing function of strategic purchasing, and the closely related provider payment mechanisms are well defined in NHIS documents. NHIS adopts global capitation among other provider payment mechanisms, to control costs. The implementation is evolving and could benefit from periodic evaluation of NHIS payment methods. Other identified implementation gaps include the exclusion of pharmacies as legal entities and other health professionals.

Conclusion: The adoption of global capitation, and the consequent exclusion of some healthcare providers, can be seen to be detrimental to NHIS' overall performance, and enrolees' satisfaction. For improved performance, recommendations include - re-designing NHIS provider payment system by contextualising lessons from countries like the Kyrgyz Republic; harnessing the expertise of all health professionals including licensed pharmacies; Also, PCN needs to craft professional development strategy to hone pharmacists' prerequisite skills for providing pharmaceutical care which Nigerians direly need.