By Umaru Muhammed
PEOPLE react to change in different ways especially when introduced by a personality who is convinced about the direction he is headed to. Some oppose change out of fear of the unknown while others who are used to the status quo do so out of worry about losing some benefits they are used to. Also, others respond to that development out of apprehension about the disposition of the change agent especially if he is one who is convinced that what is going on if allowed to continue may not augur well for the establishment. These reactions can and do lead to a chain of activities that can only slow the process of change but not stop it.

Usman Yusuf
Yusuf Usman

This situation may apply to Professor Usman Yusuf who was, on July 2016, appointed by President Muhammadu Buhari, as the Executive Secretary, National Health Insurance Scheme (NHIS).

Within one year of his assumption of office, the scheme experienced a whirlwind of transformation in terms of administration and service delivery. A professor of Haematology and seasoned by three very distinct healthcare systems, Yusuf had come with a wealth of experience that is already yielding positive results within a short period of time. His more than three decades of practice which took him through the Nigerian, UK and American Healthcare systems equipped him with the knowledge and expertise required to put the nascent health insurance policy in the country on a sure footing.

An urgent need to revamp and restructure

The structure of NHIS as at the time he came on board was, at best, shaky. There was an urgent need to revamp and restructure the system he inherited. For the records, the major stakeholders of NHIS are the public and private service employees who are the direct beneficiaries of the scheme; the government enables, subsidises and regulates the healthcare service provision, while the Health Maintenance Organisations (HMOs) which are formed by public and private sectors to collect contributions from employees and employers on behalf of Service providers in turn provide the healthcare services to the beneficiaries.

Proof of his plan to add verve to the operations of the scheme emerged when he set out from the beginning to ask pertinent questions regarding some perceived inadequacies. He embarked on a rigorous exercise of consultations, investigations and deliberations during which he discovered that the major challenges faced by the scheme was the seemingly unimpressive services given to the beneficiaries, a direct result of the inadequacy in payment by the HMOs.

He also discovered that several HMOs he inherited were not paying the service providers promptly in addition to the fact that fake enrolees were added into the scheme for selfish gains. This discovery inevitably led to the cancelation of many enrolees and refunds made to the NHIS by the HMOs. Besides the administrative clean up, Prof Yusuf displayed tenacious dedication towards greatly widening the beneficiaries of the NHIS to include those who are of much less financial strength. From the outset, he decided to involve the Nigerian youths in his policies and plans hence the Tertiary Institutions Social Health Insurance Programme (TISHIP). The programme which is designed to benefit university students was introduced in 2014 but remained largely unpopular among Nigerian youths because efforts were not made to propagate the benefits of the scheme to the target population.

As expected, those who have been living fat off the broken system of the NHIS ganged up against the positive change Yusuf introduced which cut the supply of oxygen fanning corrupt practices in HNIS. With misguided opposition rising against his policies and the drive to achieve them, he remained steadfast. With the support of the Presidency, and the teeming youths of Nigeria, he held on tenaciously to what he believes is the right thing to do. He accused some hospitals and insurance companies of ganging up against him for opposing some sharp practices. He alleged that the action he took against 57 health maintenance organisation (HMOs) operating with expired licenses led to his suspension for six months.

He accused them of doing some unwholesome practices with NHIS’ money in banks and stood firm on his principles that frown at corruption in any way it makes itself manifest.
By the provisions of the healthcare scheme from inception, it was designed to cover 180 million. But as at the time he assumed duty, only three million people were benefitting from the scheme. Of course he asked questions and the hawks in the system became obviously unhappy. It is not unexpected that those milking the NHIS dry would be after a chief executive who has made a point to block all the leakages.

Prof Yusuf, in the course of his actions discovered that there was fraud in the delivery of healthcare services in Nigeria as HMOs manipulated the figures of enrolees to benefit them regardless of the fees paid to it by the government. Only 25 per cent of monies paid out as premium to HMOs was utilized by them. They claimed to have saved 450,000 lives since the inception of the scheme, only a meagre 1.5 per cent of Nigerians are currently covered in the scheme.

It is commendable that under the Executive Secretary, the current House of Representatives was persuaded to bring the HMOs to render due accounts. This became necessary as despite the money paid out to HMOs, the nation’s healthcare delivery system was still at its lowest. Other countries achieve better figures without HMOs. And after 12 years of providing services, these HMOs declared that 450,000 lives were saved.

Increasing the number of enrolees

Prof Yusuf lamented that “Besides using only a fraction of the money paid out to them, HMOs have only succeeded in increasing the number of enrolees. They are padding the figures so that they can get paid for people who are not enrolees”. It is noteworthy that the scheme under his leadership has discovered about 23 million ‘ghost enrolees’ even as it intends to ‘biometrically audit’ the HMOs to check their excesses. Yusuf raised the alarm recently that of the 59 HMOs in the country, none had a valid license just as he implored the legislative houses to remove HMOs from the board of NHIS as their membership undermines the regulatory function of NHIS. Prof Yusuf is also pushing for the NHIS Act to be strengthened to enable it carry out its functions effectively.

From the foregoing it is then no surprise that corruption is fighting back. But the eminent Haematologist is determined to sanitise the scheme and restore it to the prime intentions of government which is to ensure that all Nigerians are captured as part of the health for all policy of government.

Muhammed wrote in from Abuja

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