Regardless of the suspension of Usman Yusuf as the Executive Secretary of the National Health Insurance Scheme, NHIS, the scheme may collapse if the cesspool of corruption in the place is not drained and systemic loopholes exploited by its Chief Executives are blocked.
BY ADEWALE ADENIYI
On normal workdays, the annex office of the National Health Insurance Scheme in Abuja is a beehive of activities-vehicles struggling for parking spaces and people streaming in and out of the three-story building. That is where the offices of the Executive Secretary, Professor Usman Yusuf, and that of the Chairman, Enyantu Ifenne, are located.
But last Thursday, the office was without its usual buzz, almost lonely with few visitors going into the Customer Care section of the building. They all came heavy with grief and impatience. A lady threw a card on the desk of one of the staff, angrily demanding answers why her name was deleted from the list of enrollees of the health insurance scheme.
As a civil servant based in Abuja, she had enrolled for the scheme since 2011 and had benefitted from its service up January 2016-the last time she had serious health challenge. But when she took one of her daughters to the Garki Specialist Hospital, Abuja, she was told her name was no longer on the list.
While the customer care officer was trying to calm the woman, her phone rang. Someone from the University of Benin was making a similar complaint. She was told at the hospital that services for her had stopped because her name was no longer on the NHIS list of enrollees.
The room was filled with women and children, and noise. It appeared everyone had a complaint to make. But the most impatient were those who claimed their names had been deleted from the database of the scheme.
“We have been receiving complaints about missing names from across the country,” said a senior staff of the department who refused to give his name and would not say why. No one was willing to speak to the journalist on tape about what was happening.
But a management staff who spoke to the reporter on condition of anonymity, revealed the problem started after the appointment of Usman Yusuf as Executive Secretary of the organization in August 2016. Yusuf brought in 15 people on secondment to the agency from different organizations and put them in strategic units.
One of these is the ICT unit which prepares the database of enrollees. Yusuf, who was ostensibly in a hurry to check corruption in the scheme, brought inexperienced people to the unit to clean the database of the agency with a view to fishing out ghost enrollees. In the process, many enrollees were deleted from the database as ghosts and could no longer access hospital services. They are now the people inundating NHIS offices with complaints.
But Yusuf has claimed the detection of 23,000 ghosts’ enrollees on the scheme as one of his achievement since taking over as executive secretary of the commission. He said the Health Management Organizations (HMOs)-the middlemen between NHIS and hospitals, were reaping off the scheme through ghost enrollees and hospitals in connivance with some staff of the organization.
Before Yusuf was appointed in August 2016, the Department of State Services (DSS) had investigated allegations of fraud at the NHIS between 2013 and 2015. The report of the investigation, which was submitted to him on resumption, showed how the HMOs received illegal payments N1.05b in 2015, and recommended they be made to refund the money.
The effort to recover the money from the HMOs invariably pitched the Executive Secretary against the 11-man Governing Council of the organization, which also has one representative each for the HMOs and private health care providers. Prof. Yusuf has repeatedly accused the HMOs of being behind his travails, stressing that the very powerful and influential health sector players also managed to get the Chairman of the Council on their side.
But most of the staff of the NHIS disagree with Prof. Yusuf’s self- portrayal as an anti-corruption crusader and argue that the ES is been economical with the truth. The Senior Staff Association Of Nigeria, NIHS chapter, explained that while Yusuf’s fight against the corrupt practices of HMOs is courageous, he has also been neck- deep in acts of corruption.
For instance, among the 15 staff seconded to NHIS shortly after he took over was one Hassan Kabir Yar’Adua who the staff claimed is his nephew. He was posted to head the Procurement Department, according to the staff, to enable him award contracts to whoever he preferred. As if to confirm the allegation, Yusuf reportedly awarded a “special public relations” contract to a company owned by his elder brother, Kabir Yusuf Yar’Adua. The company, Lubekh Nigeria Limited, got the contract for the sum of N46.7 million.
The company also benefited from a training contract on communications strategies worth N17.5 million without advertisement or competitive bidding. These are among the 13 acts of corruption alleged against the Executive Secretary by a Non-Governmental Organization-Core Mandate Against Corruption-in a leaflet circulated among journalists and Ministry of Health Staff.
Another NGO, United Youths Alliance Against Corruption, has also sued the Bureau of Public Procurement for failing to act on its petition against “gross violations of the Public Procurement Act by the NHIS under the watch of its Executive Secretary, Prof. Usman Yusuf…” One of the grounds for the suit is that NHIS engaged in the procurement of media, consultancy, training and legal services in 2018 in violation of the procurement act and” in a manner suggesting patronage of relations, friends and associates.”
