NHIS’ turmoil reveals critical operational lapses

A raging storm at Nigeria’s National Health Insurance Scheme (NHIS) is revealing critical administrative lapses, which have made it difficult for some Health Management Organisations (HMOs) to run effectively, hindering universal health coverage.
At the heart of the crisis is the high level of incompetence at the NHIS, as well as recurring cases of corruption. The NHIS was meant to be a regulator but unable to keep its fingers away from the over N100 billion of funds under its management, as the regulator now wants to be an operator.
According to a letter dated June 8, 2017, addressed to the minister of health by Abuja-based Tokunbo Kayode Law Practice, citing suit number: FCT/HC/CV/423/15: Premium Health Limited versus the National Health Insurance Scheme, the plaintiff instituted an action against the NHIS at the High Court of the Federal Capital Territory, Abuja, over its suspension by the Scheme as an HMO.
This case was eventually resolved out of court, but the Scheme has failed to keep its part of the bargain by not restoring all enrollees previously assigned to the plaintiff before its temporary suspension.
The Scheme, established under the National Health Insurance Scheme Act, Cap N42, Laws of the Federation of Nigeria, 2004, is aimed at providing easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems.
The NHIS is expected to totally commit to securing universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians, especially for those participating in the various programmes/products of the Scheme.
A recent survey shows that compared with peer countries in Africa (Uganda, Kenya, Tanzania and Senegal), Nigeria ranks one of the lowest in all Primary Health Care Performance Initiative (PHCPI) indicators but has high levels of health facility density and health worker density, which are often thought to be the major cause of underperformance of PHC systems.
One leg to this primary healthcare challenge was attended to when President Muhammadu Buhari, January 10, desirous to reverse the poor health indices and ensure universal health coverage, initiated the revitalisation of 10,000 primary healthcare centres (PHCs) nationwide by inaugurating Kuchigoro Clinic, Abuja. This model was supposed to be financed by the NHIS since attaining universal health coverage was one of its core mandates since inauguration.
Istifanus Bature, contributor to The Cable, an online news platform, in an article written July 22, said, “The NHIS Executive Secretary refused to even look at the viability of the project or the impact it would have on the poor, especially women and children in rural communities. Till date, he has refused to attend to any document relating to the reactivated Primary Healthcare Centres across the country.”
The other leg relates to the strained and in some cases, alleged corrupt practices between the NHIS and HMOs. An example of strained relationship between the Scheme and HMOs is the case of Premium Health Limited, cited above.
A source familiar with the matter said, the NHIS pays (through the HMOs) a capitation fee of N750 for primary care services. This handles all out-patient services for common ailments provided by a general practitioner. The services can be provided by most providers, as long as they have a large pool of enrollees registered at their facility. For providers with a small number of enrolees, it is not sustainable.
Secondary Care under NHIS is the worst segment of the service. Most providers do not provide this service because the fees are too low. Here, Usman Yusuf, the suspended executive secretary of the Scheme blames the HMOs.
In addition, the NHIS has been distracted from focusing on pure regulation and as part of measures to guarantee efficiency of the Health Insurance Scheme, the Health Management Organisation, (HMOs) wants the Federal Government to review the existing laws of the National Health Insurance Scheme, (NHIS)‎, to a National Health Insurance Commission.
This, the Health Organisation body said, would ensure the‎ NHIS focuses strictly on regulatory function, which would enable it address the concerns and confusion of its extant dual role of a regulator and an operator.
‎Currently, only about 4 percent of Nigerians are covered by the Health Insurance Scheme in Africa’s most populous nation, which industry watchers largely attribute to poor regulatory functions of the regulator of the health insurance scheme.
“What we are clamouring to is to review and revise the law establishing the NHIS into National Health Insurance Commission, which would translate the role of the NHIS to strictly be a regulator of the health insurance scheme. As it is now, NHIS is a regulator and operator, and that is why there is confusion, which is really impeding on growth of the scheme,‎” Lekan Ewenla, National Publicity Secretary of the Health and Managed Care Association of Nigeria (HMCAN), the umbrella body of HMOS told select journalists recently in Abuja.

 

STEPHEN ONYEKWELU & ANTHONIA OBOKOH