By encouraging Nigeria's younger population to invest in healthcare earlier rather than later, HMOs will be able to provide the health funds people need later in life.

Obinnia Abajue

CEO, Hygeia HMO

We help Nigerians get affordable access to quality healthcare. In the absence of a far-reaching and extensive national health insurance program, it is up to us as a community to provide something for everyone. Therefore, we offer plans that provide healthcare access to every Nigerian who can afford to contribute to the common health purse. There are three groups that need coverage: children who need to be taken care of, working adults, and the elderly, which is a small but steadily increasing part of our population. Structurally, only two are covered in Nigeria: the working population and minors covered under a family plan. This leaves out minors who are dependent on someone unemployed and the elderly. The moment one retires, one loses coverage, even though elders need coverage the most. It is up to us as a community to find a solution while we work on government policies to improve the situation. We also must ensure there is a well-working health system so we can get younger people covered. Coverage earlier in life ensures that as one gets older, they are healthier and reduces their need to draw out of the common health purse. The most important thing that the government can do is improve regulations to encourage people to invest in health insurance and make an investment in their own health, which, in turn, encourages people to live healthier.

Kieran Godden

CEO, Total Health Trust (THT)

There is a reasonable network of hospitals in most cities across Nigeria. Farther from more affluent cities, the network becomes slightly more restrictive. Outside of cities is where the problems are. In rural areas, there are few providers, and it is hard to access care. Even in some of the cities, we transfer people to bigger cities to get them the care that they need. We have about 2,000 hospitals in our hospital network across Nigeria. Our contribution to improving access to care is through funding care. By providing access to finance, we allow doctors to run businesses, thanks to our large client base. Furthermore, if someone goes to the hospital with our plan, the hospital knows it will get paid. The more people buy health insurance, the greater access to healthcare will become. That is the challenge the health insurance industry is facing: making sure people understand the value of insurance because access to care improves the quality of care. Our ethos is built around sustainability, and we are committed to making Nigeria healthier. 2020 will be the year of cultural revolution for us; we want to change the mindset of our people to deliver the promise of making Nigeria healthier sustainably. We are focused on preventative care for 2020. A common ailment in Nigeria is hypertension, with diabetes slowly catching up. These are both preventable if you know how to identify them early enough and make lifestyle changes.

Adesimbo Ukiri

Managing Director & CEO, , Avon Healthcare ltd.

One constraint on the sustainability of Nigeria's health insurance system is the level of awareness, which is quite low, though we have made progress in recent years. But there is still a large number of people who can afford healthcare and health insurance, yet still lack it. This is a matter of being informed of the options, though it helps that Nigeria has one of the highest internet penetration rates in Africa. The challenge is to convince younger people to take out a percentage of their funds and put it toward getting health coverage. Another challenge is also abuse from hospitals and healthcare providers. It is a vicious cycle because providers believe they are not getting paid enough, and there is the temptation to over-service and extract the maximum payment possible from each person who walks in the door. That puts a strain on the health insurance company that might or might not pay them on time. Another key challenge is the lack of regulation, although there are some stirrings on that front recently. Of the nearly 7 million Nigerians covered, over 6 million are covered under the federal government civil servant scheme. The current entity is both operator and regulator, which is a contradiction of sorts. We need to ensure transparency among sector players by ensuring audited annual accounts are publicly available for scrutiny.