Life expectancy, infant, maternal mortality will change in Nigeria---NHIS boss

Emeka Ibemere

It is not a political promise of a candidate trying to win votes from Nigerians. It is a word of a health expert who has traversed the nooks and crannies of health sector in Nigeria.

It is coming from the head of the National Health Insurance Scheme (NHIS), and he has set the machinery in motion to achieve life expectancy, reduce infant, and maternal mortality by the year 2015.

Welcome to Dr. Martins Femi Thomas, the Executive Secretary of the National Health Insurance Scheme (NHIS).

 In his effort to achieving ground success in NHIS, Femi Thomas recently secured a major leap in its resolve to extend opportunities for access to  effective care services to all Nigerians living in the rural and sub urban areas of the country, as it flags off community - based social health insurance programmes (CBSHIP), in various communities across the country. He also introduced several other platforms with the Nigerian University Commission, NUC, and National Board for Technical Education, NBTE, and Nigeria Nursing Council of Nigeria, including primary pupils of fewer than five years and pregnant women.

Speaking during a media chat in Lagos with journalists in an interactive session, NHIS boss said NHIS is removing barriers and penetrating and crossing barriers to realise the target of more than 30%, directive giving by the President Good luck to NHIS on assumption of office one year ago.

“NUC has directed all the universities in the country to log in to our platform. We are also working on National Board for Technical Education, Nigeria Nursing Council of Nigeria, to register and we are expecting 4 to 6 million from the education sector alone, so with these arrow heads we believe that we should be able to get that 30% that Mr President has directed us to achieve and even surpass that, and we are looking forward for other programme we are going to launch next year,” Femi Thomas added.

“We are only waiting on the President to give accent to national health bill, and if that is done, I’m sure that you know that something is coming from there and we are expecting N40billon, yearly and if we have that, we are going to use it like carrot to partner with the states, so that we can cover all pregnant women, and all children under five years, that is our target”.

According to him, NHIS is penetrating and removing such barriers of formal or informal sector because, the sector doesn’t know whether about the formal sector or not.

“Your children can register for pupil ship; children in the university can register, we are going through barriers of political divide. Our programme doesn’t know whether you are PDP or APC or APGA, so that is the beauty of what we are doing”.

Femi Thomas identified informal sector as the most difficult thing over the years for the managers of the scheme to penetrate and do it right in the health care sector but that is what they have achieved seamlessly with all the programmes they have embarked in the last one year.

“I believe that at this point in time, we own it as duty to inform all Nigerians to know about all these initiatives, so that they can key into this and let them know and be proud with all these initiatives that are home groom and that it is their own product”,  he stated further,

“So, with these products life expectancy will change in Nigeria, infant mortality, maternal mortality, all these things will change, in the next two years, if we are able to get it right. I think if we continue to get it right, life will change”.             

According to him, for health insurance, there are four elements of service in medical services, and those four elements drive the health system.

“You talk about infrastructure which is building, now Information Technology, IT, is seen as part of it, then you can talk about the manpower variably and whether motivated or not, the continuous improvements in terms of professionals, motivation, remuneration and everything that has to do with it and then you talk about materials”.

 He said materials could be equipment, drugs, or consumables but that they are materials. NHIS boss also identified people’s inability to pay for health services as one of the problems as various governments doesn’t care about people’s inability to pay for health care bills

“The fourth element, which is actually the most important and the least respected and neglected in this country, is ability to pay for service. You will agree with me that in the last two decades, what we hear from the political leaders concerning health sector are things like; ‘we have build 10 hospitals, we have renovated 100 hospitals, we have bought equipments, we have employed 1000 doctors, we have paid doctors’, but very few of them talk about the people’s inability to pay for services”,  

Femi Thomas said these four elements are very important in health insurance a way that if one can’t pay for service, he can’t demand for it.

“Look at this scenario, water is supplied but how do I make sure that it gets to my tummy. There is water here, if I cannot pay for it, I won’t be able to drink it. So, water is supplied and how do I ensure that it gets to my tummy”, he asked.

He said the language has changed now, going by the WHO positions in the 2012, which the whole world should go in the direction of universal health coverage with all these elements have been reduced into three.

