The poor state of the nation’s health sector has been a major concern for Nigerians. This is the reason for the country’s high index among countries with poor health delivery system. One effect of this is the huge revenue, in foreign exchange, lost to medical tourism to European countries, including America and South Africa. But there seems to be hope on the horizon going by the promise of the Executive Secretary/CEO of the National Health Insurance Scheme (NHIS), Dr. ‘Femi Thomas,to get international standard for medical services back home and at pocket friendly cost. In this interview with select Health Correspondents, Thomas shares his dreams and plans for Nigerians in getting quality health services, amongst other sundry issues bogging the scheme. OYEYEMI GBENGA-MUSTAPHA and VINCENT IKUOMOLA were at the media parley. Excerpts:
the National Health Insurance Scheme (NHIS) has not been impactful because many Nigerians are not captured in the scheme. Besides, health workers and professionals are always at logger-heads over sundry issues in the scheme. How have you been able to handle this situation?
Let me start by thanking members of the Nigerian press, for the sustained interest in the affairs of the National Health Insurance Scheme (NHIS), which has been expressed in the way you have sought to know how we have fared, particularly in the last one year. It is a demonstration of commitment to the progress of the nation and the welfare of our people. Your interest and commitment have not only inspired us, but also challenged us with regards to the public expectations from the scheme. The press has kept me on my toes.
I sat and looked at the contentious areas of the schemeand travelled abroad to study how things are done in those climes. I consulted a company on how to reposition this scheme for the benefit of Nigerians, and was given two options. These are the Brown and Green options. The green means starting afresh and discarding the old ways of running the scheme. The Brown option involves carrying on with the scheme as it were, and fine tune the rough edges. We went for the latter option and added the merits of the Green options. We reached out to the stakeholders as well, and we were able to get an understanding on how things should be done differently.
In the last one year, how have you been able to actualise the aims and objectives of the scheme?
My arrival as the helmsman for the NHIS coincided with two critical challenges before the scheme. One was the target set for the scheme by Mr. President, which has to do with the extension of coverage to no less than 30 per cent of Nigerians by 2015. The other was the emergence of Universal Health Coverage (UHC) as a new global objective set for all nations by the World Health Organisation (WHO), towards enhancing the economic prosperity and social well-being of humanity. I was excited on arrival by these objectives, as I found that they fortunately coincided with my personal agenda as I came in as Executive Secretary.
These were a rapid upscale of coverage, tangible and visible improvement in the quality of care available under the scheme, and the restoration of the enrolee to a place of eminence and pride in the implementation of the scheme. In the last one year, we have completed the moulding of the building blocks, laid crucial structures and have begun the implementation of certain strategies to make health insurance easy and accessible to all Nigerians.
Our efforts began with a Management retreat in December last year, during which we undertook a comprehensive assessment of the strength, weakness and opportunities of the initiative. At the end of that exercise, it became obvious that we have the capacity, not only to meet the Presidential target of 30 per cent coverage, but indeed, to surpass it. Arising from that, NHIS has set for itself an institutional target of 40 per cent coverage by 2015. Let me assure all Nigerians that it is still our clear view today as it was last December, that this is achievable.
What are the constraints to the actualisation of these targets and what have you done to address them?
Time is the number one constraint. The time to achieve more goals is limited. Also, as we set out to pursue these targets, we recognised that we require a corporate realignment and a well-oiled system to proceed at an acceptable pace, delivering an acceptable quality of service. Therefore, we started with the restructuring of the organisation, by unbundling the old Technical Operations Department into full-fledged formal and informal Sector Departments, as well as the creation of a new Marketing Department to enable us embark on an aggressive drive for mass acceptance and enrolment nationwide.
We have also, in the course of the past year, undertaken a painstaking study of standards, processes and strategies adopted by governments and technical organisations in the past, both locally and internationally, to acquire information and deepen knowledge that will help the scheme borrow a leaf from best practices and avoid pitfalls in the experiences of others.
Another approach we adopted was the wholesome review of the programmes of the scheme, and how they have fared. This exercise resulted in the overhaul and revitalisation of a few old programmes, but more importantly, the conceptualisation and development of certain new initiatives with the potential to help frog-leap health insurance coverage in Nigeria.
