Dr Muhammad Dogo-Muhammad, Executive Secretary of the National Health Insurance Scheme had an interactive session with some journalists, including Sulaimon Olanrewaju, on the activities of the scheme. Excerpts:THE NHIS was established in 2005 during the administration of former President Olusegun Obasanjo. How has the journey been so far' The journey has been quite exciting for me because I was initially assigned to the NHIS as its coordinator by former President Obasanjo to run its affairs for two months. I was mandated to reposition the agency in record time, owing to my track record in the Federal Ministry of Health. I quickly did a SWOT (strength-weakness-opportunities-threats) analysis and I identified about 24 different activities that were necessary to reposition the organisation. I thank God that within the two month time frame we were able to accomplish all except one, which was the amendment of the Act establishing the NHIS. And up till now we are still grappling with amending the Act. Other than that, we have achieved quite a lot. For example, when I resumed as the Executive Secretary, there were a lot of complaints as regards the operations of the HMO's (Health Maintenance Organisations). Some of them were not in talking terms with the management of the NHIS. Majority of the health providers didn't know what to do because they were deficient in areas such as the principle of social solidarity, pooling of funds and the economy of scale.You also found that the banks, insurance companies, brokers and the general public were dissatisfied because they didn't know what the NHIS was all about too. The number of enrollees was nothing to write home about. The NHIS was stagnant and disjointed. That was the picture before I resumed. But today as we speak, we have well over five million people under the formal sector programme enjoying the services of the NHIS in the country. We have engaged community health through the maternal and child health in 2008 that about 1.6 million pregnant women and children under age five benefitted. We are reactivating it again because there was a small gap in financing because in 2010 we didn't have any allocation. In 2011 some states came onboard and more states are still coming on board. We also flagged off the Community Based Social Health Insurance Programme (CBSHIP) and the Voluntary Contributor Social Health Insurance programme (VCSHIP) in the country, which again will address over 70 per cent or more of the population because the people now have various options to choose from. They can choose which way to go, either as an individual, family or a group. There are other programmes that we equally developed like the Tertiary Social Health Insurance Programme (TSHIP) which is now being tested in our universities and polytechnics. This programme will be flagged off nationally soon because it has been tried and testedfor a year and half. That means the NHIS is recording progress. We are also looking at retirees and prisoners in the country. This explains why we are looking at creating a venerable group fund that will serve as a pool of funds that will help those Nigerians that are socio-economically disadvantaged. How does the NHIS intend to go about with the vulnerable group fund' If the truth must be told, when you look at the vulnerable group fund again, the NHIS Act comes handy because it is the Act that will recognise it as a law. We expect that a lot of resources will come into the fund from different angles; our international development partners, the banking industry and some other contributions like the 'one kobo' initiative. All these will mobilise a lot of resources that can guarantee quality healthcare not only for the vulnerable group in the country, but also quite a number of the country's population will have a minimum benefit package across board. So you can see that to attain universal coverage before 2015 is very possible.Let me take you back. When we started in 2005, we had only one programme, but now you can see that we have so many programmes that address the formal sector of people who are gainfully employed and also the informal sector that consists of people who are not gainfully employed or self-employed, most of who are rural dwellers. So we have different programmes segmenting the society. Our approach is systemic in that you start from somewhere and the expansion continues and we hope that before the year 2015 we will be able to attain universal coverage. How do you identify those that are meant to be in the vulnerable group' What are the criteria' When we were going to start the Community Based Social Health ce Programme (CBSHI), we collaborated with development partners. I also wish to state that as of today, Nigeria is a member of the Joint Learning Network, a group of 10 countries that have shown considerable progress towards attaining universal health coverage for their population. This network is financed by the Bill and Melinda Gates Foundation, the Rockefeller Foundation, the World Bank and the DFID, amongst others. The network renders assistance to these countries on how to achieve universal coverage for their populace through the use of various technical tracks. One of such tracks is the way you make payment, the quality of care you give, your information technology platforms and also exchanges of experiences among member countries for learning purposes. So, Nigeria has just been made a member of this network courtesy of our efforts and commitment in the National Health Insurance Scheme.general managers that came in almost at the same time as myself and that meant I had a fresh team. We were like change agents. We relentlessly and intentionally tried to address some of those challenges and we were able to stabilise. We also instituted the principle of dialogue that ensured that all warring parties/stakeholders would sit on a roundtable to holistically diagnose the problem. And again, it was resolved that nobody takes ownership of failure or deficiency in the system. We resolved to find solutions without apportioning blames. I think we also believed that if we did not get it right this time around, it might be difficult to get it right any other time. Another challenge we have is that the NHIS has done so much publicity to the extent that it has swallowed other major stakeholders. For example, NHIS is supposed to be regulating the Health Insurance Sector in Nigeria, just like the Central Bank is regulating the financial sector. You can't find the Central Bank advertising financial products for the banks. For the NHIS, we have had to advertise for a long period so that the populace can understand what it is all about. In truth, the people who should advertise the various health insurance programmes are the health maintenance organizations; be it the Community Based Social Health Insurance Programme, Voluntary Contributors Health Insurance Programme or the Tertiary Social Health Insurance Programme. All of these are health insurance packages designed by the NHIS towards achieving universal health coverage, but ironically the health maintenance organisations are not advertising. If you don't advertise your products or services, how do people subscribe' In earnest, what I think the various health management organisations should be doing is sensitizing the people for them to be able to make informed choices. How much support do you enjoy from the health ministry and the NHIS council' The leadership of the immediate past council under Professor Eyitayo Lambo played a fantastic role because we could not have gotten a better person other than him to chair the council. Professor Lambo is somebody who knows the terrain very well because it was during his tenure as Health Minister that the NHIS was launched after being in the cooler for over 40 years. It was also during his tenure that we got solid political support to nurture the scheme. And interestingly when he left as minister, we at NHIS interacted even more with him than when he was in office. There was hardly any event that Professor Lambo attended on health financing that he didn't ask for my input. He was so concerned about the NHIS and when the opportunity came for the composition of the council, we pleaded with him to come and help us because he had all the qualities that we needed at that critical point in time.The past council gave us a sense of direction and solid policy direction. Professor Lambo's sound leadership attributes contributed to the phenomenal growth experienced in the NHIS.
Click here to read full news..
