Switching on the lights at NHIS
By Istifanus Bature
It’s time to switch on the lights at NHIS. Time to expose the pseudo reformer. The National Health Insurance Scheme (NHIS) is in the news again for the wrong reason. This time around it has assumed a dimension like no other. Commenting on this topic took me a while especially as it concerns the NHIS. Nothing seems to be working there. The only news you hear from NHIS in the past five years is worrisome. This is what has become of the NHIS since Dr. Dogo Muhammad, its former Executive Secretary left the scene in 2012, at the behest of the Goodluck Jonathan government, lest I add that not for incompetence, but for political reasons by refusing to renew his appointment despite the glaring successes being recorded. This is not the crux of this article.
The crux of this article is the suspension of the Executive Secretary of the NHIS, Prof. Usman Yusuf, which in my opinion has been long overdue. As a start, his appointment was a fundamental error because he was not only clueless on healthcare financing, he also lacked in administrative experience from the resume he currently parades as a professor of hematology, pediatrics, and oncology who has supposedly canvassed the whole continent. That claim is to be researched on a later date. His questionable days in the United Kingdom at Christies Hospital and Holt Radium Institute in Manchester is a topic for discussion on a later date.
Mallam Yusuf ran the scheme in the past 11 months abysmally. I am equally afraid to add that one of the first things he did was to appoint his younger brother Hassan Yusuf, as General Manager, Legal of the NHIS and his niece a level 8 officer from the Economic and Financial Crimes Commission (EFCC) to the NHIS on grade level 13. Where is that done? Only in the National Health Insurance Scheme. He not only violated all known procedures for recruitment into the civil service in Nigeria, but he also bragged about it. “I am only answerable to President Buhari who appointed me. I don’t have any business with the Minister of Health” The NHIS under Mallam Usman Yusuf was characterized by a flagrant disregard for civil service rules, insubordination, and contractual scam, and ethnic and religious nepotism.
As part of efforts to reverse the poor health indices and ensure universal health coverage in the country, President Muhammadu Buhari kicked off the revitalization of 10,000 primary healthcare centers (PHCs) nationwide by inaugurating Kuchigoro Clinic, Abuja, as a model on the 10th of January 2017. This model was supposed to be financed by NHIS since attaining universal health coverage was one of the core mandates of the NHIS since inauguration. But guess what? The NHIS Executive Secretary refused to even look at the viability of the project or the impact it would have on the poor, especially women and children in rural communities. Till date, he has refused to attend to any document relating to the reactivated Primary Healthcare Centres across the country.
While it might be argued that it doesn’t fall under the purview of the NHIS to fund such an initiative of the Federal Ministry of Health, it can thus be stated that the overall impact of such an intervention and coupled with the fact that it was a directive from the President ought to have given the NHIS boss a sense of reasoning. But it didn’t. And in any case, it was geared towards attaining universal health coverage, which is indeed one of the mandates of the NHIS. But all of that doesn’t mean a thing to Usman Yusuf and his gang of ethnic and religious chauvinists.
The NHIS under Usman Yusuf was not only a beehive of personal aggrandizement, but it was also a reign of shady deals with one of his closest ally named Shehu Mahdi, the owner of Dialogue Group of Companies Limited based in Kaduna. Most of the deals at the NHIS were given to cronies of Shehu Mahdi, who was reported to have bought a house for the Executive Secretary in Kaduna and a gift of N50, million upon his appointment as Executive Secretary of the NHIS. It didn’t stop there. Interestingly, this is the same Shehu Mahdi that in 2013 rose to the defense of former Comptroller General of Customs, Inde Dikko over allegations of non-remittance to the federation account.
Another enjoyable escapade of the suspended NHIS boss was the issue of the NHIS e-library project that was awarded to Promatrix Global Resources Limited at the cost of N28, 922,000.00 ( Twenty-eight million, nine hundred and twenty-two thousand naira). The infractions in the deal were too glaring. One was that the said company was paid in advance, two is that the company owned by one Salisu Garba, a stooge of Shehu Mahdi. Worrisome also is the fact that the said company has no company website, no office in Abuja and no evidence of competence. The only known address of the company is No 5 Lata Tombai Close, Malali, Kaduna.
