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The Guardian’s Special Focus on Most Dependable and Value-Driven HMOs in Nigeria

By Guardian Nigeria
02 October 2022   |   7:16 am
It is no longer news that health insurance is an important mechanism to prevent financial hardship in the process of accessing healthcare services. What is of great concern is the fact that since the launch of Nigeria's National Health Insurance Scheme (NHIS) in 2005, only 59% of Nigerians have health insurance and 70% still finance their healthcare through Out-Of-Pocket (OOP) expenditure!

It is no longer news that health insurance is an important mechanism to prevent financial hardship in the process of accessing healthcare services. What is of great concern is the fact that since the launch of Nigeria’s National Health Insurance Scheme (NHIS) in 2005, only 59% of Nigerians have health insurance and 70% still finance their healthcare through Out-Of-Pocket (OOP) expenditure!

Although experts and keen watchers are of the opinion that understanding the contextualized perspectives of stakeholders involved in NHIS is critical to advancing and implementing necessary reforms for expanding health insurance coverage at national and sub-national levels in Nigeria, the nation still awaits this reality.

Unfortunately, apart from the public distrust of health maintenance organisations (HMOs), there is equally distrust between HMOs and healthcare providers on the other hand. Sadly, some of these firms are known to always fall short in their obligations to healthcare providers. This needless saying has contributed to weakening public trust in them the more, thereby eroding confidence in the National Health Insurance Scheme, as a whole.

However, despite this myriad of challenges which include the rapidly growing population, coverage to only one sector of the population, lack of awareness of the scheme, distrust, shortage of human resources, and lack of funds to implement the scheme, there are a number of highly dependable, reliable, credible, honest, and financially-capable HMOs who are consistently fulfilling their obligations to healthcare providers and enrollees.

The Guardian showcases a number of these dependable organisations. These include Total Health Trust Ltd; Venus Medicare Limited; International Health Mangement Services (IHMS) Limited; Songhai Health Trust Limited; with input from the Health and Managed Care Association of Nigeria (HMCAN).

Toyin Deinde, Ag. COO, Total Health Trust Ltd

TOTAL HEALTH TRUST LTD:  Working Together To Make Nigeria Healthier

After 24 years of service, Total Health Trust (THT) Ltd – a member of a leading financial services group on the African continent continues to offer local and international health insurance and wellness solutions to micro-enterprises, SMEs, large local corporates, and multinationals in line with global standards, underpinned by solid corporate governance and experienced leadership.

THT remains the preferred and trusted health insurance and wellbeing partner to over 400 employer groups in Nigeria. Operating a business that is driven by “why”, which is “working together to make Nigeria healthier”, the company offers a wide range of health insurance plans, with products and services developed to meet the financial capabilities of its audience in the Nigerian market. 

As one of the leading, value-driven and dependable health maintenance organisations (HMOs) in Nigeria, THT spoke to The Guardian on the new NHIA Act, 2022, innovation in the nation’s healthcare sector, THT’s unique product offerings, amongst sundry issues. Excerpts…

Achieving maximum health coverage for vulnerable Nigerians- policy, strategy, modification

In our opinion, financial risk protection is one critical area. There has been low enrolment with just about 5% of Nigerians covered since the inception of NHIS in 2005. Such levels put the vast majority of the populace at risk of financial hardship in the event of severe health challenges. By increasing the dragnet as it were, there will be more funds to cater to the vulnerable population and this will enable the enrolment numbers needed to achieve set targets in the healthcare delivery sector, otherwise, the entire value chain becomes overburdened.

Another area that we must address is the infrastructural deficit. Once we generate the right pool of resources, we must give investors confidence that their investments will be protected and that they can recoup their investments with the least level of disruptions. Ultimately, we can now provide ready access to care, manned by qualified professionals at the right facilities enabled by technology. 

Innovation for Nigeria’s Health Sector

Summarily, there are several promising prospects that this innovation brings along if we get it right and allow the right people take the lead. This includes but is not limited to increased investment in the sector (technology, drugs and consumables’ manufacturing, training and manpower development, co-opetition and collaborations), decline in out-of-pocket payments by the populace if mandatory health insurance is implemented and establishment of more healthcare facilities.

