Federal Government retirees who used to be under the National Health Insurance Scheme while they were still in active service are getting weary of their unending wait for the government to fulfil its promise of re-enrolling them back into the scheme as part of its efforts to achieve universal health coverage, NIKE POPOOLA reports
Dele Olubodun retired from the service of the Federal Government in 2010 at the age of 60, but could not get his gratuity and pensions until 2017.
He was one of the many senior citizens who served the country in their active years, but were neglected to suffer hardships, which led to their early death.
When his entitlement was not paid, Olubodun left his home in Ibadan, Oyo State to the Office of the Head of Service of the Federation in Abuja on three different occasions to seek proper resolution of his problem.
On those trips, he had no money to pay for hotel accommodation, but he and other pensioners slept outside the government office for days, harassed by security officials but ended up returning to their homes with failed promises from the pension officials that their entitlements would be paid.
Not long after his retirement, Olubodun started having difficulty in urinating and was also feeling pains in the lower part of his abdomen.
He went to the hospital to seek medical attention and was asked to do some tests, which he could not pay for. He had been removed from the National Health Insurance Scheme after his retirement.
He resorted to self-medication and the use of some drugs prescribed to him, with the hope that things would get better.
Later, he was having coloured urine but he did not know it was blood that was mixed with his urine.
After some time, he started having back pains and he bought an ointment, which he used to massage his back.
In 2015, he collapsed in a public outing and was taken to the hospital by the organisers of the event.
At the hospital, he was diagnosed of having prostate cancer, which the doctor said had metastasised and spread to other parts of his body.
The doctor told him that if he had visited the hospital earlier, it could have been diagnosed early before the cancer spread, and he would have been placed on treatment, which could have prolonged his life.
According to the doctor, prostate cancer does not have to lead to death if detected early; but at the stage Olubodun’s case was discovered, it was already a death sentence for him.
Despite his deteriorating condition, he continued to manage his health and did not give up hope of getting all his pension entitlement.
He explored all necessary avenues to push for the payment of his pensions and arrears despite all the hurdles he was encountering.
Luckily, two of his graduate children got employed and they were able to pay his hospital bills to cater for the cancer treatment, which helped to prolong his life for almost another two years.
Early in 2017, his gratuity was paid and he was placed on monthly pensions, but he died before the end of the year from the cancer.
His son, Biodun, said, “It is unfortunate that dad was denied his pensions for years but he was only paid when he was close to his grave. He could not afford to pay the hospital bills all the time he was feeling the cancer symptoms. If he had gone to the hospital early, maybe the situation would have been diagnosed and he would have started his treatment and lived longer.
“It is more painful because he died when we, his children, are now graduates and working and have plans to take care of him because he was a wonderful dad who sacrificed everything he had to make us what we are today. Unfortunately, we had to bury him.”
While Olubodun got his pensions before his death at 67, it is worth of note that many pensioners have died without being paid their entitlements.
For many deprived retirees, their inability to eat good foods and pay their medical bills seemingly pushed them to their early graves.
Some of the problems confronting the Nigerian pensioners include non-payment of gratuity and pension, low monthly stipends and omission from and arbitrary delisting of retirees from the payroll.
The federal workers who are on the National Health Insurance Scheme are always clicked out of the system once they retire.
For years, the Federal Government had been making promises to retired workers that it will re-enrol them in the NHIS, but it has yet to fulfil its promise.
The National Health Insurance Scheme, which was established under the NHIS Act, Cap N42, Laws of the Federation of Nigeria, 2004, was aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.
The NHIS aimed to secure universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians, both at the formal and informal sectors.
Under its programme for the informal sector, its plans include coverage to prison inmates, retirees and the aged.
According to its provisions, workers in the formal sector were required to contribute five per cent of their basic salary, while their employers should contribute 10 per cent to be part of the scheme.
The Head of Media and Public Relations, NHIS, Mr Ayo Osinlu, said the NHIS was designed to accommodate retirees from the beginning.
