Since its launch in 2003, the NHIS has been struggling to overcome and manage shortcomings in its medicines benefit program (MBP), which is under the overall operation of the National Health Insurance Authority (NHIA). Examples of identified deficiencies that need to be addressed include: frequency of the update of selected medicines; inadequacy of prices quoted by the NHIS for reimbursement; increased stock-outs of essential medicines at health facilities; a growing number of patients who occasionally have to pay out of pocket for medicines; and the rising value of medicines claims as a proportion of total claims.
To systematically address challenges in the NHIS’ MBP, it was important to undertake an assessment of its current management system to identify the causes, extent, and nature of the problems and to suggest remedial actions. To this end, with funding from USAID and in collaboration with key stakeholders, SIAPS conducted an assessment of the NHIS’ MBP. The findings and recommendations of the assessment will be used to guide the NHIA on strategies to improve the design of the MBP, and to strengthen medicines claims management, pricing, and reimbursement processes. This intervention was also done with the aim of enhancing the availability of medicines and acceptability of the medicines program by all stakeholders.