“So, that means for any nation to achieve universal health coverage, we must remove financial barrier, we must remove physical barriers and physical barriers also include geographical barriers, especially in the north, where you see one health facility here and you have to travel another 60kilometres, before you see another one, not the same in Anambra State, here you can’t travel to 2 kilometres before you see one health facility and I’m sure the same thing happens in Lagos State here. So, you can see that the needs of various zones differ”.

Speaking on the quality of services rendered, he said to ensure quality; there are many elements that are involved again.

“Quality might be link to equipment, it might be link to people rendering service, but when you talk about quality in universal health coverage, the language is that quality of service rendered. When you put everything together, the question is quality of service rendered enough to meet the needs of the people. These are the three elements”.

According to him, out of the three elements, NHIS is saddled with two elements today in Nigeria. One of the responsibilities is to remove financial barriers and at the same time ensure quality through accreditation, medication, visitation, monitoring of facilities, visitation of care –givers of HMO and other things.

“So, we have two out of the three elements to open and you will agree with me that since 1999, a lot of things have been happening in that sector. Since, 1999, formal sector programme was launched in 2005 and since then, Nigerian has been doing one thing or the other to advance the cause of health insurance”.

On assumption of office, Femi Thomas said by divine decision, he was called upon to head the organisation about this time last year and specifically, when Mr President put pen to paper on 19 November 2013, and since then NHIS has been involved in one thing or the other.

“Before  I came, Mr President had giving directive to board members that they should cover 30% of entire Nigeria as a minimum acceptable target by the end of 2015, and so, I came, I met that directive on ground  and as at the time this directive was given, we were on about 3%, so what Mr President told us was that we should leap-frog; that we should move fast and that there was no place to start crawling and to do that, we did our situational analysis”, he added.

“I took all my people to LakanPian Resort, Lagos State, when people were struggling to go for Christmas, we have to cut off some personal enjoyment and say look, to reach at this target we need to work together for few days and at the end of the exercise, we came up with a slogan- that 40% is achievable. So the language at NHIS all over the country is that: ‘40% is doable,’ even when Mr President is talking about 30% when we can give 40% and we are not joking about it, it still very much possible”. But what has NHIS done in the last one year?

 “In our situational analysis, something happened at the same time, and that is the work of Accenture, Accenture was given the contract to re-align and create a digital platform but they went a bit far by going into structural and talking about major operational plans for the scheme. They came up with two major programmes and we have to choose one, the brands feel approach which meant that we could improve to what we are doing to achieve our aims”.

“Then the Greenfield approach, we said let’s end everything and start a new, which is the Greenfield approach. We reviewed that and thought it would be better to key into Bradfield approach by improving on what we are doing to see how we can move forward with the proviso; that even the elements of it could be the end points at the end of the day and that by the time we straightened ourselves about Bradfield approach”. He said to develop some of the things, that were listed under Greenfield approach, they went on.

“First we went with the structural things and before you know it, we have seven departments and we expanded the departments to 10 by breaking one larger departments and created two departments out of that; one for informal sector and formal sector. Then we also created under that department for marketing, so we now have full fledge department of marketing and there is no way you can run an Insurance without marketing, so thereafter, we moved our staff round to see whether they can fix into the system, again we expand our presence and before this time, we are in seven zonal offices nationwide; with the head office”.

According to him, NHIS decided to move to all the states of the federation and Federal Capital territory, FCT, and today are now presence in 38 states including Abuja.

“We have two offices in Lagos State and we have even further broken Lagos into six now, such that we have zonal office in Yaba, we have the Ikeja office, which is the state office and then area offices broken into four; we have in Ajah, Iyana Ipaja, Apapa, Badagry and Ikorodu, so if you look at it, Lagos consist of large percent of the nation’s population, so, its clear that if we succeed here, then 50% percent is done”.

According to NHIS boss, NHIS was not going to be driver in all cases. He said their role was to provide the enabling enviroment for various programmes, encourage states to come up with their various programmes with hope that there could be some synergy in the system.

“Lagos State is coming up with their health insurance programme, which will address the needs of Lagos State residents, we are ready to go along with them in partnership and give them necessary support where necessary we can give them financial support as long as they are doing it for Nigerians”, he added.

“In Ogun State, there is a programme going on there, and we are supporting them technically and financially because we have an agreement with them and we have signed an MOU with them, that we will take care of the pregnant women, that enrolled in that scheme. The children under five years, we are supporting them financially, and then beyond that, we are partnering with all the states of the federation in one programme or the other. We have community based programme going on in many states of the country”.