“If you look at our operational guidelines, you will see that provision had always been made for retirees,” he added.
According to him, retirees are not currently enrolled in the scheme because it is a complex thing.
“But the idea was to progressively grow over time to increase the sectors and the segments that the NHIS was taking on gradually overtime,” Osinlu said.
He, however, said the scheme had not grown as fast as expected or desired over time.
“Maybe that is why we have not moved as fast as possible to accommodate the retirees, otherwise, we had arrangements on our master plan to absorb retirees and even prison inmates,” he said.
According to him, the initial provision in the programme was that workers should contribute five per cent of their salaries while the employers contribute 10 per cent but since its inception, only the government has been paying the 10 per cent contribution for workers to be on the scheme.
“It was supposed to be 10 per cent from government, five per cent from workers, but the civil servants have never paid the five per cent because the labour union has not come to an agreement with the government for the deduction,” Osinlu said.
At a time when the government is emphasising how to achieve universal health coverage in the country, the retired workers are wondering why they should be kicked out of the scheme when they are no longer under the services of the government.
David AdodoUnlike in advanced economies where value is placed on human lives and senior citizens are given many privileges such as free health care, and free transportation, Nigerian senior citizens are being treated as if they are no longer useful, some retirees have lamented.
The retirees are not happy because they have to beg for everything they feel they are entitled to, including their pension stipends.
According to the retirees, some developed countries allow citizens who have attained a certain age to access free healthcare, whether they are still working or not.
The Chairman, Nigeria Union of Pensioners, Lagos chapter, Mr Joseph Dele, said the Federal Government promised to place the retirees on the NHIS but this had not been fulfilled.
According to him, when the retirees were still in service, they had access to free healthcare under the NHIS but unfortunately, now that their income is ridiculously low and they are having health challenges, they cannot access free healthcare again.
Dele noted that many of the retirees were not using the NHIS while in active service because they did not have health challenges that they are facing now, and this is the time they really need the cover.
He said, “We heard they were going to enrol retirees under the NHIS. But up till now, nothing has been said about it. After all these years, they did not put us on the scheme.”
According to him, as expensive as things are, considering the current rate of inflation in the country, many pensioners are not earning up to N7,000 monthly.
He said that the stipends they were being paid was not a living stipend, as it could not feed the retirees or give them access to good healthcare.
Dele worried that many pensioners were dying early because they could not pay their health bills and so could not enjoy their pensions for a long period of time.
“To survive, they have turned us to beggars in town,” he said.
Dele, who retired from the Federal Ministry of Works and Housing, said he used to have access to the NHIS while in service but was clicked out when he retired.
He said, “I was under health insurance when I retired from the Federal Ministry of Works and Housing but they cut it off when I retired. Definitely, if they do it for us, it is good; we will all enjoy it. Even before, we were saying there should be hospitals for pensioners apart from the NHIS.
“These days, if we are saying there should be hospitals for pensioners and they place us on NHIS, it would be okay. Even when we were in service, the NHIS was not working that much because then, many people were not falling sick but now is when we need it more as aged pensioners.”
According to him, the free drugs and test under the scheme will help to prolong the lives of the retirees.
Dele said, “There is one thing I would like government to do. It is not programme on paper; when you say it, do it. It is not making us just expectant. That is why we are appealing to them; let them do this NHIS and it should take effect immediately.”
Again, he said the Federal Government had promised that the monthly payment of the retirees would not be exceeding the 25th of every month, but that was not being adhered to.
He said, “They should save our soul; we are dying. Some people are not earning up to N7,000. How do they want to take care of themselves?”
According to the latest data from the World Health Organisation in 2018, Nigeria has one of the lowest life expectancy in the world at 55.19 years, sixth lowest in Africa and 178th position in world ranking.
Nigeria’s life expectancy ratio is much lower than the average global rate of 72 years.
The African countries with the highest rankings are Mauritius, Seychelles and Cape Verde’s with 74.82, 73.26 and 73.17 years respectively.
