An Avoidable Scuffle over NHIS

At a period when the relationship between the executive and legislature is at its lowest ebbs, the current brawl between some members of the House of Representatives and the Minister of Health, Professor Isaac Adewole, over an official decision taken at the National Health Insurance Scheme, is not only avoidable but can be better managed, writes James Emejo

On June 22, the House of Representatives Committee on Health Care Services launched an investigation to ascertain the “compliance rate of the Health Management Organisations (HMOs), to the National Health Insurance Scheme (NHIS) contributions and utilisation of funds by health care providers and inhumane treatment of enrollees”, following a resolution of the House on a motion urging probe of the scheme.

Then Executive Secretary of NHIS, Prof. Yusuf Usman, who was present at the public hearing had indicated that about 59 HMOs do not have operating licenses since December last year, noting that their reaccreditation ought to have commenced since July. Usman, in a rare show of courage by a chief executive, exposed alleged fraud being perpetrated by operators in the scheme, and regretted that the HMOs had never been made to account for their stewardship in the past 12 years.

He noted that “More than 70 new born babies and over a 100 women die daily from avoidable mortality, even though they are on the scheme. Millions die across the states and there seemed not to be time to fight these anomalies until now. When I came to the agency, I saw the potential and I felt the NHIS should perform its duties of helping vulnerable Nigerians to access quality health care.

“The number of Nigerians covered by the NHIS after 12 years is 1.5 per cent of the population. Countries like Kenya and Rwanda have achieved better health care delivery without HMOs and health care financing in Nigeria is nothing but a huge fraud. I know all these things because I signed the cheques and nobody has been brought to book in the last 12 years. If you want to hear the truth, hear it from me today, because my way of making the scheme work is to hold the HMOs accountable.

“We are told that they are powerful and untouchable, because they are owned by some powerful Nigerians, but I have news for you that I’m here to rock the boat. We must sink this boat of corruption that has killed the health care sector of our country.”

He didn’t stop there. Continuing, he said: “Honourable members, these people are your constituents, and these guys operating the HMOs owe them huge money. The NHIS is supposed to enhance the standard of health care delivery and crash the cost of health care in Nigeria, but covering just 1.5 per cent of Nigerians in 12 years, have we achieved the objective?

“Now, I went round and demanded that HMOs pay back monies collected without service delivered, or I delist them, and as I speak to you right now, over 95% of the debt has been recouped by the NHIS, and as we speak, there are no HMOs in Nigeria. And we are going to re- accredit all the HMOs in July and when you apply to manage a hospital, I must get a letter of non-indebtedness from the chief medical director of that hospital before you are hired.

“We gave them N37billion just for administrative fees. Patients go to the hospitals and are treated like lepers because the HMOs have not paid the providers. I had to stop it, and they took me to court, EFCC and ICPC, saying that I must be made to reverse to status quo. What should be the status quo, when you hold on to administrative fees and capitation?”
He, therefore, urged members of the committee to audit the HMOs with a view to finding out how many Nigerians had been deprived of their rights to quality health care.

However, during the hearing, Minister of Health, Prof. Isaac Adewole, also attested to the fact that the NHIS scheme was fraught with irregularities. The minister, who was represented by the Director, Hospital Services, Federal Ministry of Health, Dr. Wapanda Balami, said over N351 billion had been paid to the HMOs by the federal government within the past 12 years without measurable improvement in health care delivery for Nigerians. As a result, he said it may be necessary to eliminate HMOS from the scheme.

But barely one week after the stunning testimonies on the alleged rot in the NHIS programme, Yusuf was suspended from office for three months by the minister, stating that the former was being investigated for alleged corruption. But the House promptly passed a resolution condemning the suspension and requested Adewole to immediately recall the Executive Secretary and allow him continue with his sanitisation programme in the agency.

In a motion of urgent public importance moved by Hon. Chike Okafor (APC, Imo) and 35 others on the plight being suffered by Yusuf, the lawmakers believed he was being persecuted by the health ministry due to his revelations at the public hearing.
The House further invited the minister to show cause why he should not be cited for contempt of the House as the suspension appeared to intimidate the ES and punish him for testifying before the House as well as silence him from further testifying before the lower chamber, in its constitutional duties of investigation of issues of corruption, inefficiency and waste in governance.

They raised concern that if witnesses, who testify before Committees of the House are not offered some form of protection but are exposed to various administrative sanctions and intimidation, it will discourage witnesses from revealing the truth and weaken the House’s constitutional authority to expose corruption, inefficiency, fraud and waste in governance.

Notwithstanding the demands of the green chamber, Adewole remained adamant and also failed to appear before the House to offer clarification over his actions. But after failing to appear before the committee last Wednesday, the lawmakers took a position to suspend budget consideration for NHIS pending the appearance of the minister, who was also said to be answering to allegations of corruption and abuse of office in a petition to the presidency against him.

The House further threatened to issue a bench warrant on him should he continue to dishonour its summons. In truth, the controversy generated by the suspension of the executive secretary would have been avoidable if Adewole had honoured the House invitation and simply clarified his actions.

It is of noteworthy that the refusal of members of the executive arm to honour National Assembly summons and invitation had been one of the major causes of the deteriorating relationship between the executive and the legislature – a development which could cause the latter to devise firmer measures to bring agencies to order.

As it is, the present controversy surrounding the NHIS may still be far from over, and at the end of the day, time and resources would have been wasted over what could have been resolved amicably through shared understanding.