‘Why insurance scheme is slow’

• Providers meet in Lagos on May 16 to discuss future

Dr. Umar Oluwole Sanda is the National President Health Care Providers Association of Nigeria (HCPAN). HCPAN was formed in compliance with Decree 35 of 1999 setting up National Health Insurance Scheme (NHIS) to provide approved health services at retainer hospitals to the enrollees. Sanda told The Guardian that the NHIS, the regulator, is distorting the pre-paid scheme by owing the Health Maintenance Organisations (HMOs) and the HCPAN, and the situation has led to backlog of salaries and other challenges facing the programme. PAUL ADUNWOKE writes. Excerpts:

How far with the NHIS scheme?
I can say NHIS, is not moving forward as it supposed. As of now, we have not registered up to 60 percent of Nigerians. All the efforts to see the scheme move forward have not being fruitful in terms of coverage and registering of enrollees. Operationally there is instability is NHIS system.

Yes, there are factors one would consider for the reintegration in the scheme, we have three components in the scheme, NHIS officials, which are the stakeholders, healthcare providers and enrollees, which are people who register for the scheme referred as patients.

Now, we have new executive secretary of NHIS, who believes, there are many problems in the scheme and wants to address the problems. But at the same there is need for the scheme to progress but we have not seeing any sign of moving the scheme forward.

We reliably gathered that the scheme is shrouded with irregularities that HCPN and Health and Managed Care Association of Nigeria (HMCAN) have not received the pre-payment for April? How true is that?
Very true, according to NHIS Act and operational guidelines, payment of salary should be paid through the Health Maintenance Organisations (HMOs) for them to pay people at the primary healthcare providers. The law says we should receive our salary ahead of every month. As I am talking to you I have not received April 2017 salary. It is causing, stagnation, problems in the scheme. Without salaries what will healthcare providers will be used to carry out their duties? It is killing the morale of healthcare providers in scheme who take care for the patients. When the salary is not been paid at the right time it affects service excellence.

Have you contacted the NHIS? What is the response from NHIS?
I have sent many text messages and phone calls to the office of NHIS to pay our workers their salaries but there is no positive response. NHIS officials keep on promising to pay the salary but we are running out of patience.

The government for payment of the salaries has released the money but it has not got to them. Definitely, the money has been released because it is a pre-payment mechanism, in the past the money is been paid directly to HMOs from federal government source and HMOs will upload the money and distribute it to healthcare providers nation wide. For instance, in terms of pre-payment if you want to pay for January salary the money must be ready before 14 of December.

The April backlog salary should have been paid latest on 14 of March 2017 according to NHIS guideline but up till date no salary for our workers. These people who have families to feed and pay school fees for their children and at this moment no salary. I have called office of HMO they claims to be verifying before payment of salary. This backlog of salary started recently because there are changes in officials of NHIS but healthcare providers should be carried along.

What the consequences of this backlog of salaries?
The consequences are that it will kill the confidence of healthcare workers and not been happy while attending to patients. The patients will not be attended to properly which we try to avoid. I have sent email to NHIS national Secretary twice and called his mobile phone in several occasions but there was no reply.

The healthcare providers nationwide would meet in Lagos on May 16, 2017 at Malaria Research Centre, Lagos University Teaching Hospital (LASUTH) Ikeja. We are going to discuss what health insurance mean for Nigerians and all healthcare providers are expected to be there. Lagos State Health Insurance Scheme will be the major topic. With this meeting, it is an opportunity for stakeholders to tell us what is going on in the scheme. We do not want to kill the scheme. Health insurance is the best way for Nigerians in terms of health. It is a best way to solve the challenges confronting health sector in the country.

With NHIS you do no need to put money in your pocket before seeing doctor or go to hospital. We must not kill the morale of people who are involved in NHIS, which include HCMAN and HCPAN among others. We must all work together and HMO will be maintaining relationship between NHIS and providers and the providers provide health service at the grassroots, primary, secondary and tertiary levels.

Is HCPN, planning to go for industrial action?
We need dialog; it is dialog that will solve the problems there is no need of going on strike there is no provision for strike in healthcare acts. Industrial action is not a reliable option to these backlog salaries.

We want the executive secretary of NHIS to host a meeting to address healthcare providers, HMOs to discuss the problems and look for way forward. NHIS is the future of medical practice in Nigeria. In developed countries they have been able to implement their own way of health insurance and they have achieved 50 percent of universal healthcare coverage. In Nigeria we are covering only 4.6 percent, which means we are stagnant what is causing the stagnation? Do we have a good Nigeria NHIS system? Can we faction out a good Nigeria system for NHIS. How can we faction out a good Nigeria system for NHIS.

Lagos state government will soon start their health insurance, Kwara State has started and Oyo State is about to start. So, states across the federation should start their own health insurance because it is away of giving basic health facilities to the general populace. At primary care level alone less the privileged will benefit. NHIS will reduce cost of medical tourism because once a diagnose is made at primary care level there is no way the sickness will become complicated and you begin to travel abroad for the same sickness for treatments.

Other developed countries are getting it right for instance in Britain they have their own system, NHS, among other developed countries. Let us have Nigerian system. We cannot do without a private sector in health insurance. Government alone cannot do it, the private sector must be well informed and all health professionals must be involved. This is the reason we were formed. HCPN include the doctors, nurses, pharmacists, physiotherapists and optometrists. All health professionals belong to HCPN let them not kill the morale of these professionals.”