Are there pragmatic actions being taken to address some of the lapses in the system so as to ensure more enrolees?
Change is a tough thing. But with a resolute mind and team work, we have been able to embark on certain innovations that ginger the interest of more people in the scheme. One of the most strategic initiatives of this administration, which we are confident, will rapidly increase health insurance penetration in our country, is the National Mobile Health Insurance Programme (NMHIP). It is a novel concept, being the first of its kind anywhere in the world, meaning that great things can also come out of this country.
It provides for subscribers of the Mobile Network Operators the platform to register, select Health Maintenance Organisation (HMO) and Provider, and choose payment options and plans, all on their mobile phone, and at their convenience. To implement this, the scheme engaged a mobile technology and business aggregator, Salt and Einstein Limited, to interface with stakeholders and manage the process. The pilot run for this was launched in Lagos last July 21 on the platform of MTN, as a start-off point. Appreciable progress is being made in testing the process and structures, to determine the weaknesses and advantages. The other network operators, including Glo, Etisalat and Airtel, are all at high levels of readiness for roll out as soon as the national launch of the programme is performed by Mr. President anytime from now. When fully launched, it is expected that we shall be able to give coverage to no less than 20 million lives on that platform.
The scheme is alleged not to be enrolling the poorest of the poor. How do you react to this?
We have introduced the Mobile Health Insurance programme. The outstanding component of the Mobile Health Insurance Programme is the Adoption Tree. On this platform, rich and well-endowed individuals and corporate bodies with philanthropic hearts will be encouraged to contribute to a pool of funds from which the poor and the vulnerable will enjoy health insurance coverage.
There are two varieties of the Adoption platform, including the Specific, whereby the donor specifies who he wants coverage provided for, and Non-specific, which remains open and could provide care for any set of deserving beneficiaries.
Another new initiative of ours is the Public Primary Pupils Social Health Insurance Programme (PPPSHIP). This is designed to provide cover for about 24 million pupils of public primary schools nationwide, and pre-implementation activities are on-going at various stages. To accomplish this, NHIS will bear total responsibility for the programme in the remaining part of the year, while by 2015, state governments will absorb 60 per cent of the cost of implementation, with NHIS bringing up the balance of 40 per cent.
It is heart-warming to note that as many as 20 states have made provision for this activity in their 2015 budget. The scheme is also laying strong emphasis on the Tertiary Institutions Social Health Insurance Programme (TISHIP), which we have since restructured and its blueprint revised. A recent stakeholders’ meeting that considered the revised blueprint of the programme underlined its significance, as administrators and student bodies such as the National Association of Nigerian Students (NANS), lauded the programme, and called for its strengthening. It will interest you to note that the National Universities Commission (NUC) has directed that all Nigerian Universities, public and private, participate in the programme as a matter of policy.
Currently, a national sensitisation process initiated by the office of the Senior Special Assistant to the President on Students and Youth Matters, in collaboration with NANS, is in progress, beginning with a flag-off event in Ibadan. It is expected that we will be able to give coverage to virtually all the three million students of tertiary institutions in the country, about 900, 000 of whom are currently covered under the programme. Negotiations are equally in top gear with the Management of the National Youth Service Corps (NYSC), towards rolling out a social health insurance programme for young graduates undertaking national service. I have had the privilege to meet with the Director-General of NYSC, Brigadier-General Johnson Olawunmi to fast track the process.
But Health Maintenance Organisations (HMOs), are often the bottlenecks between the enrolees and the facilities. How is this being addressed?
It is true and we have swung into action to tackle this. Within the year, the scheme completed the first ever re-accreditation of HMOs. This process, anchored by Pricewaterhouse Coopers (PwC) Limited from 2012, was successfully completed in September . Of the 61 old HMOs, 38 were re-accredited, while 15 new HMOs were exempted, as they were newly registered, and not due for re-accreditation. The conclusion of the exercise has brought the number of HMOs operating under the scheme to 53. We can boldly assure Nigerians that the exercise has introduced a new lease of life into the health insurance industry in Nigeria, as it engendered the emergence of strong, competitive and reliable players in the industry.
