Salvaging The NHIS

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The National Health Insurance Scheme (NHIS) that had long been trailed by claims of inefficiency, has again been in the news in recent weeks for all the wrong reasons.

The scheme, which was established with the primary mandate of providing healthcare delivery solutions across Nigeria, is currently mired in a controversy that has not only led to the suspension of its executive secretary, Usman Yusuf, by the Health Minister, Professor Isaac Adewole, but has also made the duo, together with the House of Representatives, to be at daggers drawn.

It would be recalled that following allegations of financial impropriety levelled against the erstwhile executive secretary, the health minister had ordered his suspension on 6 July, saying that the decision was to allow unhindered investigation of the corruption claims.

Mr Yusuf, who became NHIS boss on 29 July 2016, had been accused of fraud of up to 960 million naira and spending beyond his scope of approval. The embattled secretary however denied any wrongdoing and insisted he would not comply with the suspension order. He also raised his own allegations of corruption against the health ministry.

It is worth noting that Yusuf’s suspension came weeks after the Nigerian Senate had launched its own investigation into the activities of the NHIS boss to uncover how 292 million naira was spent on healthcare training without recourse to any appropriate approving authority.

In a curious twist, however, the House of Representatives, which was also carrying out its own probe of NHIS, faulted the suspension of Mr Yusuf and asked the health minister to reverse the suspension, which it alleged was intended to intimidate and prevent the erstwhile NHIS secretary from testifying before the House Committee on Health Services and further reveal the scam perpetrated in NHIS over the years.

Right now, even though a new acting executive secretary of NHIS, Mr Attahiru Ibrahim has resumed, the gladiators are still flexing muscles over the corruption allegations.

This latest controversy is evidently the last straw that should trigger the much needed overhaul of the operations of the NHIS that many stakeholders have severally called for. More than the current corruption claims and counter-claims, the need for a dissection and eventual restructuring of the operations of the NHIS has become imperative, not only to save it from corruption, but to make it effective and efficient.

The health insurance idea had been initiated in 1962 when the first Minister of Health, Dr M. A. Majekodunmi, presented a bill at parliament for its establishment in Lagos area.  The scheme was eventually created by the NHIS act 35 of 1999 but did not take off properly until 2005 as a result of administrative bottlenecks.

Sadly, the scheme has, down the years, failed to justify its existence, with many putting the blame on operational problems and corruption scandals. Indeed, the fact that the number of Nigerians covered by the scheme after 12 years of operation is still about 1.5 per cent of the population based on NHIS data is a severe indictment on the authorities and personnel that have managed its affairs since its inception and a further confirmation that drastic measures must be taken to rescue it from total collapse.

However, it must be emphasised that any effort to address the rot in the NHIS must begin with the scheme’s defective structure, which puts so much money in the hands of Health Maintenance Organisations (HMOs). HMOs are private accredited companies mandated to handle the interface in the relationship between NHIS and service providers (hospitals) who are to serve the enrollees (patients). The HMOs are paid three months in advance on behalf of the enrollees and are expected to pay the hospitals. Investigations have however revealed that many of the HMOs pay little or nothing to the hospitals.

The attendant effect of this anomaly is that enrollees are dissatisfied because they cannot get the value they desire from the scheme. The hospitals are dissatisfied because they are expected to provide services that are not paid for.

But it is not only the current enrollees and the hospitals that are dissatisfied with the NHIS. Pharmacists, laboratory scientists and other health professionals (tagged “secondary providers”) have equally been up in arms against the scheme since its inception. These professionals want to be paid directly by the NHIS for their services and not through the doctors/hospitals who are also poorly paid.

The implication of these grim reports is that majority of Nigerians are dissatisfied with the NHIS. These gales of dissatisfaction must be addressed. Ironically, health insurance schemes, which guarantee citizens’ access to quality healthcare, have been successful in many other countries of the world, including even the low resource ones like Kenya and Rwanda.  Why the case of Nigeria, with its vast human and financial resources, should be different is the height of absurdity.

The onus is on the federal government to not only expeditiously investigate and prosecute those found guilty of malfeasance in the NHIS but to holistically restructure the scheme as its present structure is clearly incapable of providing the healthcare delivery succor that millions of Nigerians urgently need.

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