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FCT Health Insurance Plan – Redefining the Ways to Target the “Missing Middle” [Blog]

“Enrolling people in insurance schemes is not easy, considering that you are asking people to come and pay for their health care when they are not sick” – Dr Ahmed Danfulani, Director/CEO of FCT health insurance plan.

Each country’s journey towards universal health coverage (UHC) is highly context-specific and requires strategies that respond to the unique challenges posed by factors in that region. The national health insurance scheme is from Nigeria vehicle for achieving UHC. However, only about 5% of the population has been covered since its inception in 2005, mostly in the formal sector. When the National Health Act of 2014 mandated states to set up their own social health insurance schemes, it was intended to accelerate from Nigeria path towards achieving UHC by 2030. Since then, 34 states and the FCT have their programs in place, with the other two states passing the required legislation to start the process.

The success of these programs is variable, with most enrollees in the formal sector. Given the structure and predictability of the formal and organized private sectors in Nigeria it was relatively easier to set up health insurance schemes, compared to the informal sector where annual premiums have to be paid of their own accord. It was therefore difficult to ensure that this informal sector, “the missing link” from Nigeria path to achieving UHC, enrolled. This situation is further aggravated by the fact that health insurance is not yet required by law in Nigeria.

Federal Capital Territory Health Insurance Plan

When the Federal Capital Territory Health Insurance Scheme (FHIS) was established in 2009, it was primarily intended for the formal sector, i.e. staff in the Federal Capital Territory Administration (FCTA), regional councils and local education authorities (LEA). Although the program funded access to health insurance for all staff, not all registered or used it, leaving around 40% of those eligible uncovered and regional councils excluded. With the advent of new management in 2018, there has been renewed effort to enroll beneficiaries. According to Dr. Aminat ZakariChief Operating Officer, FHIS.


FHIS has stratified its health insurance programs into formal and informal sectors. The formal sector includes the organized private sector, i.e. organizations with more than 10 employees, and the informal sector includes individuals, small and medium enterprises, etc. The formal sector package, paid by the employer and deducted at source, covers the member, his spouse and his four children and allows the addition of additional members on the basis of a negotiated premium. Whereas for the informal sector, premiums are paid per life, at N13,500 per year. So far, about 130,000 people have been enrolled in the program, both in the formal (over 90%) and informal (less than 10%) sectors.

Reaching the informal sector

Following the assent of the FHIS Act of 2020, a plethora of activities have been planned with the aim of raising awareness, educating the public and improving community perception of health insurance among the informal sector in the Territory of the federal capital (FCT) and its six regional councils. . Research was conducted to determine what the target population would react to; awareness campaigns were carried out in markets, schools and communities; bonuses have been reduced for retirees (to N12,000); and a partnership was concluded with the bank FCT Microfinance which allowed them to pay members’ premiums in advance, allowing members to repay on an ad hoc basis at very low interest rates. According to the FHIS public relations officer, David Barauawareness pushes towards the main markets of Abuja have been so successful that the program has been asked to set up registration centers in the marketplaces, so that potential registrants can easily access them.

The FHIS has regional Council coordinators who make advocacy visits to traditional, religious and community leaders, who then educate their communities on the benefits of health insurance. They associate with the National Guidance Agency (NOA) to raise awareness about FHIS and recruit grantees to be program ambassadors to their communities. They also engage consultants to target key groups, such as road transport workers.

The program also deployed multimedia strategies, including a radio program called “FHIS & You” which was broadcast in five languages: Yoruba, Igbo, Hausa, Gbagyi and Pidgin. They used social media (Twitter and Facebook), bulletin boards, posters, flyers and banners, as well as a quarterly newsletter, to share updates with registrants. To strengthen visibility and the relationship with beneficiaries, a call center has been set up in the town centre. It opens from 8 a.m. to 8 p.m. every day and anyone can come in to learn about the program and register. There is also an online registration platform.

The FHIS benefits from the Provision fund for basic health care (BHCPF) under which they have enrolled 9,000 lives (37.5% of their target) among the poor and vulnerable, said Dr. Ahmed Danfulani, Director/CEO of FCT Health Insurance Scheme.

Did these strategies work?

Although there was some traction in terms of registration at the start of the campaign, progress was significantly slowed by the COVID-19 pandemic. Restrictions on movement and gathering caused by the pandemic prevented outreach activities from taking place as planned. Funding allocated to sensitization and sensitization is also insufficient. According to Dr Danfulani, the delay in adopting legislation making health insurance compulsory is also a major obstacle to their progress. Although the Senate passed the bill in 2020, there has been no known progress in enacting it.

What about current beneficiaries?

Mrs. Eguator Nwanneka Faith is a beneficiary of FHIS and she said, “It is very encouraging for the civil servants to be part of it. It is a very beautiful programme”. She is, however, unhappy with the fact that affiliates still have to pay 10% of the cost of services under the program.

Another beneficiary, Abubakar Ndahi, criticized the poor quality of care he receives in hospitals under the scheme, with long waiting times and poor client relations topping the list. This is a limitation of which FHIS is well aware. According to the head of the monitoring and evaluation unit of the scheme, Pharm Adedeji Fatai Oladimeji, there is a lot to be done to improve the quality of care in health facilities, because even these health care providers have poor perception of health insurance and tend to avoid providing care to enrollees because they do not pay out of pocket. To address this issue, his unit has delisted facilities that consistently refuse to provide services to registrants, and they are prepared to continue to do so.

What happens afterwards?

The FHIS, along with other social health insurance schemes, are on a long and arduous road to UHC by 2030, due to the massive and largely unschooled informal sector in Nigeria. To improve insurance rates in this group, NHIS and SSHIAs need to develop and implement innovative, evidence-based strategies specific to their context in addition to holding health facilities accountable for health service delivery. quality.

According to Dr. Danfulani, FHIS looks forward to rejuvenating its awareness campaign by strengthening its already proven strategies and hopes that innovative funding mechanisms from state governments and the private sector can be added to already existing federal government initiatives such as than the BHCPF, to make it possible.