NHIS covers cancer, other tertiary ailments - Prof. Usman
Executive Secretary of NHIS, Professor Usman Yusuf, in an interview with speaks on the range of services covered by the scheme, the need to extend it to other vulnerable groups and effort to make hospitals involved in the scheme more responsible and respo
What is NHIS doing to assist cancer patients on the scheme especially now that the cases are increasing across the country?
Cancer is covered in patients that are enrolled with NHIS in the formal sectors. Anyone that is enrolled with the NHIS and develops cancer will not be thrown out. This has been the misconception and I’ve had many people calling me to say we don’t cover cancer, but it is not true. If you enroll with NHIS and you have cancer, your case will be covered and I can say that authoritatively.
It is very expensive to treat and we know that, the large populations of the patients we treat are mainly primary and secondary healthcare. But I am advocating to the government, the large parts of people we cover are not only federal government employees but primary and secondary. We have the large group on the left side, the poor, the vulnerable, the aged, the IDPs and the prisoners that are not covered because they are not contributing. Remember, NHIS is contributory, you enjoy when you contribute. On the right side are patients who have tertiary illnesses, the cancers, the cardiac illnesses, the dialysis, those that require kidney transplant and I get a lot of those requests from doctors.
I am in serious discussions with the government. It is only the NHIS that can tell the governments how we can do it and how we can explore other means of healthcare for those vulnerable; for the aged and those who have tertiary ailment.
Is there a formula you are considering to address this problem?
Currently, there is this basic healthcare provision fund that was signed into law in 2014. The act said one percent of total revenue collection of the federal government should be dedicated to health and out of that one percent, 50 percent should come to NHIS, 45 percent to primary healthcare and 5 percent to the ministry. So, at the current collection of the FG, the 50 percent that comes to us amounts to, N15 to N16 billion. And how it should be spent is clear. It is to be spent for the vulnerable amongst us; that is, the pregnant women, the children, the poor, the aged, the disabled and the IDPs. Is the money going to be able to cover all of them, No? But whatever little way it will help these people will help. And other patients who have these catastrophic ailments, how do we cover them?
What I have been doing is reaching out and pricking the conscience of the rich amongst us, donor agencies, even drugs companies. There is a drug that is very expensive but lifesaving for patients with breast cancer. I am in discussion with the company that makes the drug. Several times they come to my office with the Oncologists from the National Hospital. We are discussing for the reduction in price of the drug so that NHIS can get them. We are also encouraging them, the government and the donor agencies, to do a retreat/conference where we can highlight this issue to the world.
Cancer is a big issue that doesn’t seem to be well addressed in Nigeria. We have seen report of most of the equipment in National Hospital and other hospitals packing up, leaving long queues of people who need treatment. What are you or other establishments doing about the expensive treatment of this disease?
Recently I was in Usmanu Dan Fodio University, the CMD, Dr Yakubu Ahmed, is doing great job. He has developed a world class kidney, cancer centre and a trauma and heart centre. He was taking me round, we went particularly to the cancer centre where all radiation therapies take place and he showed me patients, many came all the way from Rivers State, Edo State and Borno State. He said their machines are the only functional ones in this long radius. In other places, they are either overwhelmed or broken down.
We are having issues with the soft wares to maintain these machines. People come from all over the world and I hear the story all over. I addressed CMDs in Calabar when they gathered. There is this recurrent problem and I have been in discussion with the Ministry, Minister, Minister of State, the permanent secretary and the National Hospitals.
Why am I interested in these big hospitals? It is because that is where the largest number of enrollees go to, not only in Nigeria. For example, if you look at the number of enrollees, Abuja Clinic can have 10 while National Hospitals can be in 1000s.
So, we are having discussion with the ministry to know how NHIS can help these hospitals. The CMDs that we are paying must allow us deploy desk officers to all the teaching hospitals so that they can advocate for our patients; so that they can be our eyes.
We are also having this discussion to see how we can help tertiary institutions where the largest of our enrollees are. We cannot dictate to the teaching hospitals but they need to tell us where the needs are and the way forward. And we need to sit down and think on how to go about it, to see whether it’s within our mandate.
What is NHIS doing to enroll people in the informal sector?
The informal sector is over 80 percent of Nigeria’s population. We cannot say we will achieve universal coverage if we ignore the largest sector, so for me, the greatest thrust is how we can increase coverage of the informal sector. Because that is where the market is, that is where the size is, that is where poverty is, that is where the burden of the disease is and that is where our people reside all over the country.
We are in discussions with state governments encouraging them and being their technical partners to create their State Health Insurance Agencies because, in Nigeria health is on the concurrent list. The Federal Government cannot dictate to the states how they do it. So, we have encouraged them to create their own agency and NHIS will be a technical partner for them.
We are greatly aware of the financial situation many states are in. Many cannot pay salaries. Even if they pay it is going to be very difficult to deduct from the state employees and put in the pool.
So, when I am talking to state governors, traditional rulers, religious leaders I ask how can we as a people stop folding our arms and thinking government will do something. I tell them, you the strong how can you help the weak? The wealthy how can you help the poor? So, I am going around looking at creative ways of funding the healthcare, pricking the conscience of our people.
I will give you an example; we have a programme, VCSHIP, Voluntary Contributor Social Health Insurance Programme. How much does it cost a person for a year? N15,000 and you will enjoy the same healthcare coverage. To break it down daily that is N41.00 daily for 365 days. It is done so that we can cover many.
Many people go to the HMOs but are told there are no more slots left, how can people be helped?
We want to be able to control that so that we will be the one to enroll rather than handing things over to the HMOs. It is our responsibility and not that of the HMOs. We should be the custodian of that trust that people have given us to contribute money into a pool to take care of them. We should not outsource that to the HMOs.
My goal is to see millions more enroll for the programme. But I don’t want to enroll millions when hospitals cannot cater for them and that is why we are talking to hospitals to see how we can help them. As we speak now, we have been to National Hospitals, Garki, NISSA, as we ramp up the enrollment many people are coming and hospitals are going to be overwhelmed.
How is the agency handling issues relating to services not covered when enrollees go to hospitals for treatment?
This brings me to why I am deploying NHIS staff as desk officers in hospitals. Many of the time hospitals say certain services are not covered while they are actually covered, they want the patients to pay out of pocket. Don’t pay out of pocket but go to NHIS desk officer in that hospital and let that person be your advocate. He or she will come and say, no it is covered these are the things covered.
But wouldn’t that create a big bureaucratic issue?
The health officers are deployed based on the number of enrollees to NHIS accredited hospitals nationwide and we are allocating desk officers based on the number of enrollees. We want them to be our eyes and ears in the hospitals; we want them to be advocates for the NHIS enrollees at the hospitals. We are trying to regain the trust of our enrollees, that we are there for them and we will always be.