Despite being called the giant of Africa, nearby countries such as Liberia, Benin and Togo have life expectancies of 62.94, 60.09 and 60.61 respectively.
Experts have said that access to good healthcare has a major role to play in boosting the lifespan of people in any country.
For instance, according to a report by InterNations, the National Health Service is the public healthcare provider in the United Kingdom.
Established in 1948, it had been the cornerstone of healthcare in the UK ever since, and it offers universal healthcare coverage to Britons as well as legally resident foreigners and expats.
As long as a person is registered and is in the UK legally, he is entitled to a range of free healthcare that covers everything he could possibly need.
Despite different reforms to the NHS, it is still known as one of the best healthcare systems in the world.
It is worthy of note that the UK lifespan ranking is 81.4, according to the WHO.
Also, Ghana commenced its health insurance in 2000 during the administration of President John Kufuor.
Ghana’s health insurance scheme, which started almost the same time with Nigeria’s, had enrolled about 11 million, about 40 per cent of the 26.9 million population of Ghana, according to Ghanaian records.
Ghana currently has a life expectancy of 63.45 years, according to the WHO.
But in Nigeria, less than seven million out of over 180 million people are covered under the NHIS, of which about 75 per cent of the enrollees are Federal Government workers.
The President, Association of Professional and Practicing Insurance Brokers, Mr Delly Ajufo, observed that the workers, while still in active service, are covered with their four kids under the age of 18, but as soon as they retire, the scheme ends.
“In abroad, you are covered for life. In Britain, that (after retirement) is when you are covered more. If you are working, you pay for your medicals. The free medicals start when you are 60,” he said.
He said different countries, including the United States, had put in place health insurance schemes covering most of their citizens.
“Government should ensure that the NHIS covers all pensioners because there is no way they can survive with their little pension payments. The cost of medication in Nigeria is expensive, that is why you find old people dying every time without any care,” he said.
The President, Nigerian Council of Registered Insurance Brokers, Mr Shola Tinubu, said different countries had different health plans for their citizens.
He said the big debate in America’s health insurance scheme popularly called ‘Obamacare’ was on how to get more people into the scheme.
Tinubu noted that the UK’s health insurance scheme was a lot easier, as it tends to cover all its citizens.
According to Tinubu, there were different approaches used by different countries to address the health scheme because it is a major cost worldwide even for employers to be able to manage.
“The older you get, the more you actually need the health coverage,” Tinubu said.
Many retirees are suffering from serious health challenges and are unable to afford hospital bills.
They have, therefore, resorted to begging individuals and corporate organisations for help.
For instance, a former federal worker, Folu Adebamgbe, 69, had prolonged cataract and went blind because he could not afford the necessary treatment.
A pensioner, who simply identified himself as Mr Ogunyomi, 65, and another, Mrs Ebun Ajayi, suffered from hypertension for many years and could not be going to hospitals constantly.
Their situation later deteriorated to stroke, and they are currently appealing for donations to take care of themselves.
According to the Chairman, Federal Concerned Pensioners, Mr David Adodo, many retired workers are suffering from terminal illnesses that could have been detected on time, and treated before getting to the critical stage.
He worried that their inability to afford good health care was a problem.
According to him, access to some medical tests would have helped the early detection of some of these illnesses and would have prevented their health from getting worse and prolonged their life.
“If we have health insurance, they would have detected the illness before it developed to such a level and their situations would not be bad. But because they did not have money to treat them, the situation got worse,” he said.
He said the association had continued to solicit help from individuals and corporate bodies to help the retirees to buy drugs to attend to their health challenges,
“We have only been hearing that the government will put us on the health insurance scheme but we have not got any detailed explanation on why it has not done that,” he said.
Adodo urged the government to quickly return the pensioners to the NHIS so that they would have access to free healthcare and live longer to enjoy their pensions.
According to him, when there is health insurance, a retiree will be able to go to the hospital for treatment if he does not even have money with him at such a critical time.
