Strengthening Healthcare Access in Nigerian Tertiary Institutions:

A Review of the Tertiary Institution Social Health Insurance Programme

Abstract

Health is a critical factor that cannot be overemphasized in the human and social-economic development of any nation. Access to healthcare plays a vital role and is essential for maintaining and improving health. The Tertiary Institution Social Health Insurance Programme (TISHIP) was established by the National Health Insurance Authority (NHIA), and aims to provide affordable and quality health coverage for students in universities, polytechnics, colleges of education, and other post-secondary institutions.

TISHIP is a laudable initiative, designed to reduce out-of-pocket healthcare expenses and protect students from catastrophic medical expenses through pooled contributions. The programme offers a wide range of preventive and curative services without making payments at the point of accessing care. However, various studies have reported mixed findings about the awareness, knowledge, utilization, attitudes and perception about the programme.

Although the NHIA Act of 2022 makes health insurance coverage mandatory for all Nigerians as a means of achieving Universal Health Coverage (UHC), there has been a lack of enforcement, creating major setback to the its implementation. The implementation of TISHIP seems voluntary and at the discretion of each institution, with many having not yet subscribed to it, while some operate it inconsistently.

Hence, the implementation challenges need to be tackled and addressed. Strengthening the programme will require a multi-sectoral approach involving all the stakeholders including NHIA, institutional authorities, HMOs, healthcare facilities and professionals, and student bodies. To improve the programme’s effectiveness, efforts should focus on increasing student awareness, strengthening human resources, improving service delivery, and enhancing monitoring and evaluation. It is also essential to ensure transparent fund management, set a premium that is sufficient and economically sustainable, make the programme mandatory, and establish consistent implementation frameworks across all tertiary institutions in the nation.