Prof. Mohammed Sambo is the Government Secretary of Nationwide Well being Insurance coverage Scheme (NHIS). On this interview with journalists, Sambo spoke on efforts taken to revive public confidence within the scheme, amongst different points. NKECHI ONYEDIKA-UGOEZE was there for The Guardian. 

On assumption of workplace in 2019, you reeled out a three-point agenda, how far have you ever been capable of actualise them? 
On July 15, 2019, once I assumed duties within the Nationwide Well being Insurance coverage Scheme (NHIS), I unveiled a three-point rebranding agenda. One of many agenda is to revive the worth system of the group and make it a reputable, result-oriented outfit. The second is to implement normal transparency and accountability in our operations, whereas the third is to speed up the drive to achieve Common Well being Protection (UHC).

The primary agenda has to do with the restoration of worth system. We made it the primary as a result of NHIS has been bedeviled by so many issues, which have made individuals to lose confidence within the organisation. It’s supposed to take care of the well being wants of over 200 million individuals, however it’s unlucky that it has no credible plans to attain the mandate. There have been lots of squabbles inside the organisation to the extent that just about each two years, a brand new chief government officer emerges. I’m the twelfth CEO within the organisation’s 20 years existence and for those who do the calculation you’ll realise that in lower than two years, one CEO leaves; so, it has grow to be a joke within the organisation {that a} CEO can not exceed two years in workplace. This was the explanation individuals celebrated me once I accomplished two years in workplace. A lot of them stated it has been lengthy they witnessed a CEO serve past two years in workplace. I feel we now have been capable of obtain stability on this space and have additionally been capable of develop a roadmap that may assist the organisation have strong well being protection. The squabbles are over and workers can now work to satisfy the organisation’s goal.

That is the extent we now have taken NHIS to. Going into specifics, as to what we now have achieved, you may take a look at the governance and management, the human useful resource, the monetary administration system, operation of the medical health insurance, the partnership and collaboration in addition to the actual technical operation. And if we’re to dwell on every of them, we are going to speak for hours with out finish.

On the management and governance, I have to level out that prior to now, all of the group actions had been largely managed on the headquarters. We’ve got about 9 zonal places of work, 38 state places of work and the FCT; by 38 state places of work, Lagos State has two totally different state places of work as designated. These state places of work had been there, however they weren’t functioning as a result of a lot of the actions had been pushed from the headquarters. Greater than 40 per cent of about1,400 NHIS workforce had been on the headquarters, whereas 60 per cent had been distributed among the many states. The state places of work had been in a state of affairs the place you go and see solely six workers, most of them had lower than 10 workers. With workers concentrated on the headquarters, this meant individuals residing within the states had much less officers to cater for them. To resolve this problem, we engaged the precept of decentralisation of governance to strengthen the state places of work and made them credible to hold out a decentralised operate. We additionally injected related, vital human sources that may drive the organisation’s actions at that degree.

In my earlier interview, I discussed that of the 1400 NHIS workers solely 46 are healthcare staff and by healthcare staff, I meant medical docs, nurses, lab scientists and pharmacists. The core mandate of medical health insurance scheme is to interface with the enrollees who’re sufferers going to the amenities to obtain healthcare providers. We accredit healthcare amenities, guarantee enrollees obtain the suitable healthcare providers. If you happen to don’t have related healthcare professionals to do the job, how would you be capable of execute such an enormous and technical operate? It’s with this that we engaged at the very least 5 healthcare staff —two medical docs, one pharmacist, one nurse and a medical lab scientist — in every state. These individuals at the moment are turning issues round for good on the varied centres.

With such enhancements, what number of Nigerians at the moment are lined by the scheme?
I’ve stated on a number of event that I don’t wish to use figures. Earlier than I got here in, states weren’t performing medical health insurance till a legislation was handed to that impact. To this point, we now have 37 states which have began the implementation of the essential healthcare insurance coverage scheme and so they have lined lots of grounds when it comes to numbers. So, if you wish to get the precise quantity, it requires aggregation. Some states have lined about 70,000 individuals, some 50,000, others 20,000, the figures are not any common, however the states are absolutely working.