Government support to effect a noticeable change in the sector

The journey must start with human resource training, acquisition, retention, and development to stem the brain drain that we are experiencing as a nation. We must fund research that will drive innovation. The emigration of the medical personnel in Nigeria is a factor that vulnerable Nigerians put up with daily; the long queues they endure in the waiting room alludes to this. Welfarist policies must be built on a clearly thought out framework if we intend to see the successes replicated in other successful economies here in Nigeria. This framework must be backed by sustainable healthcare financing, which is what we at Total Health Trust Limited, our partners, and investors are working relentlessly to achieve. 

We need to do more about governance and that is why we talk about “frameworks, systems, and sustainability”.  A successful and result-oriented national policy in the health sector must be a collaborative effort by all concerned parties, driven by the NHIA as the regulator as stipulated in the law and backed by all state actors and stakeholders bound by common belief.

Data is also key to the development of this sector. Not just data gathering, but holistic data analytics. This will show us in the right direction and help us make the right decisions.

THT’s unique products/services, operational success 

Firstly, our expertise. Our people are at the heart of what we do. We make bold to say that our team is carefully curated, with the right mix of experience and energy driving our various teams. This expertise spans actuarial, clinical, risk management, fund management, product development and stakeholder engagements among others. These functions underpinned by digital and technology platforms ensure that we can create unforgettable experiences for our members. At THT, our business is run on an integrated system. We offer healthcare delivery services through a tested and guided structure that enhances prompt intervention for our members wherever and whenever it is needed so that intended clinical outcomes are not jeopardised. 

Lastly, the wide bouquet of offerings delivered through our wide provider network is another differentiator. This is enabled through values that we live by – creativity, accountability, customer-focus, integrity and excellence. These values help sustain partnerships that we hold dear to our hearts whether across the 36 states of the federation or while delivering our pan-African coverage or through the Global Elite plan that offers cover anywhere in the world except North America. 

THT quality assurance, brand equity 

It may not be fair to be the judge in our own case, but Nigerians attest to our uniqueness and our brand equity through their votes. We are 4-time winners of the Nigerian Healthcare Excellence Awards (NHEA) as HMO of the year. This we have won in the last 6 years. We were also awarded the Employee productivity partner of the year (2020) by the BusinessDay’s Bank and other Financial Institutions (BAFI) Awards. 

We are not there yet but we are committed to continuously improving the way we service and support our clients and position ourselves as the preferred and trusted health insurance and well-being partner in Nigeria.

Areas of growth expectations for THT and the industry 

We already are on a promising growth trajectory, as seen with the 100% acquisition of THT by “Tangerine”, an omnichannel digital-led financial services platform, with businesses in life insurance, general insurance, and pension fund administration. The acquisition will fuel THT’s financial, technological, and geographical growth plans. This development excites us as it will ensure that we become more competitive and future-ready in meeting the requirements of tomorrow’s ideal customer.

Dr. Leke Oshunniyi, Chairman, Health and Managed Care Association of Nigeria (HMCAN)

“A well-implemented NHIA Act, panacea to Nigeria’s disorganized healthcare system” – Oshunniyi

Dr. Leke Oshunniyi, a former Mobil Scholar, is a seasoned private medical practitioner and health administrator and Director of Royal Cross Medical Centre Lagos since 1990. He has been the Chairman of the Health Sub-committee of the Nigerian Economic Summit Group (NESG). He is the Managing Director and Chief Executive Officer at AIICO Multishield HMO Limited and also a Co-founder and current Chairman of the Health and Managed Care Association of Nigeria (HMCAN) – an umbrella body of Nigerian Health Management Organizations.

Oshunniyi spoke to The Guardian on the development in the Nigerian healthcare industry, the significance and implication of the newly enacted NHIA Act 2022, innovation and prospect in the nation’s healthcare sector, amongst others. Excerpts … 

Given the recent enactment of the new National Health Insurance Authority (NHIA) 2022, as a key player in this sector, what is your overall assessment of the healthcare delivery system in Nigeria?

