Reduction of maternal, child deaths our priority – NHIS boss
Dr Femi Akingbade is the acting executive secretary of the National Health Insurance Scheme (NHIS). In this interview, he speaks on the improvements made in the various programmes to ensure access to affordable health care. Excerpts: Can you give an update of the status of your NHIS/MGDs maternal and child healthcare project that you ran […]
Dr Femi Akingbade is the acting executive secretary of the National Health Insurance Scheme (NHIS). In this interview, he speaks on the improvements made in the various programmes to ensure access to affordable health care. Excerpts:
Can you give an update of the status of your NHIS/MGDs maternal and child healthcare project that you ran in some of the states for some years now?
We’ve had a lot of successes under this programme. As at today, we have treated about 1.9 million pregnant women and children below age five under the programme.
However, the programme is about winding up according to its timeline. But we are opening a new window in that direction because the National Health Act makes it mandatory for us to provide healthcare services for those that can be classified as either poor or vulnerable, and pregnant women and children under-five are in this category. So NHIS will still continue this programme but may be in a different way.
Initially, it was funded from resources provided by the federal government through the MDGs programme but henceforth, it is going to be funded from moneys that will be coming to us under the National Health Act. This will be in addition to counterpart funding provided by the states.
Unfortunately, it was recently reported somewhere that we were dispensing undue favour towards one of the states, Ekiti specifically, under this programme.
But let me make it abundantly clear, and for the records, that this is absolutely untrue. Indeed, Ekiti paid its counterpart fund of N80 million to the scheme for the NHIS/MDGs MCH Project in January 2014, which the scheme matched with another N80 million, which is normal. As at today, there is a balance of N17 million in that account. So it’s not true that Ekiti or any other state for that matter is enjoying any undue privilege under that project.
A lot of excitement greeted the launch of the Mobile Health Insurance Programme, but it appears to be having a lot of hiccups. What is the situation and what are you doing about it?
We are looking at all our programmes and we are trying as much as possible to review them for optimal delivery of service to the people. The National Mobile Health Insurance Programme (NMHIP) was actually launched in July 2014 for pilot run.
It is a very laudable programme and something we would like to scale up to the highest level. We see a lot of interpolation of that programme with so many other things we run and it also requires collaboration with a lot of other agencies.
We need to collaborate with the Nigerian Communication Commission, National Identity Management Corporation, Mobile Network Operators (MNOs), and lots of other agencies that are into identity management, and that kind of slowed the process. We are however conscious of all that and are working on modalities for improvement all around its process.
One of the things we wanted to do with the NMHIP is to leverage on existing tele-density of the MNOs because they already have about 120 million people registered under them and the idea of NMHIP is for you to link your phone number with existing data that was captured during the recent SIM card registration with the MNOs. Coincidentally the data base is being warehoused by NCC.
One of the things that we are still trying to work on and implore NCC to do is to release that data base for us to have access to those data as that will save us from reinventing the will.
They have already done a biometric registration and they have the details of the people that own these phones. What we are now saying is that if somebody that owns a phone wants to register for NMHIP, please give me the data so that I don’t need to go ahead to start capturing a new biometric data. We are working with NIMC on the harmonisation of the two data bases and we will also use the opportunity to help NIMC to register people.
What of people that have already registered by doing what the mobile operators asked them to do?
We are trying to bring stakeholders on the same page with us. One unfortunate thing that is happening is that we are having service delivery failure because the stakeholders seem not to totally agree with the payments and fees that are coming to them based on the agreed distribution of the funds that are being contributed.
This can be attributed to a lot of things. For instance, we found out that the MNOs that are involved have lots of government charges to pay and a lot of the fees are going into administrative charges which we are trying to reduce.
That is why we have not been optimally providing the service but like I said, we are reviewing the whole programme and we hope that very soon, we would be back on track and people would be able to access service.
Our promise to those that have registered is that if you go to any hospital, NHIS would reimburse such hospital directly. We have identified 20 facilities in Lagos for that purpose, and we have an understanding already with those facilities that if any of those that registered for mobile health insurance visits the hospital, we will reimburse them directly. I think the problem is that because of the spread of those 20 facilities, some people find the distance of the hospitals to their locations very far.
But I’m sure that with time, as the programme scales up to run nationwide, all accredited facilities under the NHIS in the country would be able to render service under the programme. Meanwhile our apologies go to those affected by the current situation, and we assure them as well as the whole nation that we will soon overcome that temporary hiccup.
There are still challenges from healthcare providers when patients access service. How do you address that?
Well, we have tried to strengthen our standard and quality assurance units by doing spot checks in all these facilities and now we have upped our regulatory role such that all erring stakeholders will henceforth be sanctioned.
We have criteria for sanctions in our operational guidelines. I think we have had two or three of these facilities that have been sanctioned. One of the things that we did last year also was to re-accredit the Health Maintenance Organisations (HMOs) according to capacity to deliver quality service in terms of certain benchmarks.
This exercise reduced the number of HMOs from 72 to 60. Sixteen of them were not re-accredited because they fell short of the expectations. We have all these information on our website. We will continue this process; we have sectionalised into regions and on a regional level we are checking these facilities to make sure that they are in conformity with the standards that we have laid down in our operational guidelines.
Some HMOs delay the payment of capitation in terms of arrears and so on and this affects operations. What is your take on this?
I don’t think there is any HMO that can say that NHIS has defaulted on payment of quarterly capitation and fee-for-service, because we pay capitations three months up front to all HMOs, and we have never defaulted even once. They are then expected to pay to facilities monthly. However, we have had reported cases of default by some HMOs to pay to facilities as due. And we have meted sanctions appropriately in such cases in the past.
However, there was a review that was done in 2012 of capitation and fee for service. The capitation side of it was effected immediately and the fee for service was not. We are making plans to pay for the outstanding fee for service side so that we would not continue to have cases of service delivery failures occasioned by that, because the HMOs think they are taking a risk at secondary level. We have actually started making preparations to pay the outstanding and implement the new rate for fee for service.