NHIS: What’s going on?

Expectations were high when the National Health Insurance Scheme (NHIS) came into being in 2004. Among other objectives, the NHIS was set up to: ensure that every Nigerian has access to good health care services; protect families from the financial hardship of huge medical bills; limit the rise in the cost of health care services; ensure equitable distribution of health care costs among different income groups; maintain high standard of health care delivery services within the Scheme.

The NHIS is also expected to ensure efficiency in health care services; improve and harness private sector participation in the provision of health care services; ensure adequate distribution of health facilities within the Federation; ensure equitable patronage of all levels of health care and ensure the availability of funds to the health sector for improved services.

These are very laudable objectives and if they had been achieved or were being achieved, nobody will be talking about the pitiable state of our healthcare today because the sector would have grown in leaps and bounds by now. Billions of naira lost to medical tourism every year would have been saved. Even more pleasant, Nigeria would have become a medical tourism destination by now. The NHIS has been far from achieving these objectives over the years.

One would have thought that achieving these objectives would pre-occupy the minds of the current executive secretary and the board of NHIS, but somebody or some persons have other ideas meant to ensure that the laudable objectives for which the NHIS was set up are not realised.

In June 2017, the minister of health, Isaac Adewole, suspended the NHIS executive secretary, Usman Yusuf, “after an administrative panel found him guilty of allegations of gross misconduct, nepotism, financial recklessness and theft of public funds to the tune of N919million.” About four months later, the minister made the suspension indefinite pending action from President Muhammadu Buhari. That action came in February this year when the president reinstated Yusuf. The reinstatement was confirmed by a letter to the Minister, signed by the chief of staff to the President, Abba Kyari. Curiously, Kyari was silent on the allegations against Yusuf, but simply urged him to “work harmoniously with the minister”. Many observers read ethnic bias into the reinstatement. Some even taunted the minister for not resigning over the recall of a head of government agency in his ministry without his knowledge.

But the president’s action was like postponing the evil day. Last week, the NHIS Council again suspended Yusuf. The suspension, according to the NHIS council chairman, Eyantu Ifene, was to pave way for the investigations of allegations of “infractions” leveled against Yusuf. But in another twist, Yusuf came to work the next day, escorted by armed policemen, broke the locks of the gate and forcefully went to his office. Again the presidency took side with him.

Presidential spokesman, Shehu Garba, said, the board has no such powers to suspend the executive secretary. I quickly glanced through the relevant law setting up NHIS. The law specifically states that the executive secretary is an appointee of the president and only the president can remove him. It also states that if he is resigning, the resignation letter should be addressed to the president through the minister of health and the resignation will only become effective after the president has accepted it. Nowhere in the relevant law is the NHIS Council or the minister of health given specific powers to suspend the NHIS boss. The portion the board is relied on is prone to various interpretations. This may be why the presidency took sides with the executive secretary.

But unlike the last time when we scarcely heard his own side of the story, Yusuf is talking this time around.  In an interview in the Hausa Service of the BBC, he claimed that he had been going through “unnecessary accusations of fraud” since he became NHIS executive secretary. He fingered some “powerful people” as being responsible for his plight. Specifically, he pointed fingers at NHIS agents. “I told them to pay back their debts which has (sic) already run into billions of Naira.”

The House of Representatives plans to set up a committee to probe the NHIS leadership and its operations. Even though belated, the federal government has also promised to find a lasting solution. Government had better do something fast. The monies in question here are not federal government allocations, but deductions from workers’ salaries. The NHIS subscribers are not getting the benefits for which they make contributions and it is not proper that government has allowed NHIS to operate like this for this long.

If Yusuf is found guilty, he should face the music. Even then, the allegations he made should be thoroughly investigated. A lot of information has also been flying on line. For instance, they say Yusuf is being persecuted because he changed quarterly payment of capitation to Health Maintenance Organisations to monthly payments, making it difficult for HMOs to put billions of enrollees’ money in fixed deposit accounts (yielding interests). These HMOs are supposed to pay these monies to the various health care facilities registered with them and quite a number of these facilities have complained that HMOs owe them over long periods.  Yusuf also requested HMOs to provide letters of non-indebtedness monthly from healthcare facilities as a precondition for payment of capitation by the NHIS. All these allegations are grievous and others should be thoroughly investigated.

The government should also look into the possibility of amending the NHIS laws. A board that cannot discipline the chief executive of an organisation can never perform its oversight functions effectively. Also, of what use is the NHIS under the ministry of health, if the minister cannot discipline the NHIS executive secretary? If the executive secretary is only answerable to the president, then NHIS should be under the presidency.

Francis Ewherido, ACIIN, ACIB, is the Managing Director of Titan Insurance Brokers and can be reached on +2348132433631 or titan.insuranceng@gmail.com