Without a doubt, the NHIA Act 2022 is the most important piece of legislation, regarding Healthcare, since independence. It points the way to Universal Health Coverage by making it mandatory for every resident of Nigeria to subscribe to the Social Health Insurance Scheme, as defined in the law. It is envisaged that through the Vulnerable Fund, Government at different levels, will pay premiums for the vulnerable members of society, including the economically disadvantaged, the young and the aged.

Currently, the healthcare delivery system in Nigeria is highly underfunded, fragmented and disorganized. At the federal level, we have been unable to comply with the Abuja Declaration of 2001, which urged member states of the African Union to pledge at least 15% of their national budgets to Health. Worse still, it is estimated that more than 70% of healthcare delivery in the country, is by out-of-pocket payments in the private sector. The NHIA Act, if well implemented, should provide the pathway to a solution, to the perennial problems plaguing our health system.

As the arrow head for the umbrella body of the association of the nation’s health maintenance organizations (HMOs), what do you consider as the critical areas of modification and strategy for implementation of the policy of achieving the maximum health coverage for vulnerable Nigerians?

In Section 1, sub-section 3(a), the National Health Act of 2014 makes reference to a Basic Minimum Package (BMP) of Health Services to citizens. I expect this package to be defined and articulated in the implementation of the NHIA Act of 2022, in such a manner that over 90% of ailments will be covered under the social health insurance scheme. However, the BMP cannot be all-encompassing Healthwise. One could liken a basic health insurance scheme to the 3rd party type of motor vehicle insurance. For better cover, a higher end comprehensive-type insurance is required. This is where HMOs would find their relevance, in the provision of supplementary and complimentary schemes, for those who desire a more complete and robust health insurance cover and can afford it. We must not make the mistake of trying to enforce a one-size-fits-all type of system, simply because many very good hospitals will NOT participate in the social health scheme, because the tariffs thereon, would be considered as being much too low. To ignore the critical element of CHOICE would be to drive Nigerians back to the bad old ways, of out-of-pocket payment for health services, which would ultimately discredit and destroy the social health scheme.

What prospects do you think this innovation will bring to the nation’s health sector?

The first clear benefit, is better and more predictable health financing. If sufficient tax was being collected from citizens, the NHIA Act might not have been necessary. With a Tax/GDP ratio estimated at 6%, Nigeria is near the bottom globally, in terms of Tax compliance. In comparison, many European nations record Tax/GDP scores of between 40% and 47%. To call Nigeria a nation of Tax evaders would be insulting. I would rather use the term Tax avoiders. Inevitably, we must widen and deepen our Tax net, if we are to develop as a nation.

What other policies or support do you think the government needs to put in place to effect a noticeable change in the sector?

I would recommend one baby step at a time. Let us first operationalize the NHIA Act by articulating the Guidelines which would act as a roadmap. I am delighted to mention here, that I have been assured severally, by the DG of the National Health Insurance Authority, Professor Mohammed Nasir Sambo of his plan to ensure that ALL stakeholders are carried along in the crucial task of designing the Guidelines to the NHIA Act of 2022.

It has been alleged public distrust that some HMOs always fall short in their obligations to healthcare providers and on the other hand, there is a rift between HMOs and healthcare providers. What are the efforts being made by HMCAN to curb this unwholesome situation?

Where does the money paid to Providers, through the HMOs, come from? Are the sums sufficient to meet the healthcare obligations of subscribers? It is strange that no one ever asks those questions. HMOs are simply intermediaries, for entities desirous of purchasing healthcare for beneficiaries. In the Private Health Schemes, many organisations either do not pay in a timely manner or pay sufficiently. This is a major reason why HMOs are unable to meet obligations to providers. The HMO community simply chose not to “Wash dirty linen in public”, by disclosing the real facts of the matter.  

Under the repealed NHIS Act, health insurance was optional, therefore sanctions could not be applied to erring institutions. In the past, I have had cause to seek redress in a court of law to recover unpaid premiums. Providers are totally unaware of our travails. Under the new law, sanctions ranging from hefty fines to jail terms have been prescribed for contraventions. This will definitely bring sanity to the industry.

