Six things Nigeria’s new health insurance chief must do to stabilise NHIS

Mohammed Sambo submitting and signing his letter of appointment at the NHIS head office in Abuja on Tuesday.
Mohammed Sambo submitting and signing his letter of appointment at the NHIS head office in Abuja on Tuesday.

The axe finally fell on Usman Yusuf last week Monday to herald an end of a stormy three-year stint as Executive Secretary (ES) of Nigeria’s health insurance scheme, NHIS.

Fettered with crisis and controversies, Mr Yusuf’s reign at the NHIS saw the official sent on suspension twice within a year; accused of fraud, gross misconduct, insubordination and continuous infighting with staff and management of the scheme.

So when President Muhammadu Buhari ultimately terminated his appointment based on the recommendation of a probe panel set up eight months ago to investigate the official for alleged fraud and infractions, workers at the scheme heaved a sigh of relief.

Thereafter, the president appointed Mohammed Sambo to replace Mr Yusuf.

The appointment, however, came with mixed feelings largely because the NHIS appears jinxed with a leadership crisis, a situation linked to the poor performance of the scheme.

The NHIS leadership seat appears too hot for anyone to sit on since the inception of the scheme almost a decade and a half ago.

Between 2012 and 2019, the NHIS has had seven executive secretaries – both acting and substantive heads – with the new appointee being the eighth.

Before Mr Sambo’s appointment, Nikki Mohammed, Dogo Mohammed, Abdulrahman Sambo, Femi Thomas, and Mr Yusuf were substantive heads of the scheme between 2005 and 2019.

Each had an average of 20 months on the seat as substantive heads even though an NHIS executive secretary is meant to serve for five years per term.

Apart from Mr Dogo, who managed to complete his tenure, other past heads of the scheme faced similar fates as Mr Yusuf.

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Though Mr Sambo, a professor of Community Medicine and Epidemiology, was described by keen observers as rather a sharp contrast to his predecessor and received with high hopes, a question on whether he can weather the storm and break the jinx of the leadership crisis in NHIS has become rife.

Partly mined from interviews with Mohammed Dogo, a former head of NHIS and workers at the scheme, PREMIUM TIMES enumerates six urgent steps Mr Sambo must take to break the jinx of leadership crisis and get the scheme up and running.

Do Needs Assessment

“If I were him, I will do a rapid need assessment of NHIS first and see what are the gaps,”, said Mr Dogo, whose reign at the NHIS came to an end after Abdurahman Sambo was appointed to take over from him in February 2012.

“He has to do SWOT analysis to access the strength and weakness of the agency, identify areas where he needs to concentrate as someone coming during crisis.”

Mr Dogo admonished the new head to address pressing issues head-on, “prioritise and then rank them”.

Reunite workers

Currently, NHIS workers are divided into two parallel unions: the Association of Senior Civil Servants of Nigeria and the Nigeria Civil Service Union.

The latter, which was allegedly supported by Mr Yusuf, is widely considered ‘illegal’ by the former which has the majority of the staff of the agency as members.

Instead of making efforts to unite workers, Mr Yusuf stoked more division that further aggravated the tension at the agency by trading accusations of fraud with top officials upon his return from his first suspension.

To ensure optimal output and high morale among workers, Mr Dogo said the new official should call and listen to both unions and find a way to reunite workers.

Follow due process

Mr Sambo was advised not to toe the line of his predecessor who allegedly ran the scheme with an ‘iron fist’, flouting laws, and breaking protocols and financial regulations.

“To avoid conflicts, the New ES should follow due process and run the scheme in accordance with laid down laws, principles and guidelines,” Chris Achir, a senior official at the agency told PREMIUM TIMES

“He should treat everybody with fairness and equity. Promotions, transfers and recruitment in the scheme should follow due process,” Mr Achir, a principal manager, said.

The official admonished his new boss to develop a strategy for capacity building of workers at the scheme so as to promote industrial harmony.

Work in Sync with management, higher authorities

To avoid scuffle, the new E.S was advised to work in sync with the management of the agency; Health Management Organisations (HMOs); the governing council of he NHIS; and higher authorities, especially the health minister.

There has been a power tussle between the tiers that make up the structure of the NHIS: the management; the governing board and the HMOs.

One of the major highlights of Mr Yusuf’s alleged leadership was his disregard for laid down regulations and constituted authorities.

He was suspended twice within a year. The first was by ex-health minister Isaac Adewole and then the NHIS governing council.

In both instances, he defied the sanctions by refusing to comply.

Complete abandoned buildings

A recent check at the Abuja office of the NHIS showed that the scheme is suffering an accommodation crisis as many staff do not have desks or work tools.

“I cannot give you a graphic number but I am telling you there are some departments that more than half of the staff do not have offices today. The principal officers, senior officers, senior managers, level nine officers, assistant managers, all of them, no offices,” Mr Achir said.

Some staff argued that the situation would have been reversed if management had completed the building of a multi-purpose office complex it started four years ago.

In what has come to be labelled by government and private investigators as vastly inflated, the NHIS purchased a landed property almost a billion naira in 2015.

Since then, the property has remained undeveloped as it is currently covered in bushes and refuse.

“Though not immediately, it is necessary for the ES to start putting plans together on how to develop that property to solve this accommodation crisis which is responsible for the low morale and disaffection among staff,” the official said.

Learn from past mistakes

Mr Achir also advised the new ES “to study and learn from mistakes made by his predecessors to avoid falling into the same pothole.”

“Since 2012, there has been a high turnover of executive secretaries,” Mr Dogo said. “The new ES is number 8 in just seven years. He has to have an idea of what is really behind this.”

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