Repositioning NHIS for effective services

Unfortunately, this situation is stalling the achievement of the universal health coverage the country so richly desires. But over the years, a lot of advocacy and sensitisation have been dedicated to educating people on the benefits of having insurance to reduce out of pocket expenses. Yet, apart from been sceptical, management of insurance by some […]

Unfortunately, this situation is stalling the achievement of the universal health coverage the country so richly desires. But over the years, a lot of advocacy and sensitisation have been dedicated to educating people on the benefits of having insurance to reduce out of pocket expenses. Yet, apart from been sceptical, management of insurance by some Health Maintenance Organisations (HMO) and providers(hospitals) have left a bitter taste in the mouths of many Nigerians. Nike Adams relating her experience at one of the hospital where she access care said: “Immediately I said I was on insurance, the nurse’s attitude changed, she was not rude but cold. “I had to wait a long time before seeing the doctors. I think even hospitals need a better orientation about how to treat patients with insurance.” But the story is not the same everywhere. Lami Hadi works with the ministry of education, she says the benefit of insurance is enormous. Her words: “when I had my first baby, I paid only about thirty thousand for caesarean operation, and I accessed treatment for almost next to nothing. “This is the only reliable gift government has given to Nigerians.” The executive secretary of NHIS, Dr. Femi Thomas, came on board November 19, 2013, promising to consolidate on the past achievement of his predecessors and overhaul the system to realise the 30%coverage desired by the president by 2015.
Giving a summary of his achievements within the last one year of his tenure, he undertook a reaccreditation of HMOs which handles care packages of patients. According to him, “within the year, the scheme completed the first ever reaccreditation of HMOs,” adding: “This process, anchored by Price water house Coopers (PwC) Ltd from 2012, was successfully completed in September 2014. Of the 61 old HMOs, 38 were reaccredited, while 15 new HMOs were exempted, as they were newly registered and not due for reaccreditation.  “The conclusion of the exercise has brought the number of HMOs operating under the scheme to 53. We can boldly assure you, ladies and gentlemen, that the exercise has introduced a new lease of life into the health insurance industry in Nigeria, as it engendered the emergence of strong, competitive and reliable players in the industry.” He said the president identified him two critical challenges for him to tackle. One, to extend coverage to no less than 30% of Nigerians by 2015 and, two, enhance the economic prosperity and social well-being of humanity.
Thomas added that his personal agenda was to ensure an upscale of coverage, make tangible and visible improvement in the quality of care available under the scheme, and the restore the enrolee to a place of eminence and pride in the implementation of the scheme. NHIS is positioned to provide the kind of services that Nigerians can be proud of, said the executive secretary, adding that an assessment of the strength, weakness and opportunities of the scheme was carried out at a retreat and the scheme realised that it had the capacity, not only to meet the presidential target of 30% coverage, but to surpass it and reach40%.  Speaking on some of the achievements recorded, Thomas said: ‘We started with the restructuring of the organisation, by the unbundling of the old technical operations department into full-fledged formal sector and informal sector departments, as well as the creation of a new marketing department to enable us embark on an aggressive drive for mass acceptance and enrolment nationwide.”
Excited about new initiatives that would put healthcare into the hands of the patients and increase coverage, the NHIS boss revealed that the scheme has introduced the National Mobile Health Insurance Programme (NMHIP). His words: ‘It is a novel concept anywhere in the world meaning, of course, that great things can also come out of this country. It provides for subscribers of the mobile network operators the platform to register, select HMO and provider, and choose payment options and plans, all on their mobile phone, and at their convenience. “To implement this, the scheme engaged a mobile technology and business aggregator, Salt and Einstein Ltd, to interface with stakeholders and manage the process. The pilot run for this was launched in Lagos on the 21st of July, 2014, on the platform of MTN, to start with. Appreciable progress is being made in testing the process and structures, to determine the weaknesses and advantages. “I am happy to inform you that the other network operators, including GLO, ETISALAT and AIRTEL, are all at high levels of readiness for roll out, as soon as the national launch of the programme is performed by Mr. President shortly from now.
When fully launched, it is expected that we shall be able to give coverage to no less than 20 million lives on that platform.” Speaking on other initiatives, the executive secretary said the mobile health insurance programme would have the adoption tree which allows well-to-do and well-endowed individuals and corporate bodies with the spirit of charity to contribute to a pool of funds from which the poor and the vulnerable will enjoy health insurance coverage. “There are two varieties of the adoption platform, including the specific, whereby the donor specifies who he wants coverage provided for, and non-specific, which remains open and could provide care for any set of deserving beneficiaries,’’ he said.
Bearing in mind Nigeria’s rising population and challenges, the executive secretary is desirous of protecting the leaders of tomorrow by introducing the Public Primary Pupils Social Health Insurance Programme (PPPSHIP), designed to provide cover for about 24 million pupils of public primary schools nationwide. NHIS  is expected to bear the total responsibility for the programme for the rest of the year, while by 2015,state governments will absorb 60% of the cost of implementation, with NHIS paying the balance of 40%. It is heart warming to note that as many as 20 states have made provision for this activity in their 2015 budget. Tertiary Institutions Social Health Insurance Programme (TISHIP) has also been rolled with the National Universities Commission (NUC) directing all Nigerian universities, public and private owned, to participate in the programme as a matter of policy.
Community insurance schemes are also introduced several communities buying into the initiative for the sake of their indigenes. However, the scheme looks towards a comprehensive digitalisation of health insurance, focused on attaining a paperless process and administration of health insurance. Thomas: “This will bring to a final end, the perennial crisis associated with the production and distribution of ID cards for enrolees, which has hindered access to care for many. “The digitalisation will be deployed to cover the entire process, ranging from registration to encounter management at points of service including, of course, data administration. It is expected that the digitalisation will eliminate delays in processing eligibility for access and other forms of malpractices observable in the past.”
The NHIS boss said that his leadership has seen the enrolment figure went up by about 2 million, saying: “As at today, total enrolment figure stands at about 7.2 million lives.” But most importantly to Nigerians is the fact that healthcare must be affordable to all. To achieve this objective, the NHIS added other services not previously covered such as conditions like oncology, orthopaedic surgery, trauma, open heart surgery and renal cases. “So far, 6 open heart surgeries, 1renal transplant, 2 orthopaedic surgeries and 4 oncology treatments have been successfully carried out under this programme.” Continuing, Thomas said: “Our objectives is to reward our enrolees who kept faith with the scheme, especially in the years of our infancy and difficulties, discourage outward medical tourism and showcase the capacity of Nigerian medical centres and personnel to deal effectively with these complex conditions.           END