What other area(s) of growth do you expect of the industry in the next five years, and beyond? 

Today, less than four percent (4%) of Nigerians have health insurance cover. I look forward to a Providential journey, whereby there will be a minimum ten-fold increase in this abysmal percentage. Then and only then, will we commence our advance to Universal Health Coverage (UHC).

Barr. Bello Bawa Bwari, CEO, Songhai Health Trust Limited

SONGHAI HEALTH TRUST LIMITED: Providing Affordable Products/Services of International Standards, Accessible to All Nigerians

Songhai Health Trust Limited (SHTL) is one of the first generation Health Maintenance Organizations (HMOs), incorporated in 2001 and has grown to become one of the leading HMOs in Nigeria.  SHTL is one organisation that takes pride in being driven by ethics in the provision of managed healthcare services to public and private sector employers/employees, as well as its teeming population in the informal sector. The company services are provided under a prepaid arrangement, in partnership with a network of carefully selected healthcare providers spread across the country. 

With highly standardised products and services designed with due consideration to the varied needs and ability to pay, SHTL’s offerings are of high quality, affordable and reliable. This range of unique health plans covers individual, family and corporate. It then comes as no surprise that SHTL works with over 1,950 healthcare providers in 14 locations, and equally, caters to over 126 corporate clients cutting across all sectors of the nation’s economy.

With a vision to become the most efficient managed care service provider in Nigeria, SHTL’s healthcare plans cover promotive, preventive and curative healthcare services and are specially designed to address the varied needs and ability to pay of individuals and families. 

At the apex of the company, the structure is the board of directors comprised of seasoned, accomplished and trustworthy professionals with diverse backgrounds. According to the Managing Director and Chief Executive Officer of Songhai Health Trust, Bello Bawa Bwari – a trained lawyer, businessman and entrepreneur with over 15 years of working experience, “Our flexibility also allows us to develop customized healthcare plans tailored to address unique peculiarities, and provide a personalized healthcare experience, through the cost-effective solution, seamless technology and transparent engagement with all stakeholders.”

He added that “SHTL’s goal is to ensure that quality healthcare services that meet international standards are made available, accessible and affordable and delivered ethically to our clients, through a network of accredited healthcare providers across the country.”

Bwari explained further that “There are many factors that have come into play to giving SHTL its brand equity in the Nigerian healthcare market. The first part is complete adherence to corporate governance – we have different stages in the management of the company with integrity and credibility. We have one of the most experienced and competent boards in the entire industry. In addition, we have quite experienced hands in the organization – people with robust knowledge of the industry and customer service. These combined factors have enabled us to reposition SHTL to create a new value for our customers which has helped in projecting the company positively.”

In terms of the key strategies that other sectors can learn from Songhai Health Trust to achieve result-oriented operations, the health insurance expert noted that “part of what has led to SHTL’s excellent performance is understanding the needs of the client and keeping a close relationship with the healthcare service providers ensuring that there is good communication. Similarly, we do not default on our responsibilities to them, we operate a transparent system of engagement between our company and the stakeholders in the value chain. This is one of our greatest strengths and we will continue to push that, to do better.”

While rating the quality assurance of his brand, Bwari pointed out that “Without sounding boastful, I know for certain that the service we provide here is exceptional and we do as much as we can to ensure that we move beyond some of the challenges that will possibly discourage any company from forging ahead. The commitment of our staff is unequalled and also the stakeholders have been cooperating very well with us.”

Concerning how effective Songhai Health Trust’s grassroots advocacy on health insurance, he disclosed that “Songhai HMOs is present in all the geopolitical zones of Nigeria and our activities with most state’s healthcare Insurance Scheme has exposed us to large individual roles at different levels in society and this makes it possible for us to encourage them in understanding the importance of a healthy society and health insurance, itself. Most of all, knowing full well of the advantage of health insurance is reducing, if possible, even closing out of unexpected pocket expenditure on health, and many people seem to be embracing that. We are making good progress with that. And we’ll continue to make good progress.”