On the other hand, Shehu Mahdi, the suspended executive secretary crony, owns Dialogue Global Links Ltd with specialization in “Development of E-Library and Database and ICT Education through customized and tailored training.” This same company was awarded a contract of over N400, 000.00 (Four Hundred Million naira) for ICT training by the suspended executive secretary.
The atrocities of the NHIS executive secretary are too much that it would take a day or so to thoroughly dissect them. Impeccable sources also hinted that Usman Yusuf’s claim on being a professor is questionable. He has not also been in active employment before his appointment as Executive Secretary of NHIS. Sources hinted that he has been around the country for an upward of three years before his appointment hanging around and feeding on close friends and associates including Alhaji Shehu Mahdi of the Dialogue Group of Companies. Little wonder why the Dialogue Group of Companies executed major contracts in the NHIS under Usman Yusuf?
Back to his lack of respect for constituted authority. The suspended NHIS Executive Secretary came on board with a clear motive to instill nepotism and religiosity in the NHIS. One of the first things he did was to carry out a mass transfer of key NHIS personnel to NHIS state offices regardless of your competence. And guess what? He brought in 15 people that were later tagged the group of 15 northerners as secondment without the knowledge of the supervisory ministry. This much the minister of health admitted before a Senate hearing on the secondments. The other anomaly with the supposed secondment is that because they are coming in from the mainstream civil service, they are ordinarily expected to report to the NHIS one level lower, but the Executive Secretary did waive this off and instead promoted most of them three steps higher. For example, someone on grade level 8 was given grade level 13. Someone on grade tier 1 was given grade level 15, and so on and forth. Why? Because he is from Katsina state and was appointed by Mr. President and therefore his words are yes and amen.
Secondly what he did was simply a new recruitment and not secondment. In the case of secondment in the public service, which also means transferring of service, the practice is that the date of first appointment and date of current appointment are not supposed to be the same since it is assumed that they are merely transferring service. But in the case of the NHIS, the both dates were the same for all 15 of them. An example is that of the general manager, legal, Hassan Yusuf, who is also his younger brother. In his records, the date of the first appointment was 10th November 2016, and the date of current appointment was also 10th November 2016.
It is also ironic that despite the show of arrogance and disregard for constituted authority, the suspended NHIS boss has been running from pillar to post soliciting the support of a major traditional ruler in the north to intervene. His crony, Alhaji Shehu Mahdi is also reaching out to the mighty in a bid to save his cash cow. It is also understood that an option muted is to whip up ethnic and religious sentiments by playing of the ethnicity of the minister of health and the Ag. President and labelling his suspension as a “Yoruba” agenda against the north.
How this would play out remains to be seen. The atrocities perpetrated by Usman Yusuf in eleven months are unimaginable. It is hoped that the committee would do a quick and good job. This is another parable of goats and yam.
Views expressed by contributors are strictly personal and not of TheCable.
The former ES of NHIS should be sent to the an health centre for possible investigation. I suspect strongly that there is a mental health issue.
Mr Bature,ur article on NHIS is well articulated but there is also an element of nepotism in ur analysis. U did not bother to mention what the ES met on the ground regarding the HMOs and the corruption level from the supervising Ministry. The HMOs setting from the onset was a fraud cos it was dominated or only own by people from one ethnic group serving all parts of the country, it is an open secret that those HMOs were not delivering on their mandate, but were collecting millions of naira monthly for services they do not render.
That was the position of NHIS before Usman came in.His first sin was stopping those monthly ghost payments & his effort to de centralise the HMOs.This will naturally not go down well with those people enjoin the monopoly.
Ministry’s interference with their budget was another fraud he refused to continue with. So many similar corruption cases he met on the ground WC he try to correct his own ways.
I concur that he made so many mistakes in his effort to correct the wrongs he met,but I expected u to mention some +ve steps he took in his own way.
When he appeared @HOR committee on Health, his revelations make the house passed a resolution of his recall.
