‘Why health insurance scheme can’t cover every Nigerian’

Dr Mohammed Dogo, Executive Secretary/Chief Executive Officer, National Health Insurance Scheme (NHIS), in this interview with Oyeyemi Gbenga-Mustapha presents a scorecard of the organisation’s activities in the past 12 months vis-à-vis challenges and prospects for the New Year.

SOME enrolees are alleging that their premium does not cover certain diseases, especially terminal ones, why is this?

Whenever you develop a social health insurance, it does not cover everything. Social health insurance looks at the burden of diseases in a society or country and tries to capture 80 per cent to 90 per cent of the disease burden. That is the case. So by the time you try to think cancer, it means all is susceptible to getting cancer. The basis is that if Nigerians want to get cover for everything, they should be ready to pay more. The scheme is contributory. It is not free. As of today, no employee of the Federal Government has started contributing six years after the scheme took off, yet they want increase in the benefit package. Better soup, na money kill am. If you want everything, more money has to be paid. The Federal Government is standing as cover for its employees and is paying 10 per cent on behalf of its employees and that is the agreement. Labour on behalf of employees say too many deductions were being carried out in their earnings, so labour in the light of the need to expand benefit to cover more services and diseases, said we should carry them along to see where more resources can be mobilised. Let me add that the scheme takes care of preliminary of diseases. If for instance, a lady notices a lump in her breast, she will have biopsy and if it is not advanced, she will have radical mastectomy. It depends on the level of cancer we are talking of here. If it is confirmed as malignant cancer, she cannot get chemotherapy or certain treatment, which is exclusive. If somebody has prostate and cancer is detected, radical mastectomy would be given, early cancer can be covered under the scheme, but late cancer, where a person requires real treatment, at the moment, the scheme cannot bear the cost. It is not about what we want, but about what can be given to Nigerians in lieu of the available resources.

The theme of the gathering in Kano was ‘All stakeholders’ summit for the amendment of the National Health Insurance Scheme (NHIS). But only members of the House Committee on Health were prominent, why?

That was supposed to be a re-treat with the Senate Committee on Health. And this aspect is just to know and gather what the people have got to say about the Act. This Act has got a lot of grounds since 2005. It has enjoyed the presence and input of all the stakeholders, but this is the last lap and we’ve gotten the bye-election of the legislators’ now we want to do something with it and use this opportunity to call and bring it back to public domain so that there could be new things.

From the contributions, I have not seen anything new. According to the scores by people, essentially all those we’ve been scoring remain germane and that actually are the areas we want to pump up. And because life is dynamic, you cannot say life is static, you will reach a certain stage and say you can have done with it.

I know this Act went to Ministry of Health and Ministry of Justice. It came back. It was to go to Federal Executive Council (FEC), but there was a new National Health Insurance Scheme (NHIS) Board which called it back saying they want to see it. And that is why it took this long. Am glad that with what they seen and the lecture from the legal luminary- whereby he really dissected and exposed those areas that are controversial, that input is more than enough for a new input by any other body.

Are other stakeholders really carried along, because one thing is to send a Bill to National Assembly, it is another to package it by carrying all other stakeholders along?

That is it! In the last six years, we would have had so many summits and fora and we’ve always carried them along, so as far as am concerned, bringing it to this level is not the end of it because once they take it, they are going to debate it and bring it to public hearing again; so there will be more and more opportunities. But we must give them something on where to start. We do expect there will be some input that will affect what we have now, either a deletion or addition. We know National Health Insurance Scheme (NHIS) is a process, and it is not possible in a country like Nigeria to get everybody at the same time because people have their own trades, you can only invite somebody but you cannot force him to come. You can take a horse to the river, but you cannot force it to drink. So really, that is the situation at the moment with the National Health Insurance Scheme (NHIS). What we are interested in is for this Act to cover every Nigerian as much as possible and recognise the Nigerian that cannot contribute and for the government to take responsibility. If we can get that, then the covering is going to be wider.

As you journey towards this Act, what is happening in National Health Insurance Scheme (NHIS) in terms of programmes?