NHIS said they have about 18 programmes going on throughout the federation and that there are some other things that they are coming up with by the end of next year. Revealing some of the programmes, he said they have started training some of their enrolment officers and from next week, to enable them register those in primary schools nationwide.

“Our target there is 24million lives and the journey has begun. So we expect that as from next week, we will begin to move round the country to start the exercise and you might ask me, how you intend to fund this. The thing is that just doing the right thing, even the investible funds of NHIS have improved this year. I’m happy to say that we have improved our investible fund to say 15% on what we met and two is that we are just doing the right thing”, he explained.

“I told you the enrolment figure, when I came it was in the realm of 5.2million lives, but we have added 2.2million lives this year, like 40% of what we met on the ground, have added this year alone and we believe that with what we have by the time we are through with mobile health insurance and the enrolment, we should be targeting around 70% by December”.

So with all these, we are using proceeds from our investment and we are using that as a carrot to the states such that by the time, we finish the enrolment, we are going to meet the 40% capitalisation for payment of the pupils in primary schools to get health insurance and the state government will now add 40% and as I talk to you now, I’m aware that 20 states in the country have put something in their budget for 2015 for them to join the scheme, that is in the primary schools enrolment”.

 NHIS boss further explained that they appointed one staff for each state, to go to all those states on daily basis to interact with the commissioners of health, commissioners for finance, commissioners of education and all the government officers in those states to make sure that the programme is there.

“To make sure it works, I personally went round the country with my team to see many state governors, about 12 to 15 of them and those we met formerly, we have been able to interact with them and that is yielding results”. To achieve the avowed target of the NHIS, Thomas stated how they went to USA to tap from the ObamaCare initiative and see how it would work in Nigeria.

“ Aside that, you are aware that we have gone round the country, and we went to USA, we have to go to Oracle headquarters in US, because you remember, Oracle did a website, for Obama-Care and we needed to know what is behind the Obama-Care, so we interacted with them, with the US department to ask questions, digitalisations, processes. We invited somebody from another state in US, where the ObamaCare thing started from and he gave us information”.

“We also went to US House of Representatives, we interacted with some caucus and we got all the information and thereafter, we went to Netherlands, to see how digitalisations, HMO, Health Care facility can be factored in. We went to Einthoven, we saw many things, and we invited HMOs and we even sponsor them to visit; so that they can also plan their own programmes in line with that, we are planning own digitalisation and processes which is going to be 24 hour operation, which we can be operating even in the night so that we can met the needs of our people”.

Beyond this, NHIS launched mobile health care insurance in the country and in July, they come up with the pilot mobile health insurance platform. He stated that the platform is novel, so flexible, easy to manage and robust enough for the needs of Nigerians.

“You again ask me how you came about this, it is by tapping from everywhere that we have been to, what we have now is like hybrid. A hybrid in the sense that this is only country where it’s operational in the whole world today, no other country has succeeded in coming up with this kind of platform and we are just leveraging on what some people did in the past, leveraging on the density of Nigeria, we have 140million Nigerians on various network lines in Nigeria, so we felt that if we can leverage on the networks, we can go far”.

 “I understand that many people have registered on-line and about 10,000 have paid, so if you MTN now, you dial *16# and the plat form will show you on how to enrol and how to manage the process and we are also digitalising a counter. When you start to enrol, you will see how you send in your details”.

He explained how to enjoy the benefits of the health insurance through the mobile network starting with the MTN.

“Go to the NCC database and pick your data you used to enrol your sim, because everything is there and you copy it and send to our database and immediately text message will be send to you, that text message you have your NHIS number, which is like identity card and with it and after paying the N12, 000 per year, you can pay N1, 000 per month, you can pay N250, weekly and we are thinking making it daily for N35”, he said.

“And beyond that there is an adoption platform, on this programme. It allows wealthy people to adopt poor members of the society, so that those who are endowed can pay for those who are not and we call it adoption platform. It’s expected that when you are registering you can pick your health facility and you will see your HMO and you pick one and become fully registered and you pay. After that you can for your health facility after a month and start enjoying your facility and for your identification, you don’t need ID card again. Those of you, who are close with us, know that ID card has been the problem of NHIS, over the years. But we have solved that problem”.