Executive Secretary of the National Health Insurance Scheme (NHIS), Professor Usman Yusuf, was until his appointment a professor of Paediatric Haemetology/Oncology at the St. Jude Research Hospital in Memphis, Tennessee, United States of America. He is also a stem cell specialist. Prof. Yusuf who graduated in Medicine from Ahmadu Bello University, Zaria, in 1982, worked in the United Kingdom before moving to the United States, where he was involved in bone marrow transplant on children. In this interview, he explain his blueprint for the NHIS amongs others
State of NHIS and Healthcare system in Nigeria
“We have essentially been sleeping on duty. We as the regulators have been dictated to by the regulated.
“It is like a subsidy to Healthcare Management Organisations (HMOs), which is worse than oil subsidy. It is worse than oil subsidy because in Oil subsidy nobody dies, but these guys have caused human sufferings and deaths from their actions and inactions. We need to do better. we must take healthcare to the people, for the people to take ownership as HMOs, as providers, as enrollees, as patients and beneficiaries.”
Set Targets
Towards achieving set targets, Prof. Yusuf promised to work with what he has and make it better. He said his mandate at the scheme is to design and implement strategies and instruments that will make NHIS a good steward of the nation’s commonwealth.
He also said he will “have to clean the house, of corruption, political patronage and inefficiency. The house that people entrust their money to, we are misusing that money and not being good custodians of people’s trust, that to me is the first change.
“I will put the HMOs and the hospital in order, go out and play advocacy, talk to people, talk to traditional rulers and see how we can get various more fundings to help our people. This is my goal and it is achievable.”
He further said special attention would be given to support the poor and the vulnerable in the informal sector to be able to access efficient healthcare without financial constraints. This according to him will show a different phase for NHIS and regain the trust of people.
He is also working towards ensuring that the money being deployed to for the scheme is judiciously used. “If we do tertiary diseases all our money will be wiped up in no time. For instance one bone marrow transplant cost up to $5m. There is no where in NHIS funding that says we should be treating these expensive diseases. There are more children that die of malaria than HIV, they are more pregnant women dying during child birth because they can not get anti natal care. We need to deploy our resources wisely and judiciously.
“The current NHIS structure is primarily covering Primary health care, secondary health care like caesarean section and other non complicated tertiary illnesses. If we chase this other important, but expensive diseases, all the funds will be wiped out.
Coverage
Prof. Yusuf said the goal of NHIS is universal health coverage for all Nigerians; that is 170 million people. He expressed disappointment over the low level of health coverage recorded by the scheme, adding that the primary goal of the agency is to increase healthcare coverage for all Nigerians especially the poor, vulnerable, children under five, the disabled, prisoners and the old.
According to him, Nigeria has one of the worst figures in health coverage in the world with only four per cent, despite our huge human and capital resources.
“Countries like Kenya, Ghana, and Rwanda, have achieved over 50 percent coverage of its citizens. We have more resources; human and capital, than any of them, but it is how we use the resources that is the problem.
“We can do better. We have the resources both human and capital to deploy, we have to cover more people. There is so much inefficiency, so much corruption and political patronage.
“It is however not that depressing, because the quality of staff I find in NHIS is truly great; pharmacists, doctors, accountants, lawyers, nurses, etc… There are not many organisations with that quality of staff.
“NHIS as it is structured now is only catering essentially for the federal government workers. Majority of our people live in the states, in the towns, in the villages. We need to find out how we can extend this coverage to them. Many of our people all over the country are sick and do not have money to go to hospitals.
“Even if I increase the coverage by one per cent, I would have done something. One per cent of 170 million people is not a small number.”
Cutting off the middleman
As part of the need to increase coverage and deploy resources to get healthcare services directly to the people, the NHIS boss said there is need to cut off the middleman.
“Health financing in Nigeria is composed of National Health Insurance as a regulator, the HMOs as the middlemen. The HMOs are the ones NHIS give money to on behalf of the patients.Essentially what the HMOs have done is they have corrupted the system.
“NHIS gives them money on behalf of the enrollee three months ahead. So, I do not see any reason why our patients should be maltreated in hospitals; they are not treated with the dignity they deserve.”
Removing ghost enrollees
He said NHIS will conduct new biometric audit of enrollees in the scheme, to remove ghost enrollees and plug wastages.
“If you are a federal government worker, and you have a wife and four children, the money comes out straight from the source to cover your family. But if you have more than one wife or more than four children, you will pay N9,000 extra per person to add more.
At least we know you, but we do not know the rest of the people. I am going to do biometric audit of all our enrollees. With that we will know the true number of enrollees the scheme has.
“If there are ghost enrollees that are not there, but are put in there for us to pay Healthcare Management Organizations (HMOs) or doctors, I will find out.”
Partnership for wider coverage
The Executive Secretary urged governors of the 36 states of the federation, traditional rulers and stakeholders to adopt the scheme in order to achieve universal health coverage in Nigeria.
He said the partnership between the NHIS, state governors, traditional rulers and stakeholders will extend healthcare to most Nigerians and also create strategies to improve healthcare financing across the States.
He further added that majority of Nigerians live in the states, towns and villages and the scheme covers just a little fraction of the population’ essentially federal government workers.
“This partnership would create a platform for governors, traditional rulers and stakeholders to formulate policies that would be implemented by states.
“We need to think outside the box and not always about the government, because there is no government in this world than can shoulder all responsibilities, especially health.”
Enforcement
Prof. Yusuf promised to enforce the laws and punish infractions of all HMOs and any offenders.
“Enforcement is key. We have enforcement unit under a department, and I’m going to pull that out. I will make it a department and put a strong person there.
“The first thing I did when I came before I addressed HMOs was to ask my finance department to pull up all the debts that HMOs owed us. Some of them were owing us N89 million, N68 million, which they had not paid us back. I asked my legal department to write a letter to each one of them that they need to pay us before December if not I am going to delist them. They are returning money to us.
“I have also asked all the hospitals accredited to NHIS in this country to send us debts that HMOs owe them.
“I told them it is not going to be business as usual. I do not need new laws to enforce what the Act has already given me.
“Our operational guidelines give us the power to enforce. I am going to put the enrollees on the driver’s seat, because we are working for them, they pay our dues. I will empower them to choose their HMOs and choose their hospitals. They should be the king because it is their money.”