Final week, we launched the NYSC programme, the place about 360,000 Youth Corps members shall be registered. If in case you have been following us, you will notice that the Nationwide Meeting has put in lots of fund of their constituencies, we now have been visiting these constituencies and are enrolling them into the social medical health insurance scheme. We’ve got additionally launched what we name ‘GIFSHIP.’

With GIFSHIP — Group, Particular person and Household Social Well being Insurance coverage Programme — we intention at driving the formal and casual sectors into social medical health insurance programme.
The programme goals at bringing the casual sector into the healthcare scheme and thru it, extra Nigerians together with these in Diaspora will register. We hope to automate our system to retailer and mixture knowledge. I can inform you that lots of work has been accomplished by way of our reforms, however I won’t be able to present you a really correct knowledge as a result of I’m a public well being doctor; I don’t wish to discuss statistics.

However in absolute quantity, we will say we now have lined over 15 million Nigerians. As I’m speaking to you, for those who go to our NHIS MCC workplace, you would possibly see extra numbers dropping; so, it’s steady course of.

Final 12 months you partnered Roche to subsidy medication for most cancers therapy and in addition, established Catastrophic Fund for terminal sicknesses. How are these tasks doing? 
NHIS got here up with the thought of building a catastrophic fund for terminal sickness, nonetheless, earlier than I got here right here, there was a price range for most cancers, however the unlucky factor is that the cash for that was despatched to the Ministry of Well being. To additional look after the individuals, we launched the NHIS drug initiative to make sure that medication can be found in our system and the fee subsidised. We’ve got an excellent interplay with drug producers affiliation of Nigeria on this. They’ve agreed to collaborate with NHIS and all of the stakeholders on board. This implies we will begin branding medication with medical health insurance prescriptions. Doing this, we are going to make the medication out there and at a decreased price too. In reality, we now have a Memorandum of Understanding with Roche Prescribed drugs to subsidise most cancers medication by 70 per cent; so, NHIS enrollees will solely pay 30 per cent of the fee.

Final week, Roche knowledgeable us that they’ve secured the approval of NAFDAC to start out branding its anti-cancer medication with NHIS prescriptions. That is how far we now have gone. We’re decided to make most cancers medication out there by way of this sort of collaboration. With this, points that should do with prescribed generic medication or substandard generic medication shall be a factor of the previous. We’re going to have a branding and the Minister of Well being has authorized it.

Would the N3trillion you as soon as proposed for insurance coverage healthcare protection nonetheless be enough to cater for 200 million Nigerians on this present financial system?
It’s a easy arithmetic, assuming no Nigerian has entry to healthcare providers globally and also you wish to deliver all of them into the system on the present price of N15,000 per head per 12 months, it’ll contain enormous sums of cash. So, for those who multiply N15,000 by 200 million individuals you may be speaking about N3 trillion, that is only a projection. We’re not saying you must give NHIS the cash for healthcare providers; it’s simply the fee required.

You stated social medical health insurance would cowl the susceptible and, additionally the one-kobo-per-second telecom expenses will increase funding if linked to NHIS. Because the one-kobo-per-second telecom cost has been faraway from the proposed amended act, what’s changing it; when will the medical health insurance begin and when will the president accent to this amended Act? 
I do know Mr. President will signal the NHIS Amended Act as a result of social insurance coverage could be very vital to the healthcare supply system of any nation. There was an argument within the one-kobo-per-second name and can’t be carried out for now till all of the gray areas are eliminated.

Nevertheless, Nationwide Meeting members have created a susceptible fund inside the proposed Modification Invoice. However do we now have necessary social medical health insurance? No! We must also consider the way to innovatively fund it. The creation of that susceptible fund is step one in direction of having a compulsory social common protection as a result of we now have been knowledgeable that by way of dialogue we will have the susceptible fund included within the monetary act. Even when high policy-makers settle for it, the proposal nonetheless has to go by way of the suitable channels; perhaps the monetary act. So, hope just isn’t misplaced, as we will proceed to dialogue to attain our intention.