I would like to address 3 issues:
1. Ghost enrollees under the NHIS
2. Why services are poor under the NHIS
3. Lack of regulation by NHIS
4. Challenges with HMOs
Ghost Enrollees Under The NHIS
NHIS database is manned and housed at NHIS.No HMO has access to the NHIS database. So how were these ghost enrollees registered?For any enrollee too be registered under the NHIS scheme verification between NHIS and the MDA or Ministry must have been done. HMOs cannot identify a federal civil servant. It is only the Ministry/MDA that can verify who is a genuine staff or not.When a federal civil servant retires or leaves the service, communication form the Ministry/MDA would ensure that the enrollee is taken off the register. For dependants older than 18years the system is set to delist them accordingly. If theses are not done why should the ES blame any HMO. Please note the NHIS itself is the greatest beneficiary of this fraud and not the HMOs. NHIS retains greatest percentage of theses funds after providers . How many NHIS staff involved in this fraud have been fired or even named.Why shuld the ES coninue to blame HMOs who do not have access to its database, do not print ID cards or approve registration of enrollees.
Why Services Are Poor Under NHIS Scheme
There two major type of services:
Primary Care
Secondary Care
NHIS pays (through the HMOs) a capitation fee of N750 for primary care sevices .This handles all out-patient services for common ailments provide by a general practitioner.The services can be provided by most providers as long as they have a large pool of enrollees registered at their facility.For providers with a small number of enrollees it is not sustainable.
Has anybody bothered to ask the ES of NHIS to confirm how many hospitals in this country can truly providers with less than 500 enrollees it not sustainable due to likely over-utilization of the capitation fund – this is the major reasons enrollees are not given proper care or are even turned back from the hospitals.
Secondary Care under NHIS is the worst segment of the service.Most providers do not provider this service because the fees are too low. Here Usman Yusuf also blames the HMOs . Please confirm how many hospitals in this country will accept a Specialist Consultation of N1,000 for any of the following:Consultant Gyneacologist, Cardilogist, Orthopaedic Surgeon, Paeditricain etc. Is this the fault of HMOs that hospitals are not accepting these low fees and are turning the enrollees back?Also, accreditation of hospitals is done by NHIS officials and not the HMOs.There are a lot of sub-standard hospitals under the NHIS that HMOs will not even work with under their private plans that are on board the NHIS.
Lack of Regulation By NHIS
The NHIS has been distracted from focusing on pure regulation .Because of this i am of the opinion that another body be made to manage the funds while NHIS focuses on regulating the HMOs.HMOs are health insurance companies- they represent an industry- they are the operators of the health insurance industry .They cannot be scrapped as recommended by Usman Yusuf.The NHIS should provide evidence regards corrupt practices of any HMO rather than inciting the general public against the operators of the industry.Can the CBN scrap the banking industry because some banks were involved in housing stolen monies or involved in money laundering?- NO. Such HMOs should be sanctioned by the NHIS. The ES should desist from distracting the public by sensationalizing corruption and actually get down to do the job- REGULATE!He seems to enjoy doing his job on the pages of newspaper , tv and playing to the gallery.
If the ES did not have anything to hide why is he refusing to step aside for 3 months and allow investigations to be conducted by the committee setup by the MoH. If he is clean he will not be bother. he would rather go for a nice vacation and resume 3 months later. Why is he being fighting his supervisor? This is gross misconduct and disrespect for constitutional authority.
Challenges With HMOs Under The NHIS Scheme
1. Some HMOs divert capitation payment meant for primary care providers.
2. Some HMO do not pay claims for secondary care to provider due to financial instability or poor corporate governance
3. Some HMOs do not do enough monitoring of providers under their care
4. Some HMOs have poor customer service- poor 24hr contact centre service
The NHIS should identify the HMOs which have challenges and address these issues. That is what regulation is all about. The NHIS Act stipulate what should be done for various offences . Several HMOs have been sanctioned in the past , some had their licenses withdrawn without the unnecessary sensationalization of the problem- just do your job as a regulator.
The tripartite system – NHIS-HMO-Provider ensures a check and balance system that ensures that everybody is checking each other.