A stakeholder in Nigeria’s Health Management Organisation and Managing Director, Ultimate Health Management Services, Lekan Ewenla, has envisioned a country where health insurance is accessible to every citizen. In this interview with BRIDGET CHIEDU ONOCHIE, he applauded Federal Government for the recent automation of National Health Insurance Scheme (NHIS) and called for the passage of a bill enforcing mandatory enrollment in the scheme.
How is the relationship between the Federal Government agencies in boosting healthcare in Nigeria?
I want to emphasise that this government, irrespective of whatever challenges bedeviling the country at the moment ranging from insecurity to the economic situation, has been assiduously working to enhance the well-being of Nigerians. I would like to put it on record that this is the first time we have government to government agencies collaboration in health care. Since the health insurance policy was introduced in 2005, it has been driven manually. We have been clamouring for the automation of National Health Insurance Scheme (NHIS) since inception. However, in the last one year, this administration encouraged NHIS to partner the National Identity Management Commission (NIMC) and as I speak today, with a minimal cost implications to NHIS, that project has been achieved. NHIS would be launching its ICT platform any moment from now. That implies that the data on NHIS system can be used for any purpose because of the partnership with NIMC. Indeed, the capacity of what is being worked on is robust to cover the entire population in the West African region.
How does this partnership help in improving the health care system in the country?
The partnership has translated into creation of a robust ICT platform for NHIS so that data of Nigerians already enrolled on NHIS programme can easily be uploaded. In addition, with this data, names of Nigerians already on the NHIS programme will be in consonance with the names being captured by NIMC. The implication is that there would be transparency and no duplication of identity on the health insurance programme, although, we have not recorded any form of manipulation of the process. The only challenge was that it was formerly being driven manually. The other form of challenges that we may identify is a situation where an applicant’s name might not be captured correctly. However, with the ICT platform being deployed as we speak today, it is in compliance with the NIN being done across the country. Whatever data we have on NHIS platform is the data of individuals you see everywhere.
In addition to that, for the first time in the history of this country, NHIS as a regulator of health insurance programme in this country would be mirroring the operations of the Health Maintenance Organisations (HMOs) and health care providers directly. So, the issue of health maintenance organisations not paying the health care facilities as and when due is going to be completely eliminated.
Also, issues of health care providers not treating clients the way they are supposed to be treated is going to be a thing of the past. The non-confirmation of payment by providers is also going to be a thing of the past. As we speak today, that programme is being driven manually and we have situation where HMOs could have paid hospitals but such hospitals may find it difficult to identify who has paid and what was paid. At the end of the day, hospitals would keep writing NHIS that someone is indebted to a tune of certain amount. That process would be completely eliminated with this automation.
From the communication platforms of the HMOs serves to monitor the response time by the HMOs in giving approvals to the health care providers. If it is declined, the reasons must be well spelt out. So, they are equally coming up with a very robust call centre such that they know what is going on across the nation concerning health insurance programme.
What the Federal Government has done in areas of enhancing the operations of health insurance is very commendable. I am saying this because the fact that there are security challenges does not mean the government is not working. They have completely turned around the operations of health insurance in this country.
And also for the records, this is the first time in this country that government would be looking at health care services from demand and supply perspective. Before now, government has been focusing simply on supply. But with the directive of the United Nations, government of all nations are now looking at addressing health care services from demand and supply and that was why the introduction of mandatory health insurance became fundamental across all nations that are members of United Nations. Now, all countries are introducing mandatory health insurance programme because it is the only way they can make health care affordable, accessible and equitable. In Nigeria, the health insurance that we have been driving since the law was passed in 1999 hasn’t been mandatory and I want to put on record that it was majorly responsible for the low enrollment for the health insurance programme.
What we are agitating now is for the federal government to sign the law making health insurance mandatory. It will be a game changer. The Ninth Assembly has passed the NHIS bill and it has been sent to the Presidency for assent but I learnt that the bill was sent back to the National Assembly from the Ministry of Justice for few adjustments. That has been done and sent back and I want to plead that Mr. President assent to it.
Would the passage of the bill imply that Nigerians in the informal sector would be captured?
Once that bill is passed into law, every residents of this country must be enrolled on a basic benefit package of the health insurance programme.
For now, how are those in the informal sector being taken care of?
Effort is being made to bring the informal sector on the health insurance net but it is difficult to achieve that. This is because most times, when laws are passed, if there is no instrument of law to enforce it, it becomes difficult. However, the moment this bill is passed, it will give the authority to critical stakeholders like the regulators to begin to drive towards enforcement of compliance. Why we can’t enforce it for the informal sector to be enrolled on this programme is because the present law we are using does not recognise the informal sector. So, we are just trying to ensure that we extend it to them but the good news now is that almost all the states have passed the law making health insurance mandatory. Only two states are foot-dragging but efforts are being made to ensure compliance and take off of the programme, especially with the informal sector. This is because 80 to 85 per cent of Nigerians are in the informal sector and that is why the passage of this bill becomes urgent and necessary.
You have commended government’s efforts at implementing health-related SDGs. How can you rate government’s implementation of those goals?
I will give government a pass mark. This is the first time in the history of this country that government has been religiously deploying one percent of its consolidated revenue towards the provision of health care services for those who are vulnerable.
What are the challenges currently confronting the NHIS?
I think it is better for me to commend the patriotism, commitment and passion of the Executive Secretary of NHIS, Prof. Muhammad Sambo, for his efforts at changing the game plan and converting all the identified challenges affecting the smooth driving of health insurance programme from inception till date to solutions. All the challenges we identified in the past have been systematically converted to solutions by the incumbent ES. Those challenges, with the deployment of ICT platform will completely fizzle out. This is because majorly, what was affecting the operation of health insurance programme was systemic and capacity of personnel but he has addressed the systemic issue with the ICT platform. He has also addressed the issue of capacity of personnel by enhancing the capacity of existing and newly recruited staff in the agency. He has completely restructured the operational framework of the scheme.
I can confirm to you that there are minimal challenges in the health insurance programme because the major issue has been addressed. The only challenge that we have now is the passage of that bill and once it is done, it changes the narration completely.
What about the acceptability NHIS by Nigerians?
Acceptability would follow the passage of the law because the moment that law is passed, the platform to create awareness for everyone to begin to appreciate and understand the importance of health insurance programme would be vigorously launched. I am saying this because I know what the government is doing. I am not just running an HMO, I am on the governing council of NHIS and as a council member, I have seen health insurance programme being driven for the organized private sector.
Why do many people consider HMOs an elitist programme?
HMO is an acronym for the private investors in the health insurance ecosystem. Health Maintenance Organisations are registered company licensed by the regulator to drive health insurance for Nigerians. HMO are like banks licensed by Central Bank to anchor deposits for Nigerians. So, the HMOs by law are recognized as the body that drives health insurance schemes for Nigerians and the requirements for their setting up is well spelt out. Globally, it is no longer government’s business to do business; hence, the global direction or global approach to development is for government of all nations to create the enabling environment for the private sector to drive the economy while government regulates. The HMOs are licensed and regulated by the NHIS. No matter how rich one is, one can’t deposit in the Central Bank. The HMOs are the drivers of health insurance programme, the NHIS is the regulator while the health care providers are the service providers. We want to implore Nigerians to begin to take their wellbeing seriously because sickness does not give notice. Nigerians must learn to provide for their wellbeing by enrolling in the health insurance programme. This is just to prepare the minds of Nigerians towards the passage of that bill because the moment it is passed, it becomes mandatory for everyone to be enrolled on the health insurance programme.