Contributory Pension Scheme
Before the establishment of the Contributory Pension Scheme under the Pension Reform Act 2004, Nigeria operated only the Defined Benefit Scheme, which had a retirement age of 60 years or after 35 years of a worker in service.
When the CPS commenced, it stipulated a minimum retirement age of 50 years but many workers were not comfortable with it.
However, the federal workers who retired after June 2007 were moved to the CPS, which now operates side by side with the DBS pension.
While the DBS pensioners are well organised under the NUP and are still agitating for re-enrolment under the NHIS, retirees under the CPS seems to be hopeless in this regard.
The CPS retirees are not under any organised union and are, therefore, not able to make advocacy to the government for them to be enrolled under the NHIS.
The Head, Research and Corporate Strategy, National Pension Commission, Dr Farouk Aminu, said, “There is currently no plan for health insurance for retirees under the CPS because health insurance is not under our regulation.”
PenCom is the government office that manages the pensions of workers under the CPS.
He said, “Pension, as we regulate, does not cover health insurance. There are two insurance products that are normally covered under the scheme: the group life insurance policy and the life annuity.”
According to him, every employee of the Federal Government has health insurance, including the staff of PenCom.
While Lagos State has promised its retirees health insurance, majority of the retirees in the other states and local governments in the country have not received such a promise.
In fact, many states either owe salaries or pensions, a reason health insurance will not be on their priority lists.
According to the Director-General, Lagos State Pension Commission, Mrs Folashade Onanuga, the importance of managing one’s health in retirement cannot be overemphasised.
“The fast pace of change in every sphere in life, family, economic downturn, and inflationary trends, among others, result in a reduction in real income/earnings, particularly for retired people, and thus have a huge impact on the health and lifestyle of retirees, hence the need to manage their health,” she said.
LASPEC identified minor ailments associated with aging and retirement to include minor mood swings, sadness about their present status, persistent reference to the past good days, some sleep disorders and minor visual impairment.
It listed the major ailments to include serious visual impairment, and cardiovascular diseases such as high blood, hypertension and diabetes mellitus.
Other major ailments, it added, include obesity, arthritis, cancer, anaemia, reduced kidney function and mental health issue.
Onanuga said it was critical for retirees to visit the hospitals regularly for necessary tests to identify potential problems.
Due to rising cost of qualitative healthcare in Nigeria, she said it was important to plan in advance.
According to Onanuga, Lagos has plans to include retirees in the health insurance scheme of the state.
“This is because health is wealth and we want to ensure that our retirees are in the best health condition to enjoy retirement,” she said.
Nigerian workers are usually engulfed by fear of the future ahead of them, especially when they are nearing their retirement.
Many of them have had to grapple with fear in terms of whether they would get their pensions or not, apart from the health challenges associated with old age.
While the importance of a virile health insurance scheme cannot be overemphasised, the operators under the NHIS usually do not cover chronic illnesses.
In areas where such are provided, treatment is usually limited to the initial stages of treatment. This means the enrollee will have to source for the remaining stages.
The Managing Director, Clearline HMO International, Dr Isaac Akintunji, described the health insurance scheme as maturing and “the only way out for healthcare delivery in the country.”
Akintunji urged the government to propagate the health insurance scheme and make it compulsory for Nigerians, create awareness and also promote the benefits of the scheme to Nigerians.
One of the executives of the NUP, Sunday Omezi, said that some Health Maintenance Organisations under the NHIS had approached the union and urged its members to register under the scheme by paying a premium of N15,000.
He said senior citizens should be covered for free, having served the country meritoriously for many years.
While the health insurance may not cover all sorts of treatments, he said it would still go a long way in addressing major illnesses among pensioners.
The Executive Secretary, Pension Transitional Arrangement Directorate, Mrs Sharon Ikeazor, said that the directorate was making efforts to have health insurance for its pensioners.
PTAD is the government agency that manages the pensions of the federal retirees under the DBS.
She said this was part of the current and future initiatives of the directorate.
“Our initiatives include continued engagement with the National Health Insurance Scheme for enrolment of pensioners,” she added.
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