Our flag-ship programme in the informal sector, the Community-Based Social Health Insurance, has been thriving. We are now pursuing it with greater vigour, and the results are inspiring. Right now, we are inundated with requests from various communities around the country for the flag-off of their CBSHIP programmes. Within the period under review, we have inaugurated the Community Based Social Health Insurance Programme (CBSHIP) in Emoriko and Egbe both in Kogi State, Nkana West Ward II of Akwa Ibom State and Lamodi-Offa in Kwara State.
It is observed that Federal Civil Servants are the major enrolees in the scheme. How do you plan to get participants at the state level?
Your observations are fair. You will observe that there is an evident lull in the folding in of state governments’ work forces into the scheme. Reasons for this range from political will to other factors. However, we are intensifying efforts to release the will of political leadership at the state level for this purpose, as I have paid advocacy visits to no less that 12 governors across the country since I came on board, marketing health insurance and spotlighting the advantages for them and the people they lead. Following our high-level advocacy efforts, several of the state governors have accepted our request for plots of land, as we plan to concretise our presence in the states, by building permanent office structures in the state capitals. Many of the governors have already issued Certificate of Occupancy (C of O) to us. So also are we in high level consultation with the leadership of the Nigerian Employers Consultative Assembly (NECA), to facilitate the penetration of the Organised Private Sector, which holds a huge pool of Nigerians.
From experience, enrolees are denied reception at facilities because they can’t provide their Identity cards (ID) cards and it is frustrating when such people realise that their policy is almost near expiration (maturity) before they can access care. Why is your scheme not addressing this?
A critical part of our work in the last one year has involved the groundwork for a comprehensive digitalisation of health insurance activity in our country. Our focus has been the attainment of a paperless process and administration of health insurance. This will bring to a final end, the perennial crisis associated with the production and distribution of ID cards for enrolees, which has hindered access to care for many. The digitalisation will be deployed to cover the entire process, ranging from registration to encounter management at points of service, including data administration. It is expected that the digitalisation will eliminate delays in processing eligibility for access and other forms of malpractices observable in the past.
Human Resource is a key factor in any organisation. How were you able to manage the rank and file of this scheme?
Well, the Governing Council, management and staff of NHIS, did not only receive me warmly and accepted to share my vision, but had proceeded to work with me at a similar fast pace and with equal vigour. It is to our collective credit that within the last one year, enrolment figure went up by about two million lives, about 40 per cent of total figure for the preceding eight years. As at today, total enrolment figure stands at about 7.2 million lives. I am aware that progress in any organisation revolves around staff welfare and motivation. I, therefore, wish to pledge my unfailing commitment to the constant improvement in the conditions under which the staff operate. This will be in addition to our modest successes in that area in the last one year, especially concerning staff emolument, healthcare, retirement benefits and capacity building, among others.
There are certain diseases and other life threatening conditions that have been excluded from the scheme from the onset. How are you addressing that?
NHIS registered a prominent presence in our nation’s centennial celebrations this year. This is by way of offering our enrolees access to services that were ordinarily on our exclusion list, such as capital intensive super tertiary disease conditions like Oncology, Orthopaedic surgery, Trauma, Open heart surgery and Renal cases.
So far, six open heart surgeries, one renal transplant, two orthopaedic surgeries and four oncology treatments have been successfully carried out under this programme. Our objectives for this unique intervention are three. First, it is to reward our enrolees, who kept faith with the scheme, especially in the years of our infancy and difficulties, discourage outward medical tourism and showcase the capacity of Nigerian medical centres and personnel to deal effectively with these complex conditions.
The scheme’s feet are now firmly on the ground, and we are ready for the race, even as Nigeria relies on us as her major hub for the attainment of Universal Health Coverage by 2020, while Mr. President looks forward to the accomplishment of our target of 40 per cent by 2015. We wish to solicit the partnership of the press in this process of working to remove financial barriers to effective healthcare for our people, as we seek to unlock their potential for economic productivity and social welfare.
