The National Health Insurance Scheme (NHIS) has always had a penchant for being in the news for the wrong reasons. So, it was not surprising when the chairperson of the NHIS Board, Dr Enyantu Ifenne, announced recently that the Scheme has axed 23 Health Management Organisations (HMOs) for failing to meet up with the minimum operational criteria expected of them.
According to Dr Enyantu Ifenne, the decision to delist the 23 HMOs was taken after a validity test was carried out on all the 57 HMOs operating in the country. What is however very instructive was the disclosure by Dr Ifenne that out of the 57 HMOs evaluated, only one actually passed the validity test and scaled through and that the 34 others not delisted have been granted only provisional accreditation because they actually failed to meet the minimum standard required.
She explained that the National Health Insurance Scheme (NHIS) committee “scored the HMOs based on aggregation of criteria and, at the first cut, only 11 out of the 57 HMOs scored between 50 and 70 per cent while 6 HMOs scored below 50 per cent. The committee re-examined this and reduced the score further from 70 to 50 per cent, yet only the Defence HMO fulfilled and met most of the conditions. But if we apply the law, none of the 57 HMOs fully met all the NHIS requirements for accreditation.”
Amongst the criteria used to reaccredit the HMOs, according to Dr Ifenne, were ascertaining that they had the critical irreducible minimum payoff capital shares – which is N400 million for national HMOs, N200 million for zonal HMOs and N100 million for state coverage. The payoff capital is to confirm the financial ability and stability of the HMOs. Other requirements are submission of an audited financial report from 2014 to 2016, having corporate affairs commission’s document, shareholders composition, composition and Board of Directors, integrity of shareholders, current tax clearance of companies and directors etc.
That virtually all the HMOs operating in the country failed to meet the minimum standard required for re-accreditation even when they know that this is required every two years fundamentally explains why the NHIS concept has failed abysmally in the country,
The operation of the HMOs is a key component in the National Health Insurance Scheme NHIS operational chain and when they are hapless like the accreditation evaluation has shown, they become what they are now – a clog in the wheel of progress of the Scheme.
What is even more abhorrent is the fact that these HMOs take the bulk of the money in the National Health Insurance Scheme (NHIS) and their ineptitude is a source of great frustration both for the service providers and the enrollees. They (service providers and enrollees) are usually at the mercy of HMOs who are bogged down by their own incompetence or/and mischief.
It is thus unsurprising that most enrollees under the NHIS have become disenchanted with the scheme and many have even opted out to resort to the wrong fee-for-service concept when they are sick.
Nigeria needs to move beyond this cosmetic reaccreditation of the HMOs and the inappropriate bending of rules to accommodate weak organisations incapable of taking the NHIS to the next level. It is high time a holistic evaluation of this scheme was done and its governance structure reviewed. Palliative measures cannot save this National Health Insurance Scheme (NHIS).
It is important to have a more fundamental reengineering. This is imperative for progress of the nation’s health sector and health system. This scheme is working and helping the health systems of other countries. The time to make it work in Nigeria is now.