National Health Insurance Scheme (NHIS) started with only one programme- that is the formal sector programme which is to cover the workers in government and organised private sector. In that light, knowing that not all Nigerians are employed, we’ve developed so many programmes over the years, such as Community Health Insurance which was flagged off by the President in December, together with voluntary contributors. That addresses individual that is self employed and interested and that will be contribute. That is also part of community insurance. We’ve developed that programme and tested it and it is working. Now, we are going to cite some sites- about 50 up and down the country. Before we agreed on the number 50, we did an initial inventory-Micro Finance groups in Nigeria; Corporate Societies; all artisans etc. We had close to 70 consultants and they went into nooks and crannies of Nigeria and that is as a result of our activities based on that, we developed some parameters to select those that are likely to quality, because they must score according to our rated parameters which is 70 per cent and above. We’ve selected 50 per geo-political zones and now we are going on verification, to interact through advocacy, identify for instance- do they have a hospital they can access, because you cannot have a community where they cannot access care. This is work in progress. Before the launch, we were engaging different communities for the community health insurance. We’ve developed a programme for students in tertiary institutions-Universities, Polytechnics and monotechnics, etc.

The Health Maintenance Organisations (HMOs) are already piloting that now and we will launch that early this year. You know, some of our students who are above 18 years and are not gainfully employed are covered. Likewise, retires, the PENCOM Act did not accommodate health component. When people retired, they get older and get some diseases like diabetes, more hypertension and other diseases that naturally come with advancement in age. There is now a retiree programme which we’ve been working on in the last two years.

In the last four years, we have had national summits, now we are on zonal summits to get final input from all the groups- how to finance it, what benefit package they are supposed to enjoy and what diseases are to be covered. Because they must get some subsidies, where would the resources come from?! That is another one. The Armed Forces are under 100 per cent cover throughout life, even if they are retired, they will continue to get cover. The Ministry of Defence have written and about to get the approval of the Federal Executive Council (FEC), they got that from our input we have another programme which we would like to be recognised in this Act, that is, the vulnerable. It is for Nigerians who are physically challenged like prison inmates, indigents and orphans who cannot afford care. The programme is tagged ‘Safety Net’. There must be a pool of fund called ‘Safety Net’ that can give them cover 100 per cent. There are many areas from which you can mobilise these resources. Already, we’ve thought of National Health Bill which impacts some amount of money that can be used. That is innovative. In addition, in the operations of NHIS, it is not all a bed of roses.

Can you expatiate on these?

We’ve reviewed the blue-print of all packages; we are awaiting the final report and asking the government to take a look and approve it. We’ve all the benefit packages from primary, secondary and tertiary levels of care. About 38 specialists were selected and they sat for two weeks. They were trying to do the job. We extended for six weeks and we’ve about three benefits packages all comprehensive. Nigerians have been complaining that there are no provisions for cancer, renal failure transplant among others. Now there is everything there. There are now two forms-optimal and basic. We have given those to relevant bodies to complete and see how much it will cost and how much people or beneficiaries can afford. It is giving much people options of choice. And we will make them to know what each package entails. In the Kano workshop, somebody said, what was NHIS doing about drugs lists. All these are being reviewed. In state hospitals, before it was 15 days cumulating, but now 21 days. When people speak like this, we know they don’t know, it is just an argument.

Concerning Health Maintenance Organisations (HMOs) right now, some are delisting individual enrolees, asking them to either withdraw voluntarily or they get delisted because they intend to take on corporate clients. As a regulator, is this permitted?

As regulator, we must first find answers to some questions. Are the enrolees in organised private sectors or federal enrolees? We need to get the facts of what is happening with the HMOs with their private companies being de-loaded from HNIS. Sometimes back, providers were saying some HMOs are owing them over one billion naira, and expected NIS to get them their money. I enquired why the HMO were owing so much when we paying them upfront. They told me these were private business. And I told them that when they were recruiting and signing papers, NHIS did not know, and now that it is sour, you want us as regulator to come in. The same applies to what you have just hinted. We have a way people complain to us- an online service that is 24/7; website and people do write us as well. So am not aware of this brief by you. But if the provider is guilty of such, we need to get a formal complaint from the affected enrolees so we can go after that development as a regulator. No one goes after somebody without an official complaint. A candid example is of three months ago, when a provider complained that so, so, so is happening. I encouraged such to formalise it, but said he was just giving me information. I insisted he should write, but he declined and I told him I am not his houseboy he can order about without evidence. So that is an example of market talk, it holds no water. People should take responsibility to device genuine information, not using us as regulator to witch hunt. If I have evidence, I will call the provider and find out the details and know what to do as a regulator.

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‘Why health insurance scheme can’t cover every Nigerian’