While reacting to the recent enactment of the new National Health Insurance Act 2022, and the implication for the health delivery system in Nigeria, the SHTL’s boss believed “the Federal Government has done very well in the pursuit of universal health coverage because there is no country that survives when its citizens do not have access to quality care and healthcare delivery, reaching to the very doorsteps of even those in the most remote areas, particularly for women, children and the vulnerable group in society. Therefore, filling the few gaps in terms of the actual practical implementation of the bill as a whole is not something that will happen in a flash. It is going to take time. What I think the NHIS is making continuous progress in terms of making this come into reality and as we go along, there is going to be a great improvement in the nation’s healthcare delivery system.”

Dr. Chidi Ukandu, CEO, International Health Management Services Limited (IHMS)

Why IHMS’ affordable, reliable healthcare packages, best for Nigerian families, organizations

The NHIS Formal Sector Scheme includes the Federal Government sponsored Formal Sector Programs, and State-supported Social Health Insurance Programs, while NHIS Tertiary Institutions Social Health Insurance Plan (TISHIP). This plan is for students in tertiary institutions with a premium of N2000/annum. 

The IHMS Group and Individual Social Health Insurance Plan (GIFSHIP) is for Individuals and Families under the National Health Insurance Scheme and is marketed and managed by IHMS. 

For the Private Corporate Health Plans, we have the IHMS Corporate Health Plans which are for organizations with a minimum of 20 staff members. It covers individual staff members with/without their families, Health coverage is comprehensive and includes general and specialist consultations, admissions, surgeries, maternity care, eye and dental care etc.

The IHMS SME Health Plans are designed for Small and Medium Scale Enterprises whose staff strength is not up to 20 but is more than 9. The plan covers the staff and family. Health coverage is the same as in the IHMS Corporate Health Plan but may be slightly limited in scope.

The Easy Health Plan is a low-budget plan for junior and contract staff. It covers conditions as listed in the National basic care document and the premium is highly pocket friendly, while the IHMS Pro-Life Wellness Plan. The plan is a preventive, wellness, and health promotion programme that is based on research studies that have proven that people who take good care of themselves and make healthy lifestyle choices are healthier, happier, and more productive, miss work less, and have lower healthcare costs.

The IHMS Worksite Clinic Administration Plan – an arrangement where IHMS sets up and manages a clinic for the purpose of taking care of the health needs of an organisation’s staff. The clinic is usually located within the premises of the organisation.

The IHMS Third Party Administration (TPA) Plan, As the name implies, IHMS acts as a third party in the payment and management of healthcare delivery. It is not Insurance based and so you don’t pay any premiums. IHMS performs functions ranging from Provider engagement, Utilization Management, Claims Management and Quality Assurance etc for a fee. Lastly, the IHMS Retail Plans are for Individuals and families that are not under any of the other plans.IHMS clients stand to get seamless access to quality healthcare facilities and professionals all over Nigeria and overseas.

When it comes to quality we do not compromise. Our choice and standard of healthcare providers are hinged upon our goal of providing the best healthcare services for the satisfaction of our clientele.

Access to emergency medical care.

Emergencies are unexpected events that sometimes meet people in financial conditions that cannot cater for them. With an IHMS plan, you are guaranteed access to emergency health care irrespective of the plan you choose.

Predictability of healthcare expenditure annually.

Now, you can predict exactly how much you get to spend in a year on healthcare. No more irrational unplanned healthcare expenses. IHMS has got you covered. 24/7 Call center and Live chat support. Your staff members get 24/7 access to our dynamic customer care agents for quick resolution of issues and seamless service delivery.

Dedicated medical/admin service personnel for your company.

We know how important it is for you to access quick healthcare services and so in addition to the customer service you receive from the call center, you also get a medical/admin service official dedicated to your staff members.

Seamless enrollment process.

Even if you have hundreds of thousands of staff members, they can all get enrolled in a few minutes and with a few clicks. No more paper-based enrollments.

Significant reduction in current healthcare expenditure.

And yes! You get to spend lesser too. 

Enhanced staff productivity and increased Return on Human Capital Investment.

It is true that a healthy staff is a happy staff. However, more than that, a staff member whose health is insured is a happier staff member. With an IHMS health plan, you can increase your staff’s productivity and get a higher