A Depressing Tale from NHIS

An effective health insurance scheme will ensure every Nigerian gets better and accessible healthcare. But the present drama in the National Health Insurance Scheme and the inability of the scheme to grow beyond four per cent means citizens might continue to die from preventable and treatable diseases.

Few months ago, 31-year-old Rita Bassey ran to THISDAY in tears. Her 10 months old son, Nolan, was going to die within weeks because of a hole in his heart. They desperately needed at least N3.5 million for surgery if he must live. As typical with THISDAY, a cry for help story was published and she got support from kindhearted Nigerians. Nolan did the surgery in Tristate Heart Centre in Babcock University, Ogun State. Today, little Nolan is healthy and full of life.

In another instance, 25-year-old teacher, Serah Osabuohien, came with her mother to THISDAY with a customised bag in her hand. She was desperately fighting for her life, but saw the media as the last hope, having done all she could to raise money for surgery and chemotherapy. She was suffering from colorectal cancer. That customised bag was her mobile toilet. It collects faeces at will. It was obvious Serah was going to die if she does not start treatment immediately. She needed N10 million. Again, THISDAY did another report on her and she was able to raise around N700, 000. Within days of commencing treatment, the money was exhausted. THISDAY ran another story, and few other monies trickled into her account, but it was not enough. On October 18 2017, Serah died from a disease that could have been treated if there was money. She died from what clearly shouldn’t be an out-of-pocket cost for her, especially considering her class as a poor citizen. Serah was a poor Nigerian living in Nigeria, but did not benefit from Nigeria.

Donald Nwosu is a medical doctor suffering from non-hodgkins lymphoma, a rare type of cancer. He needed N30 million for treatment, and no hospital was willing to start treatment on him until deposits were made. He had exhausted the resources in his circle of families and friends, and had started a Go-Fund- Me account. He got in touch with THISDAY for help, and a story was published. While what he got through the publication was not close to the needed amount, he was able to start treatment. He is clearly still battling to manage the scourge. As usual, being a Nigerian is not enough for him to access healthcare funding by government. He is not rich or a government official, hence he is not that important.

Just few days ago, the very emaciated 15-yearold Abubakar Abdulazeem was on Television Continental (TVC) soliciting for funds so he could live. At four, he drank caustic soda which damaged parts of his internal organs, and since then life has been unbearable for him and his poor parents. He has now been withdrawn from school so he can wait on God because there is no money to fix his health. If Abubakar gets the medical atttention today, he will live. But as usual, there is nothing to differentiate that Abubakar living in Nigeria is benefitting anything more than a visitor or a foreign resident in Nigeria. He has been left to suffer from innocently drinking caustic soda for the past 11 years. And all his family does now is move from one media house to the other, soliciting for funds from kindhearted Nigerians.

Bassey, Serah, Nwosu and Abubakar are not the only ones who run to the media, philanthropists or nongovernmental organisations for financial help, there are clearly several millions of Nigerians who are running helter-skelter to get funds for treatment.

On the average, THISDAY receives at least three of such cries every month; same with other media houses, philanthropists, nongovernmental organisations, corporate organisations and hospitals, even though it is clearly government’s responsibility to take care of the health of its citizens, especially the poor ones who cannot afford it.

While cases of cancer, hole in the heart, kidney failure, and heart diseases have prompted many poor Nigerians to solicit for fund from anywhere, millions of Nigerians have died because the country has refused to provide the basic healthcare services they need. For instance, lack of effective primary healthcare services in rural and sub urban corners of the country have led to high rate of maternal and child health, deaths due to pneumonia, malaria, and typhoid fever, among others.

To prevent occurrences like these and ensure every human has the right to basic healthcare, the World Health Organisation (WHO) and other global health bodies commenced campaign for universal health coverage, so that all classes of humans, whether rich or poor, have accessible, affordable and qualitative healthcare. This led to global campaigns for health insurance and the drive for universal health coverage globally.

Establishment of NHIS

Bringing this home, the then Nigerian President, Olusegun Obasanjo, saw reasons with the campaign and then perfected the legal framework for the establishment of the National Health Insurance Scheme (NHIS) in 1999. In 2005 the scheme kicked off under the supervision of the then Minister of Health, Prof. Eyitayo Lambo who immediately began to grow it in trickles. By the time Obasanjo’s tenure ended in 2007, it appeared the passion and vision to grow the scheme left with it, and what seemed like a beautiful idea to save poor Nigerians from health disaster began to evaporate into thin air.

