Professor Mohammed Sambo is Director General of the National Health Insurance Authority (NHIA). In this interview, he discusses the organization’s rebranding agenda, expanding health insurance coverage for Nigerians, and operationalizing his NHIA legislation.
W.What is the current level of health insurance coverage for Nigerians?
About 16 million people are currently covered by health insurance, still less than 10%.
The National Health Insurance System (NHIS) was originally modeled to provide health insurance to people in the public sector. What has been done to increase the range?
Much has been done to ensure that everyone can participate in the National Health Insurance Scheme (NHIS), now known as the National Health Insurance Agency (NHIA).
You recognize the crisis that plagued the organization through 2019 and the Presidential Commission of Inquiry that led to some bold steps to reorganize the organization. It came as a result of that presidential panel report.
After getting involved and digging into the ecosystem, we found that there were so many issues. Aside from scrutinizing the situation, the Presidential Commission’s report indicated a number of problems, outlining about 10 major problem areas that needed to be addressed expeditiously.
So the first year was dedicated to bringing stability to the organization. He then embarked on what he called the Agenda, a rebranding of the organization based on three pillars.
One is to restore the value system that makes the organization credible and results-oriented. Second, how to create transparency and accountability across the organization’s operations, and third, accelerating the move towards achieving Universal Health Coverage (UHC).
I felt that the rebranding effort was very important for stabilizing the organization. The second is to reorganize and the third is to reorganize for better performance.
Then I went straight to breaking down the column into its various elements. Looking at the first pillar, it is about creating a very good and enabling environment, ensuring discipline within the organization and creating mutual respect and harmony, and creating equity in the process of managing the organization. There are about three factors involved in ensuring organization.
And we stepped in to implement all the elements we identified as key to stabilizing the organization.
So this organization, notorious for its crisis, is now completely transformed. Crisis is no longer heard inside or outside the organization.
What are you doing to ensure transparency and accountability in the health insurance ecosystem?
We have worked very closely with all stakeholders in the health insurance ecosystem. We have also consistently undertaken a process of informing, educating and educating people so that they understand what health insurance is and what their roles and responsibilities are.
We also recognize that in order to achieve a comprehensive transparency system, we need to digitize the system, digitizing everything that happens across our organization and ecosystem.
As CEO, you are here to oversee everything that happens in terms of service delivery, finances, and more. So we did it all.
Can you briefly tell us how you are expanding your fiscal space?
We’ve pursued it with two approaches that align with the third pillar of rebranding. First, I tried to integrate existing programs out there. Programs for formal sector employees and non-formal sector employees.
There were many bottlenecks in the implementation of these programs, so I tried to examine those bottlenecks to find ways to solve them. operation of that system.
The second is about innovation. We have created a number of innovations aimed at expanding our fiscal space.
One of the things we’ve done is the Basic Health Care Provisions Fund (BHCPF) issue, which we’ve met in the field but not implemented. This is the creation of the National Health Law.
It comes from 1% of the Consolidated Revenue Fund and about 50% goes to the NHIA. The state has a state health insurance agency that can cover vulnerable segments of the population, so it is distributed to the state. Vulnerable people are the poor, women of childbearing age, children under five, people with disabilities and other disadvantaged groups.
This is the goal of the BHCPF, and if you go to almost any state except Rivers and Akwa Ibom, you will find that many vulnerable people are already benefiting from the programme.
Second, we also created what we call the Group Individual and Family Social Health Insurance Program (GIFSHIP). About a year and a half ago, the Minister of Health launched the program, which aims to introduce the informal sector.
Looking at the informal sector segment of the population, the majority are self-employed, working in organizations with less than 5 employees.
Before we came in, there were no significant provisions for providing health insurance to these Nigerian groups. You can now join the National Health Insurance regardless of your occupation.
But the most important thing we’ve done in expanding the physical space is ensuring that the legislation establishing the National Health Insurance Scheme (NHIS) is aligned with what we currently have as the National Health Insurance Agency (NHIA). is changed to
So how have you been operating the NHIA Act?
The most important aspect of this law is that it defines what we call the Vulnerable Group Fund (VGF). The fund aims to account for the approximately 83 million poor Nigerians who do not have financial access to the health care system.
The signing of this law made health insurance mandatory. Therefore, regardless of your ability to pay, wherever you are, you must join the National Health Insurance Scheme.
If you are not in paid employment to the extent that you are unable to pay for medical and health insurance services, you have the opportunity to receive compensation through this vulnerable group fund.
And in order to realize it, it is necessary to formulate operational guidelines. We also need to have very strong conversations on the issue of innovative funding, which can bring more resources to the health care system, and we are already working on it.
What is the role of Health Maintenance Organizations (HMOs) under the new legislation?
There is social health insurance, which is a solidarity agreement aimed primarily at catering to those without access to medical care, which the government health insurance scheme is intended to promote.
The second part is private health insurance. Private medical insurance is an insurance system that people who can afford it can join.
So what the new law says is that there needs to be a very clear line between the two. You have Social Health Insurance with little or no HMO participation. Next, get private health insurance, driven by HMO.
By the time you start enforcing this law as a package, you’ll find that a lot will change when it comes to surgery. Because health insurance is trying to provide what is called a minimum health care package that all Nigerians need. It is accessible regardless of socioeconomic status.
And under this new law, this will only be driven by the National Health Service and state health insurance agencies. So the frequent bottleneck of interfacing with HMOs is gone.
However, HMOs are allowed to do other things. First, HMO promotes so-called supplemental health insurance. Insurance beyond the minimum medical package is driven by HMO.
HMOs can also run so-called private health insurance, as I explained.
And there is something in the law called third-party management (TPS), which allows HMOs to have third-party management. A third party is a privately oriented organization that participates in health insurance either at the national or state level and can handle some aspects.
For example, one state wants to create a call center system that allows registrants to make inquiries and complaints over the phone. The states may say we don’t have the ability to call or the structure to do so. Third-party administrators can assist with other matters such as state or financial management systems.
So the rumors that we are ditching HMOs are not entirely true. We are redefining their function to better everyone in Nigeria.
