By Levinus Nwabughiogu
This is the concluding part of the report on the face-off between the National Health Insurance Scheme, NHIS, and Health Management Organizations, HMOs, at the two-day public hearing conducted by a Committee of the House of Representatives. The hearing as captured for Sunday Vanguard.
“The suspended NHIS Executive Secretary, Usman, in his presentation, went on: “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 percent 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 sign 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.
“They have never been brought to account for the 12 years. The number covered 1.5 percent of Nigerians. You can quote me anywhere because I sign the cheques.
“Health care financing in Nigeria is nothing but fraud. This is the truth. You want to hear the truth, hear it from me. Nobody has done this over the last 12 years.
“In 12 years, we covered only 1.5 percent of Nigerians. They have been padding with complicity. They have formed themselves into a cartel.
“You will be Mr. Magu’s guest. My NHIS will be fighting NHIS. This NHIS will fight for the enrollees.
“Honourable members, these people are your constituents, and these guys operating the HMOs are owing 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 percent of Nigerians in 12 years, have we achieved the objective?
“Now, I went round and demanded that HMOs pay back the money 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”?
While declaring the event open earlier, the House Speaker, Yakubu Dogara, who was represented by the Deputy Minority Leader, Chukwuka Wilfred Onyema had said that the exercise was necessitated by the concerns of Nigerians who bemoaned the poor health services under the insurance scheme.
Similarly, the Chairman of the Committee, Hon. Chike John Okafor, said that it was part of the oversight functions of the committee to investigate the goings-on in the health sector.
Giving his remarks, the Chairman, Senate Committee on Primary Health and Communicable Diseases, Ohuabunwa, declared his committee support for the House Committee.
In their harmonized representation to the Committee, the HMOs said that it was unfortunate that the Executive Secretary of NHIS had shown open hatred for them.
Making a verbal response to the allegations against them, a representative of a faction of the HMOs, Mr. Lekan Ewenla, regretted that they were washing their dirty linens in the public.
Day Two: More stunning revelations
Many would have thought that the seemingly frayed nerves, which characterized the first day of the hearing, would have simmered before the second day, but that was a wishful thinking. There were more verbal vituperations and vilifications.
In fact, provoked by further submissions by the HMOs, Usman, when it was his turn to speak, debunked the claims that the HMOs were in touch with the people in their respective domains.
“N60 billion is what we have paid them since 2005. These are peoples’ money. They are not everywhere because my men and women are in the field. They are not there. You come down from your hilltop and cash your cheque and you say you are everywhere. Everybody should serve where they are.
“HMOs, I am going to re-accredit you based on your performance and you are going to pay all”he said.
“N2.276 billion is being owed hospital by HMOs. For you to continue, you have to pay all the debts.
“For 12 years, 450,000 Nigerians only. We have identified corruption. Straight from our office, we will pay hospitals and save Nigerians.
“NHIS should not be allowed to die in the hands of HMOs”.
Earlier in the day, the Deputy Chairman of the committee, Muhammad Usman, stated the positions of the NLC and TUC, saying that they would prefer direct transaction with hospitals.
The Committee Chairman, Okafor, remarked: “There are critical questions we’ve posed as part of what stared us in the face yesterday, which is that, how do we satisfy the needs of the enrollees, and that must we have a third party player (HMOs)? Will there be any problem if hospitals are paid directly”?
He, however, said that the committee would expose the erring HMOs, assuring that those living up to expectations would not be unduly punished.
In his remarks, Dr. Mustapha Jibril, who represented Commissioners of Health in the 36 states, underscored the need to domesticate the scheme across the country.
Also speaking on behalf of the Association of Health Care Services Providers, Dr. Ugwu Ukachukwu Odoh called for proper implementation of the laws regulating the scheme for effective service delivery.
But Dr. Tunde Ladele, who chairs a faction of the Association of HMOs, wouldn’t stomach all the darts thrown at them.
He blamed NHIS for misrepresenting the facts before the committee and Nigerians, adding that “70% of whatever amount quoted as being spent on the scheme goes to the service providers”.
The leader of the other faction of the HMOs, Ewenla, who is also the Publicity Secretary of the Association of Health Managers, accused the NHIS boss of high-handedness.
Meanwhile, a mild drama ensued in the course of the proceedings when the Committee Chairman randomly called an enrollee who later gave his name as Olalekan Oluleti, a pharmacist, to bare his mind on the performance of the scheme.
Narrating a story of how he assisted a pregnant woman at a private hospital through the HMOs service in Abuja to obtain medicare during a national strike of resident doctors in public hospitals, the enrollee called for caution in the demands to scrap the HMOs.
Mentioning a particular HMO, he said that had there not been such service in place, the woman’s life would have been in more danger.
“Who are we replacing them with?
The HMOs are doing their best. If there are no HMOs, what would have happened when public hospitals went on strike. We should sit down and look at every side of it rather than calling somebody a bad name maybe because we don’t like their faces”, he warned.
His testimony sparked commotion in the audience amongst whom were many who disagreed with him.
The shouts of “shut up and get down. You are not speaking the truth! Where do you work. Lies! What you are saying are lies”, rent the air.
Swiftly, many participants raised their hands in protest, apparently ready to counter the claims.
For over five minutes, the room turned rowdy.
To calm the crowd down, the Chairman of the Committee said Oluleti was randomly picked.
“I don’t know the man. When I called for hands, it was his hand that went up first. I have some names here but I decided not to call them”, Okafor said.
He later gave opportunity for more contributions.
This saw the coming of Hajiya Fatimah Abdulkadir, another enrollee and midwife, who shared her own experience in a private hospital when her son was rushed there.
According to her, the authorities of the hospital after the diagnosis and prescription of drugs for her son told her to pay for the services.
When she referred to an HMO as her cover, the hospital advised her to buy the drugs from a regular shop.
She lamented the rot in the system, saying that she ended up treating her child.
This also caused another round of commotion.
But another enrollee took a middle course, saying that a holistic approach needed to be taken to overhaul the system.
“I want to ventilate my problem with the whole scheme. The pricing since 2005 has been very, very ridiculous. Whether it is NHIS or HMOs, we cannot recycle the money meant for drugs. Let’s have a holistic approach to this and overhaul the act”, he said.