It was Anne Bishop the novelist that wrote in her book, Heir to the Shadows, that “When honour and the Law no longer stand on the same side of the line, how do we choose?” This rhetorical question flashed briefly through my mind as I perused a recent story, headlined “Real reason Buhari reinstated NHIS boss, Yusuf – Rep Okafor,” published in the Daily Post newspaper.
In the story, Hon. Chike Okafor, chairman of the House of Representatives Committee on Health Services, argued that President Buhari reinstated Prof. Usman Yusuf, the executive secretary of the National Health Insurance Scheme (NHIS), in respect of a resolution of the legislature and said that the development would restart a healthy relationship between the parliament and the executive arm of government.
Okafor’s argument was that the House had passed a resolution that the man (Yusuf) should resume from suspension because the parliament disagreed with the suspension as it truncated the House Committee’s investigation into activities of Health Maintenance Organisations (HMOs), but the resolution was not respected by the health minister.
Okafor said he was happy that the presidency said part of the reason the NHIS boss was reinstated was because the lawmakers called for his reinstatement, adding that investigations into activities of the HMOs, based on damning revelations by Prof. Yusuf, that the organisations needed to account for the billions paid to them every month will now continue.
As much as I am for cordial relationship between the legislature and the executive, this Prof. Yusuf’s saga is so untidy to put it mildly. Let me first note that despite the fact that no court has convicted Prof. Yusuf of the corruption allegations levelled against him, the uproar alone and his subsequent suspension should have prompted a more conscientious action by the government and the man himself.
In civilised climes, public officials accused of such malfeasance usually tow the honourable part of resignation to concentrate on clearing their names and give due respect to the public position they hold and the government of the day. The fact that this doesn’t happen in Nigeria does not make it less inappropriate. It must be emphasised that the handling of this issue by the government has been quite indecorous.
However, beyond the imbroglio of the NHIS boss’ suspension and reinstatement by the president is the more fundamental fact that the NHIS, aside from the scandals besetting it, has largely failed as a scheme in Nigeria.
The scheme, launched in 2005 by former President Olusegun Obasanjo and tasked with enlisting at least 70 per cent of Nigerians by 2010, has failed to get off the ground due to policy inconsistency, poor governance structure and scandals such as that of Prof. Yusuf.
Even though the immediate past government of President Goodluck Jonathan shifted the goal post and asked the NHIS leadership to cover at least 30 per cent of Nigerians by the end of 2015, this still did not come to pass as latest figures show that less than seven million, out of the over 180 million people in Nigeria are covered by the scheme. This is less than five per cent of Nigerians.
Based on Act 35 of 1999 which established the NHIS, the scheme was supposed to help improve the health of Nigerians and ensure they have access to affordable health care. The scheme was to cover government employees, the informal sector, the organised private sector, children under the age of five, prison inmates and permanently disabled persons, but unfortunately this has not happened. Majority of the present enrollees are workers of the federal government, as the scheme is not on ground in most states in the country. It has also made little or no impact within organised private sector and the informal sector. Worse still, most of the enrollees are disenchanted with the quality of care they are getting under the scheme. Stakeholders providing care under the scheme like pharmacists are also dissatisfied with the payment system which gives the doctors the power to determine what other professions get for their services.
The consequence of not having a functioning and reliable health insurance scheme in the country is that most Nigerians still pay out-of-pocket for their health issues and there is no gainsaying that this has continued to in no small way impacted on why Nigeria still rank very high in mortality rates from deaths from conditions that are preventable, manageable and treatable.
It is high time Nigeria holistically rejigged the NHIS and ensured it has a governance structure that will not only prevent scandals such as that of Prof. Yusuf but make it deliver on its mandate of ensuring all Nigerians have access to good healthcare services. The NHIS must also be restructured to address the present incongruous system that puts so much money in the hands of the HMOs to the detriment of service providers and enrollees.
It is also imperative to do more in terms of creating awareness of benefits of the scheme to Nigerians to ensure they embrace it because the more the people covered by the scheme, the more the funds the NHIS will be able to pool for its services.
The federal government, I must reiterate, must also without delay, commence the implementation of the National Health Act 2014 which stipulates that at least one per cent of the Consolidated National Fund should be set aside annually for NHIS and Primary Health Care Services. This fund which is said to be about 60 billion naira can go a long in helping to save the NHIS. This is the time to end the scandals and transform the NHIS.