The Governing Council of Nigeria’s National Health Insurance Scheme (NHIS) says the scheme is near a “tipping point” and may collapse within the next three years unless urgent measures are taken.
“This tipping point may occur sooner if remittances decline further, budget deficit trend persists and the management fiscal indiscipline continues,” it warned.
The council gave the warning in the concluding part of the nine ‘infractions‘ it listed against Usman Yusuf, the Executive Secretary of the scheme , after it on October 18 suspended him over allegations of fraud and infractions.
Mr Yusuf ignored the suspension, saying the council had no power to suspend him. With the help of armed police officers, he was able to get himself into office after the controversial suspension.
Activities remained grounded at the agency since then, with workers and management pitched against each other until President Muhammadu Buhari ordered the controversial official to proceed on an ‘administrative leave’.
Mr Buhari approved the establishment of a seven-member panel to probe Mr Yusuf’s alleged infractions after he ‘dissolved’ the panel earlier set up by the governing board and annulled the board’s appointment of Sadiq Abubakar as acting executive secretary.
The president deployed Ben Omogo, a Director of Administration in the Office of the Head of the Civil Service of the Federation to “oversee the affairs of the Scheme” for now.
In the document sighted by PREMIUM TIMES, the council explained how “pervasive corruption and turmoil which is past, present and ongoing” will eventually lead to the end of the scheme soon if not checked.
The council said it had “unfortunately” been trapped in a vicious cycle of conflict and corruption swirling around the scheme since the council’s inauguration earlier in March.
“Our dreams to contribute the rich resources of members’ professional, corporate and administrative experiences to add value to FGN vision for the agency is constantly frustrated by non-collegial leadership approach of the Executive Secretary.
“We are pained that council meetings are reduced to acrimonious and confrontational platform for management staff and ES to air petitions and counter petitions of corruption and present frivolous housekeeping matters. In fact, council efforts to restore the agenda, refocus the agency and on a strategic path and change the narrative is resisted at every turn.”
The council expressed deep concern about the situation which it described as “incremental drift that may tip NHIS into financial, operational and organisational collapse.
“In fact, we must reiterate that with current deficit budget trends and dwindling net reserve funds, the probability of the scheme collapsing withing three years is high.
“This tipping point may occur sooner if remittances decline further, budget deficit trend persists and the management fiscal indiscipline continues.”
Since Mr Yusuf’s reinstatement after a previous suspension by the health minister, the agency has been engulfed in infighting as the executive secretary and some senior officials traded accusations of fraud.
Apart from several allegations that affected operations of the scheme, for which Mr Yusuf was suspended last year, PREMIUM TIMES reported more recent allegations levelled against him by the governing council of the agency.
The council repeatedly rejected the 2018 budget of the scheme over alleged ‘padding’ by Mr Yusuf.
Sources at the NHIS further explained the fears of the council.
“What the governing council is saying about the imminent collapse being worrisome is that remittances to the scheme even from the federal government has declined in recent years. So in other words, less and less money has been coming to the scheme from the government” a senior official who would not be named for fear of being victimised explained.
“While the scheme is receiving and holding less funds progressively, we are having leakages and abuse of funds here and there. If funds continue to be lost through these leakages and remittances to the scheme are dropping progressively then the pool of funds for the scheme will shrink drastically. This is why the council projects that in three years if it continues like this, we will be in trouble.”
The NHIS Conundrum
While millions of Nigerians remain uncovered with the few enrolled under the scheme complaining of inadequate service delivery, the NHIS has reputably become the centre of power tussle in the health sector.
Mr. Yusuf’s almost three years reign at the agency is notable for controversies. He has been on war path with the Minister of Health, Isaac Adewole, who supervises the agency.
He posed an ‘untouchable,’ said workers who accuse him of ”high-handedness”, and on many occasions brazenly disregarded directives from higher authorities.
When he was previously suspended last year by the health minister, the executive secretary challenged the sanction, saying the minister has no power to suspend him. Mr Adewole then asked a panel to investigate the allegations against him.
He, however, was reinstated in February by President Muhammadu Buhari despite his indictment by the panel that probed the allegations against him.
While the president is yet to make public his resolution on the panel report submitted to him, Mr Yusuf would later accuse members of the panel of being paid N19 million each after his suspension was effected last year.
He made the allegation when he appeared before an ad-hoc committee set up by the House of Representatives to investigate the latest controversy trailing the scheme last Friday.
He also alleged that the health ministry requested N975 million, “which he turned down”.
Similarly, in his second suspension by the council over similar allegations, Mr Yusuf brushed aside the sanction until the president’s intervention.
He also instituted legal action against the ministers of health and justice as well as the NHIS at the Federal High Court in Abuja, challenging his suspension.
During last Friday’s appearance before the ad-hoc committee, Mr Yusuf described his suspension by the governing council as a ”coup” against transparency which he stood for at the agency.
He told the committee that he was suspended on October 18 because it was the day he was due to present to the board a report of the violation of the public procurement processes at the agency.
The executive secretary alleged that he was also expected to present before the board a forensic result of the activities of HMOs (health maintenance organisations) as well as a report of the NHIS performance.
Nigerians, The Losers
Corruption and poor management in the NHIS predates Mr Yusuf, a PREMIUM TIMES report showed.
Ultimately, enrollees and those yet to be registered but have hopes to access health services at reduced cost are the main losers in the upheaval at the NHIS, an official of the scheme explained.
“They (Nigerians) are the losers eventually because in all of this crisis, nobody is talking of the quality of services rendered by NHIS. Even in his so-called reformist agenda, Yusuf has not had a moment to address the quality of service the enrollees are getting at the NHIS. He has always been conscious of money.
“The operation of health insurance in Nigeria is for expansion to cover many more Nigerians. Its our mandate in ensuring universal health coverage, but this has received zero attention under Yusuf. He is not doing anything to expand coverage of NHIS to more Nigerians. Now the average coverage is three percent”, he noted.
It was because of what Nigerians go through in the quest for often expensive medical care that brought about the establishment of NHIS.
However, since its establishment 13 years ago, a majority of Nigerians are yet to be covered under the scheme. Mr Yusuf said earlier this year that over 90 percent of Nigerians are not captured under the NHIS.
Many have traced the relative poor coverage to the structure of the scheme which has been tainted with financial irregularities which had gone unchecked even before Mr Yusuf took over in 2016.
In fact, many described the arrangement of the scheme as skewed against the people.
NHIS deals with two major operators; Health Maintenance Organisations (HMOs) and Health Service Providers (HSPs). The agency disburses money to the HMOs every three months who in turn pay the health service providers monthly for health services of enrollees.
But there have been complaints that the scheme is unable to relieve Nigerians of their health finance burdens as a result of which people still largely spend out of pocket for health care.
At least 450 petitions were sent to the National Assembly by frustrated Nigerians. The complaints ranged from lack of attention by hospitals, delayed attention, low drug dispensing to enrollees in the scheme and sometimes rejection of patients because of the inability of HMOs to meet their payment obligations to hospitals.
Calls for investigation into the activities of the scheme prompted a public hearing by the House of Representatives last year June on how N351 billion was spent by the scheme since inception.
Mr. Yusuf at the hearing blamed the HMOs for the failure of the NHIS to deliver on its mandate.
The HMOs were engaged in 2005 and had operated freely for 13 years without formal examination of their operations, he said.
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