The poor unemployed father in Ifueko Island in Edo State will no longer have his healthcare paid for by middle or rich Nigerians; the petty trader in Riyom in Plateau State will most likely die from kidney disease for lack of financial power to treat it, same with the poor mother in Igbese area of Ogun State, who developed complications while having childbirth.

Decline in Growth

While it is now 13 years after the establishment of the scheme, only four per cent of Nigerians are enrolled in the scheme, where as 11 years ago, when the world thought the country had gotten it right with seven per cent of the population already registered to it. Ghana and Nigeria however started at about the same time, but the neighboring country recently celebrated its 45 per cent mark, leaving behind Nigeria; a country which often prides itself as the giant of Africa.

Renewed Hope

When President Muhammadu Buhari appointed Professor Usman Yusuf as the Executive Secretary (ES) of the scheme, there was renewed hope that soon, the scheme would live up to its billing and grow. But as Nigerians continue to wait for a turnaround, the scheme continued to drag behind due to inconsistency in policies, scandals, and lots of drama.

In fact, of the 180 million Nigerians, only about six million persons are enrolled in the scheme, many of whom are the federal government workers.

This, no doubt has contributed to the several abysmally poor healthcare indices the country has lately been notorious for. For instance, Nigeria is currently the worst place on earth to be born. It is the worst in many healthcare indices.

According to UNICEF, preventable diseases such as malaria, pneumonia, diarrhoea, measles and HIV/AIDS account for more than 70 per cent of about one million under-five deaths in Nigeria.

NHIS Drama

While healthcare observers, both globally and locally, have been hoping that the APC led administration will hit the ground running in the provision of universal health coverage and grow health insurance in the country, the body saddled with driving this responsibility seemed to have suddenly become the new Nollywood platform. A good movie producer could possibly run a movie on the true life story of NHIS and the movie will become a blockbuster.

First, there was a cold war between the Health and Managed Care Association of Nigeria (HMCAN) and the executive secretary few months after his resumption. He was accused of having a mindset to undermine the Health Management Orgaisations (HMOs) with a malicious disposition. On his part, he accused the HMOs of corruptly amassing wealth for themselves.

In June 2017, the ES was suspended by the Minister of Health, Professor Isaac Adewole, over allegations of corruption. A committee was set up to investigate him, but Buhari, who was away on medical leave when the suspension was announced, reinstated him in February 2018 against the Ministry of Health and panel of investigator’s stance. He was at the time accused of corrupt expenditure to the tune of N292 million, which he allegedly spent on healthcare training without recourse to any appropriate approving authority. But when THISDAY reached him few months back, he said those complaining about his style of leadership were corrupt, because he has blocked loopholes for stealing.

Eight months after his reinstatement, the NHIS council suspended him again for what they termed corrupt practices. While many Nigerians thought the drama would finally go down, Yusuf surfaced last Monday with policemen, and forcefully resumed, insisting that the council had no power to suspend him. Protests by some staff of the scheme however did not prevent him from defiling the suspension order.

Dissenting Opinions over Suspension

The recent suspension of Yusuf has no doubt elicited several reactions, while some say the council has the right to suspend him, others believed only the president can suspend or sack the ES. For instance, frontline lawyers, Olisa Agbakoba and Femi Falana have said the council simply exercised its power by suspending him. HMCAN and some other health bodies have also toed this line. But earlier this week, the Secretary to the Federal Government, Boss Mustapha, said governing boards of federal agencies or parastatals have no power to remove Chief Executive Officers appointed by the President.

He said such boards may, however articulate infractions, investigate wrongdoing and make recommendations to government through the supervisory ministry.

A staff of NHIS, who does not want to be named, said with the stance of the SGF, it means the president is strongly backing the actions of Yusuf, but at the same time, does not want to openly counter the council in other to avoid the outcry from Nigerians like when he reinstated the ES after Adewole previously suspended him. “Do you think if Buhari didn’t back him he would have forcefully resumed with the aid of the Nigerian police?” the source said.

Citizens as Victims of Tussle

As cliche as the saying ‘when elephants tussle, the grass suffers’ might be, the bottomline remains that Nigerians are paying dearly for this. While this drama seems not to be ending anytime soon, the effect since 2016 has continued to have a drastic toll on the scheme and Nigerians who deserve better healthcare. Just like Serah who died because the society refused to provide her better healthcare, the millions of Nigerians currently battling to live will continue to have their hopes dashed in the present circumstance.

For instance, Nigeria is currently the worst place on earth to be born. It is also the worst in many healthcare indices. According to UNICEF, preventable diseases such as malaria, pneumonia, diarrhoea, measles and HIV/AIDS account for more than 70 per cent of about one million under-five deaths in Nigeria