Why Buhari must sanitise, reorganize NHIS-Stakeholders

Stakeholders have suggested ways of making the beleaguered National Health Insurance Scheme (NHIS) to achieve its mandate.

The scheme which has been in comatose in recent years now does not have a substantive Executive Secretary.

The last Executive Secretary, Prof. Yusuf Usman has been placed on indefinite suspension on allegation of infractions.

Besides, the Dr. Eyantu Ifenne led Governing Council of the scheme has been technically set aside by the government over its crisis with the Executive Secretary. It was the council that accused Usman of committing infractions and thus suspended him from office indefinitely.

The committee set up to investigate the allegation of infractions against Usman by the Secretary to the Government of the Federation has since turned in its report with far fetching recommendations which the government was yet to act upon.

All these put together, stakeholders are of the concern that the country is fast losing ground in the efforts at ensuring Universal Health Coverage (UHC), as it is globally accepted that provision of health insurance is the only way to go if the country is to attain UHC.

Stakeholders agreed that to get the NHIS working, it must be sanitize and reorganize to achieve its mandate.

They are of the opinion that the huge fund in the possession of the scheme, has become a source of distraction and needed to be pulled out.

Consequently, they called for the establishment of National Health Fund, an independent body to manage the fund.

The fund, according to them should manage all monies and contributions both local and foreign that is meant for health sector development.

That aside, the stakeholders also pointed out the need for NHIS to stay strictly by its mandate, by limiting its operations at the zonal offices rather than establishing offices in all states of the Federation.

This, the stakeholders explained was responsible for the bloating overhead cost the scheme is grappling with.

But, Mr. Theophilus Egwudah, Vice Chairman, Association of Senior Civil Servants of Nigeria (NHIS Chapter) described the call for establishment of the fund as unfortunate.

Egwudah noted that those opposing the structure and operations of NHIS at it stands today are people who felt threatened by the scheme’s responsibilities.

Besides, he said the only problem hindering the scheme is the Treasury Single Account (TSA). He, therefore, pointed out that it must be noted that the fund in question does not belong to government, hence it should stop appointing politicians to head the scheme.

According to him, “The proponents of independent Health Fund are those who feel threatened by the regulatory responsibilities of the established NHIS.

It’s unfortunate sentiment and propaganda has taken over the Nation.

“Note: sentiments, lies and propaganda!!! TSA are NHIS problems. NHIS fund is not Govt Money.

“Govt should stop appointing politicians as the administrative head of NHIS. Politicians are only interested in siphoning money,” he said.

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However, stakeholders insisted that the way of the perennial leadership crisis in the scheme is to totally sanitize the odor actions of the scheme, which according to them include removing the management of workers contributions (premium) from NHIS.

Some of the stakeholders who spoke to The Nation Newspaper on the condition of anonymity out of fear of victimization maintained that the fund has continue to constitute a major distraction.

They pointed out that since the establishment of the scheme, only one Executive Secretary had actually completed his term. Others they said had their tenure cut short by one allegation or the other.

Hence, they reason that “the main solution to the sanitization of the operation of NHIS is to completely take away the management of the Fund from NHIS. If that fund is still in the custody of NHIS, there is nothing that can be done. The scheme is rich and in some cases richer than some states in the country.

“This is true because there is no state in this country with N100 billion in its account. So the fund is the only distraction and what we have suggested in the past is what government should do. Government should set up another agency which is called National Health Fund.

“This health fund should be created majorly to manage this fund, the presuming for the federal civil servant and the one percent consolidated fund for health. That body should also manage funds from local and international donors. Like funds from Dangote foundation, Bill and Milinda Gate because even the international funds, why they are not coming regularly is because of the feat of disbursement and proper utilization. We have cases where fund were ready for the disbursement to the country and by the time the conditions that were given for the disbursement were read out, the country found it difficult to assess those fund.

“So national health fund is the way to go. So the national health fund should manage such fund, whatever is due to NHIS for its administrative fee is given to it. As we speak today, if not for the introduction of Treasury Single Account (TSA) bank managing directors were major contractors to NHIS because they were always going there for fund placement. So the Executive Secretary of NHIS is more or less a contractor. This scenario was saved by TSA. Even at that, now the fund in TSA that was meant to be separated was placed in the single port. The NHIS administrative fees was in the main account that was meant to be used for the provision of service.”

On the bloated overhead of the scheme, the stakeholders noted that “What NHIS is spending today as administrative fee is over 40 percent of what is given by the Federal Government while in actual sense they are not meant to send more than 10 percent as administrative fee. They are entitled to just 10 percent of whatever is contributed by the government as premium for federal civil servants.

“Because the staff strength is unprecedented. In NHIS, there are 138 drivers. The overhead is extremely bloated and they cannot manage it.

Those are the challenges noted by the council. Comparing it with central bank or other regulatory agency in the country, I doubt if any has as much as 138 drivers on their payroll.”

The stakeholders also blamed the spread of the scheme to states instead of limiting itself to zonal offices in accordance to the Act establishing it.

“Again, NHIS are meant to be in the six geo-political zones of the country and not in all the 36 states of the federation. The zonal coordinator who is like a general manager who are meant to coordinate the activities of those states insuring that they set up a parallel agency to run health insurance for the states. That is majorly the responsibility of NHIS. The zonal office coordinates the operations of NHIS in states under the zone.

“The way health insurance was designed, NHIS was meant to be the regulator, then the Health maintenance Organization as health insurance operators in the country utilizing both private and public hospitals.

“So it is the responsibility of NHIS to accredit the two critical stakeholders. Anyone that is not accredited by NHIS is not meant to operate. NHIS is meant supposed to regulate the operations of the HMOs to make sure they comply with the operational guidelines and anyone that is found culpable is meant to be sanctioned by the regulator.

That is why you see, even CBN sanction banks. So operation of NHIS is supposed to be extended to states through the zonal offices,” they explained.

Part VI of the NHIS sub-section (g) talked about “zonal offices. It stated, “the council shall divide the country into such number of zones as it may, from time to time determine, and establish in each zone, a zonal Health Insurance Office (in this decree referred to as “Zonal Office”.

Section 22 also stated that a zonal office shall be responsible in the zone for (a) determining the areas in which there are sufficient services for the scheme to operate; (f) developing health care services in area where those services are not adequate; (i) the general administration of the scheme; and (k) doing such things which, by this Decree or any other enactment, are required or permitted to be done by the Scheme as may, from time to time, be directed by the Council.