NATIONAL HEALTH INSURANCE SCHEME- THE YET TO BE UNRAVELLED STORY- By Sanni Inuwa Baba

The National Health Insurance Scheme (NHIS) is implementing the Constitutional Obligation under Directive Principles of state policy in chapter 2 of the constitution. This Directive Principle of the state policy mandate is to the effect that all Nigerians are entitled to quality health care services delivery. In order to implement this constitutional policy, the NHIS was established in 2005. 

One of the best concepts meant to directly make an impact on most or all of its citizens was the establishment of the NHIS. What makes this a unique strategy is that each Nigerian, no matter his/her age and status in the country would be a direct beneficiary. After 13 years of its implementation, unfortunately only 3 million Nigerians are enrolled under the scheme. The NHIS was for many reasons seen by concerned Nigerians as another avenue for some people to enrich themselves rather than a scheme to ensure delivery of affordable health care services to ordinary Nigerians.

In recent times, Hospital Management could only grumble since there wasn’t an organized avenue to voice out their concerns, which was that HMOs were refusing to pay for capitation or fee for service provided to registered beneficiaries of NHIS. Hence, NHIS was nothing but a cash cow for few people to milk millions of Naira without ensuring delivery of the intended services. 

It was sad to note that almost all the licenses of the HMOs have expired as far back 2005. With these atrocities, it wouldn’t surprise anyone to know that some highly placed officials were involved in the atrocities being perpetrated by the HMOs.

By August 2016, Nigerians welcomed the decision of President Buhari to appoint Prof. Usman Yusuf as the Executive Secretary of the NHIS, a United States based Bone Marrow Transplant Physician. It was reported that after he took over stewardship of affairs of NHIS, he took more than a month of meetings and conversations with staff of NHIS at all levels in order to understand and have an overview of the operations of NHIS. 

The height of open corruption he found within the institution was both scary and alarming and called for immediate and aggressive approach. Some staff gossiped that he wasn’t going to win the battle, he might just “join” to have his share of the National cake, or at best he might only try and get himself tired. 

One of the major strategic actions he took in trying to eradicate corruption in the institution was that he issued a statement that all HMOs must have their licenses renewed. Under the stewardship of Prof. Yusuf ostensible, objective and transparent criteria of evaluating eligibility to have license renewed for HMOs, was that any HMO must not have backlog of arrears of unpaid remittances to Hospitals. Applications of license renewal must be accompanied by a signed statement by each of the CMDs of the hospitals they were representing notifying the NHIS that all debts were paid. 

The actions of the ES has started yielding results. Hospitals are indicating backlog of payment by HMOs have been cleared. Beneficiaries of health care services in the hospitals under the NHIS are reputedly commenting improved quality and quantity of services. However, the actual status of the Trust Fund and Beneficiary Contribution is undergoing audit and there appears reluctance on the part of some HMOs to renew their license or to allow audit and accountability that provides for transparency in NHIS operations