How have you ever been capable of deal with the variations between HMOs and healthcare suppliers, and the complaints that service suppliers exploit subscribers by giving them solely ache relieves medication of their amenities?
You’ve gotten requested two questions in a single, however I’ll separate them for this dialogue. The primary query has to do with the variations between service suppliers and HMOs. Once I got here into NHIS, the HMOs had been alleged to be owing healthcare suppliers some huge cash; the truth is, we didn’t know the precise quantity, so, we despatched out advertorial in three nationwide dailies for service supplier owed by HMO to submit proof of indebtedness to the NHIS. We bought lots of complains claims from the healthcare suppliers and due to this, we setup a committee that went by way of the claims and found that HMOs had been owing healthcare suppliers over N5billion. With this, we got here up for the primary time with what we known as decentralised reconciliation system, the place we reconciled each events on the state degree.

We developed a device for this and skilled our workers on the state degree on the way to function them. We despatched data to them because it pertains to their state and so they labored for nearly 4 weeks reconciling the 2 teams. Happy with the committee’s work, a few of the HMOs paid the well being gives what they had been owing them out rightly, whereas others signed settlement to pay in two or three months’ time. We will conveniently say that we recovered over N2.3 billion from that course of. Though, there have been some contentious points, however as a result of a few of the healthcare suppliers haven’t any proof to substantiate their claims their points stay pending.

Not too long ago, healthcare suppliers launched a brand new tariff, saying from February 1, 2022, HMOs would pay them based mostly on the brand new tariff or they cease attending to their purchasers. What’s your tackle this?
You will need to perceive that there are two methods medical health insurance works. Despite the fact that we frown on the different one, the primary one is the one which comes from the nationwide medical health insurance scheme. There was a squabble between healthcare suppliers and the HMOs that the NHIS needed to intervene. We summoned them to a gathering, the place we stated with out concern of contradiction that the healthcare suppliers haven’t any proper to set tariff for medical health insurance. The duty of setting tariff is that of the medical health insurance, due to this fact, that tariff they’ve set is void and of no consequence.

Secondly, we realised that the HMOs and healthcare suppliers have launched a cost system they known as roaming, which is alien to the nationwide medical health insurance. The cost system is neither in response to our guideline nor in our legislation. We’ve got instructed them categorically that the cost is alien to NHIS and have complied them to revert to medical health insurance correct if they’re to be regulated and any HMO that’s not taking part in in response to the principles or tips of NHIS may have itself in charge. NHIS has elevated its charges for providers, which is why the healthcare suppliers are glad and have requested the HMOs to extend tariff for his or her non-public traces. Because the HMOs haven’t accomplished this, the well being suppliers held a convention and develop the brand new tariff.

We’ve got reconciled them and are additionally trying into the tariff to see if it could possibly be carried out by NHIS. The assembly ended on a pleasant notice, which is why no supplier has denied any enrollee from getting its providers.

The second query is extreme complaints by the enrollees within the supplier’s setting. This is among the main issues we now have inherited. Previous to this era, there was room for enforcement, monitoring and monitoring, however the monitoring instruments are not any extra there for us to make use of, so, suppliers at the moment are doing what they need. Nevertheless, since we now have stepped in to reconcile debt, we now have efficiently settled the healthcare suppliers, and improve tariff.

The issues within the organisation are systemic and if you wish to deal with them, you’ll want to perceive the basis causes and put credible construction on floor to verify them. To attain this, we now have developed a framework to mixture all complaints from healthcare suppliers. This can allow us to sanction any healthcare supplier that’s registered with NHIS and isn’t dwelling as much as its tasks to the purchasers.

With the eNHIS we’re growing, enrollees can name administration centres with NHIS toll free quantity from anyplace and file complaints, if any, of the healthcare amenities defaults. As soon as the decision will get to our MCC in Wuse, we are going to en-route it to our medical docs or healthcare staff within the involved state or states and they’ll attend to the complaints and probe the amenities if vital.

On the state degree all our amenities have a contact particular person to take care of complaints; we now have created the construction and can launch it quickly. Via this, we can mixture month-to-month complaints of every healthcare facility. There can be a tolerable restrict of complaints we will take and if a facility goes past that restrict, we give the ability a warning. And if by subsequent month the ability doesn’t enhance, we are going to difficulty a warning, to be adopted by a yellow card if the state of affairs persists. And if after that, nothing has modified we are going to difficulty a purple card and transfer all of the enrollees to a different accountable facility. Up to now there was no construction, however at the moment, we now have developed one and I hope within the subsequent few months you’ll start to see the fruits of our reforms and rebranding.

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