The time to empower the NHIS in its regulatory and oversight functions is now By Adewole Kehinde

On Thursday, June 22nd, 2017, major headlines such as “NHIS: FG Wants Health Management Organisations Scrapped Over Mismanagement of N351bn – Daily Times; “Health Insurance: FG Wants To Scrap HMOs For Mismanaging N351bn – Independent Newspaper and “Health Insurance: FG may scrap HMOs over N351bn fraud – Authority Newspaper hit the news stand.


Many comments hit the social media asking why the Ministry of Health  and the National Health Insurance Scheme (NHIS) will support the scrapping of the Health Management Organisations.

It will be recalled that the House Committee on Health Services has requested the Honourable Minister of Health to attend a public hearing on the “Investigation on compliance rate of Health Maintenance Organization (HMOs) to the NHIS contributions and utilizations of funds by the Health Care Providers (HCPs) and inhumane treatment of enrollees”.

The hearing was scheduled for the 21st and 22nd of June 2017.

The Minister of Health, Prof. Isaac Adewole was represented at the public hearing by the Director of Hospital Services in the Ministry, Mr. Wapanda Balami.

From the submission of the Minister of Health, he never called for the scrapping of the Health Management Organisations (HMOs) but rather he called on the House of Reps to amend NHIS Act in the area of inclusion of representatives of HMOs on the board of NHIS and the weak punitive measures under the NHIS Act.

To set the record straight, below are the Honourable Minister’s position at the public hearing:

 Access to affordable and good quality healthcare is a key element in the actualization of our Universal Health Coverage (UHC) goal.

Efforts by the House committee to address the challenges faced by Nigerians under the National Health Insurance Scheme (NHIS) is a step in the right direction.

The Honourable Minister notes the issues raised by the House Committee and looks forward to a resolution that reduces inefficiency within the system, improves service delivery and elevates patient centred care.

The Honourable Minister also notes that the issues raised under the votes and proceedings, appears to suggest that States and LGAs employers and employees currently pay 10% and 5% respectively as contributions to a health scheme. This is inconsistent with information available to my office.

The Honourable Minister also notes that the document appears to suggest that the N351bn premium paid to HMOs was geared towards the expansion of the scheme. This assumption appears incorrect.
Federal Government pays between 5% and 5.25% of consolidated salary as premiums for federal civil servants.

These funds are deducted at source and paid into the NHIS account.

HMOs are paid by the NHIS to provide care for registered beneficiaries under their portfolio.
70% of the fund paid to HMOs is expected to be transferred to HCPs immediately as capitation
A default by HMOs to transfer the funds as at when due is a punishable offence under the NHIS Act.
The NHIS needs to perform better in its regulatory and oversight functions and ensure funds are transferred by HMOs within stipulated periods.

Equally important, is that the role of expanding the coverage is the mandate of the NHIS and not that of the HMOs

The Honourable Minister also notes that the document states that the funds (premiums) are being diverted.

He further said that the House Committee reserves the right to review the allegations of diversion of funds. That said the NHIS’ role, as a regulator could be better. In line with its powers, it could do more to ensure errant HMOs are appropriately sanctioned.

In his submission, the Honourable Minister Health suggested that the House Committee may wish to empower the NHIS in its regulatory and oversight functions particularly as it relates with sanctioning errant HMOs.

I want to use this opportunity to call on Editors to scrutinize news report submitted to them by their reporters before publications to avoid embarrassment and unnecessary rejoinder.