One of the key elements that underscores the seriousness with which the President Muhammadu Buhari Administration takes the health sector was the appointment of professors of medicine of global repute – the Minister of Health Professor Isaac Adewole and the Executive Secretary of the National Health Insurance Scheme (NHIS), Professor Yusuf Usman.
Yusuf was appointed with a clear mandate to cleanse the Augean stable and turnaround the fortunes of the NHIS. Nigeria had in 12 years recorded very dismal health insurance coverage of only about 5 per cent, whereas available statistics show that smaller African countries like Ghana, Kenya and Rwanda have achieved a coverage of between 50 to 60 per cent. This is in spite of the fact that Nigeria was spending N32 billion annually on health insurance, whereas those countries achieved what they did with only a fraction of that amount. The key difference was that those countries were transparent and honest, while we were unprecedentedly and unashamedly corrupt.
If the almost one trillion naira that was spent on health insurance was truly applied to the sector in the last 13 years of the establishment of the NHIS, Nigeria ought to have recorded the highest coverage in Africa, with enrollees receiving quality health insurance.
Prior to the appointment of the new chief executive, NHIS could pass for one of the most corrupt institutions in the country. In one day, for example, fraudulent transactions totaling N13.7 billion were carried out by the former management. Cases of contract splitting were the order of the day, and the procurement process was one of the worst, anywhere. The management in those years of the locust were never distracted. They enjoyed the best cooperation of all stakeholders that were benefitting at the expense of Nigeria. That, expectedly, resulted in a situation where enrolees received very shabby and resentful treatment from hospitals. Though the NHIS paid the Health Management Organisations (HMOs) a whopping N8 billion upfront quarterly, most of them ended up pocketing the money, without caring to pay the hospitals that render services to the enrolees. And the hospitals were gradually being chased out of business.
Immediately he assumed office, Prof Yusuf wasted no time in initiating reforms aimed at restoring confidence in the scheme and ensuring that contributors get real value for their money. As is done in other countries with enviable record of health insurance coverage, the new NHIS management targets making the enrolee the determinant of his destiny by giving them the power of choice. By this, the Executive Secretary aims to reverse a situation where bureaucrats choose health management organisations for contributors, leaving them at the mercy of these mostly-unscrupulous elements.In many countries with record of coverage, the red tape HMOs don’t even exist. In a few where they do, subscribers choose the ones they want, the same way a customer chooses which bank to deposit his resources with, or which petrol station to buy fuel from. Other reforms include reducing the upfront payment from three to one month, and efforts at establishing desk officers in hospitals to ensure the best deal for the enrolee.
Corruption is now fighting back as those entrenched in the system who have become used to getting free money without offering commensurate services have made efforts to compromise the management team but having failed, have unfortunately found in the in-house workers Union, a willing tool in desperate efforts to distract the Executive Secretary and bring him down. Part of their plan is to use the National Assembly to change the law setting up the NHIS and render it a toothless bulldog. They want to make it only a regulator that will no longer have the power to protect the funds of the subscribers and ensure they are applied in accordance with the law. If this happens, they will continue the damage and gradually render the sector comatose. Some of these enemies of Nigeria have succeeded in sowing a seed of discord between the Minister of Health and the NHIS Executive Secretary on one hand, and pitching the National Assembly against the Executive Secretary, on the other. Their ultimate plan is to ensure he is removed from office. There is also the issue of secondment of some federal civil servants to fill-in some important portfolios in the NHIS, a normal process well located and allowed in the Civil Service, which is also being used against the executive secretary.
While we admit that Prof Yusuf is not perfect, just like every other human, the National Assembly and the Ministry of Health must not allow themselves to be drawn into a battle which ultimate goal is to stop reforms in health insurance and perpetuate corruption.
The minister of health, in particular, as the supervising minister, must immediately look into the matter and bring an end to the campaign of calumny against the NHIS management which is capable of derailing ongoing reforms in the scheme, which are already yielding results. A case in point is the reported recovery of 92 per cent of funds, amounting to N350 billion, allegedly mismanaged by some unscrupulous HMOs. The NHIS must not be allowed to return to the years of the locust. This can only be achieved when in the minds of all the key actors, Nigeria comes first, and if all differences – perceived or real – are set aside. Nigeria must not allow the corrupt rubbish the best in our midst.