The suit was filed at the Federal High Court Abuja by LAWTRUST CONSULTS on behalf of the group.
Yusuf has also been accused of working to feather his nest and not work selflessly for the advancement of the agency he leads. He allegedly tried to move the sum of N25 billion of enrollees’ fund into Cowry Asset Management Limited for investment in bond two days before the inauguration of the Council, contrary to a directive from the ministry of health stopping the investment. But a senior manager in NHIS who was privy to the ministry’s directives, stopped the transaction.
There have also been allegations of budget padding against the Executive Secretary, a reason why the 2018 budget of the organization has not been approved by the Council since March when it was submitted by the Executive Secretary (ES). A memo from the Council sighted by The Crest asked the ES to remove the sum of N264 million padding discovered in the budget proposal and reduce N1 billion training budget for 2018 to a realistic N250 million to avoid the training stampede witnessed in 2017 when N919, 664, 800 was spent, in just three months, without needs assessment and departmental; training plans.
The Crest was reliably informed that apart from ghost workers and contract inflation and kick-backs, subheads like training, especially oversea trainings), as well as travels and tours are other major conduits civil servants employ in siphoning money from government coffers.
On the extant matter, the ES was also asked to remove the N100 million posting and transfer provision since the council had adopted an early policy that transfers/postings shall be contingent upon outcome of comprehensive staff audit to enable the scheme align transfers and postings with needs, structure, skills and organization strategy. The ES had also made a provision of N50 million for an additional SUV even though he acquired a new one in 2017.
The Chairman of the Council has refused to sign the budget because the ES failed to re-adjust the budget, thereby stalling activities of the organization. The view is popular among staff of the NHIS that Yusuf has no respect for the Council and routinely flouts instructions given by the council. They told The Crest that Yusuf always touts President Muhammadu Buhari as his only boss, and the only authority that can question his actions and inactions.
In a BPP response to the last reminder from the United Youths Alliance Against Corruption for the investigation of Yusuf, dated October 15, the bureau also stated its frustrations. The letter signed by Mufutau Oloyede, for the Director-General, the bureau said: “This is to acknowledge receipt of your letter dated 17th September, 2018 reminding the Bureau of the expiration of deadline earlier given by the Bureau for NHIS to respond. In other words, NHIS did not respond to the Bureau more than six weeks after expiration of the deadline.”
The Bureau said it had given NHIS a new deadline which expired on October 22. The anti- corruption group subsequently filed the suit at the Abuja High Court.
Effort to reach the ES for an interview did not succeed as he neither picked his calls nor was the reporter given access to see him at his office.
But through some statements in the media, Yusuf denied all allegations made against him and accused the Council and some staff of the NHIS of doing the bidding of the HMOs who he’s fighting to sanitize the scheme.
The NHIS which was established with the mandate to ensure access to good health care services to every Nigerian and protect Nigerian families from financial hardship of huge medical bills now appears to be doing the opposite.
The NHIS is the custodian of funds believed to be above N100 billion, now warehoused at the Central Bank of Nigeria, in compliance with the Treasury Single Account policy of the Federal Government. But its operational funds are also huge, and believed to be over N1 billion.
Nearly every executive secretary of the organization has been enmeshed in allegations of corruption. The reason, according to some management staff of scheme is because of the NHIS Act which puts representatives of the HMOs and private healthcare providers on the governing council of the organization. Moreover, the Act does not specify how HMOs should be paid, leaving room for executive secretaries to manipulate the system.
The NHIS Act 1999 No 35 provides for an 11-member governing council. They are: the chairman, who shall be appointed by the President, on the recommendation of the Minister; one person each representing the Federal Ministry of Health, the Federal Ministry of Finance, the Office of Establishment and Management Services in the office of the Head of Civil Service of the Federation, and one person to represent the Nigerian Employers Consultative Association.
Others are: the Nigeria Labour Congress, the registered health maintenance organizations, the private health care providers and two persons to represent public interest and the Executive Secretary of the Scheme who shall also be the Secretary to the Council.
According to Rasak Omomeji, Chairman of the Senior Staff Association of Nigeria, NHIS chapter, as long as HMOs are included on the NHIS Council, it will be difficult to check them. “A situation where the regulator sits on the same board with those it is regulating is not in the interest of the enrollees of the scheme,” he stated. Also, because the Act does not specify how HMOs should be paid and when they should be paid, it has allowed executive secretaries of the organization to move funds around according to their whims and caprices.
“Even if you sack Yusuf today and bring another person, he will see the loopholes and exploit them,” Omomeji said, adding that the solution to the crisis Is to review the NHIS Act.
