INSURANCE FOR HEALTH COVERAGE

Kelechi Ohiri urges Nigerians to subscribe to health insurance as it’s the strongest form of solidarity to family and fellow citizens, writes

BASHIR IBRAHIM HASSAN

There’s something about Kelechi Ohiri that makes you admire his ideas even if you disagree with some of them – he brings a perspective of vast knowledge to his argument. He also brings passionate conviction and passion to the argument.

So, when he sounds dismissive of the potential of free health delivery to achieve universal health coverage, he deserves to be heard. “We’ve tried free programmes in Nigeria politically across the spectrum, and it never works because someone has to pay for the care, even if it is not the patient that pays for it. And when we say free care without it being matched with resources, it’s a recipe for disaster.”

Not surprising for one who was appointed by President Bola Ahmed Tinubu as the director-general of the National Health Insurance Agency (NHIA), health insurance is the correct way to go.

He has enunciated his preferred options in health care delivery in policy papers, peer-reviewed publications, and books that he has co-authored on health systems. He has contributed to the work of expert advisory committees for the Institute of Medicine, the US Centres for Disease Control and Prevention, the World Bank, the Global Fund, and the World Health Organisation. Additionally, he has served on the Board of the World Health Organisation’s Alliance for Health Policy and Systems Research and the Programme and Policy Committee of the GAVI Alliance Board.

However, beyond the economics of it, his choice of profession defines his passion. Of this, he affirms, “I am a medical doctor, and I don’t think there’s any medical doctor that is not out to save lives. For me, at the end of the day, I’m fortunate, but there are people that are not. And when we all go back to our maker, they’ll ask you what you did with what you had. I don’t have everything, but whatever is given to me, how do I use it to make life better for the person that can’t make life better for themselves?”

He ponders the following grim spectres: a woman about to die because she does not have 250,000 Naira to pay for a Caesarean section; a woman who is “too young; her body wasn’t ready” and has a fistula and has been abandoned by her entire family in a village; and the man with a stroke or cancer who cannot afford care.

These are critical challenges that humble everyone that the public health system must deal with daily, he says, because he employs a quote: ‘Of all forms of injustice, injustice in healthcare is the most inhumane.’ He asked, “What can we do to reduce that burden on Nigerians? I don’t have any messianic complex, but I just want to ensure that in my own lifetime, when I had the opportunity, I did my best. So hopefully while I’m here, I’ll build on what others have done before, and I will try my best to move the needle a little bit so that it will impact people who live behind the more resilient organisation that can actually continue to serve Nigerians, because a lot of people depend on this. A lot of people depend on this working. And if this doesn’t work, people will get impoverished, and people will die. It’s tough, but I’m sure it’s tougher for other people.”

But, while health insurance is his preferred option, he insists that “explaining how insurance works is also really important.” Just how important is it to do this explanation? “It’s very important to create awareness, but by creating awareness about how insurance works. Insurance doesn’t mean we’re walking into a place that’s free,” he says.

Born in Aba, he earned a medical degree from the University of Lagos, as well as a Master of Public Health degree and a master’s degree in Public Health and Health Policy and Management from the Harvard T.H. Chan School of Public Health. During his time at Harvard, he was a healthcare management fellow. He is a Desmond Tutu Fellow of the African Leadership Institute and a member of the Aspen Global Leadership Network.

Over the course of his career, he has been involved in numerous global expert advisory panels for international organisations, including the Institute of Medicine, the Centres for Disease Control and Prevention, the World Bank, and the World Health Organisation.

His public sector career includes previous roles as the senior adviser to two ministers of health and the minister of finance in Nigeria. In these capacities, he led the delivery of several large-scale transformation programmes, such as the Saving One Million Lives Initiative aimed at reducing maternal and child deaths and the conceptualisation and design of the National Social Safety Net Programme to alleviate intergenerational poverty. Before then, he was an engagement manager at the London office of McKinsey & Company, where he served clients across Europe, the Middle East, and Africa. He also worked with the World Bank Group in Washington, DC through the Young Professionals’ Programme, focusing on social protection and strengthening health systems in Asia, the Middle East, and Africa.

This new organisation needed to step up to the task that it had been entrusted with. And we had a population that was very restless, asking more and more questions. A lot of people who couldn’t afford health care saw a rise in health care inflation. That created a storm that we walked into.

However, the situation was helped by Mr President having signed a compact between the federal government and the states with his signing into law the Health Sector Renewal Investment Initiative that is championed by the Coordinating Minister for Health and Social Welfare, under whose watch the ministry began to develop a sector-wide approach to have just one plan and one form of accountability for the system. “He articulated a very clear vision of what he wanted the health system to be. This, together with Mr President’s full backing for our journey towards UHC, provided the strategic direction,” he recalls. “This ended the chaos that we met.”

On integration, there’s the challenge of harmonising the national health insurance system with state health insurance schemes, the private sector-led insurance systems and the schemes of other organisations in the insurance value chain. So, for the synergies achieved, an integrated mechanism needed to be put in place to reduce the fragmentation that exists and the inefficiency to create a more sustainable industry.

According to Ohiri, “the new organisation needed to step up to the task that it had been entrusted with. And we had a population that was very restless, asking more and more questions. A lot of people who couldn’t afford health care saw a rise in health care inflation. That created a storm that we walked into.”

To enhance service integration, NHIA has engaged with different stakeholder groups, other health insurance entities, state health insurance agencies, private health insurance, the HMOs, as they are called, other civil society, the ministry and other people, just to get a better sense of developments in the agency, including the policy space. And then a year ago to date, the agency developed a strategy to enhance financial access to good-quality healthcare for all Nigerians.

Another important development was that the president signed a compact between the federal government and the states with his signing into law the Health Sector Renewal Investment Initiative that is championed by the Coordinating Minister for Health and Social Welfare, Prof. Muhammad Ali Pate.

It necessitated the development of a sector-wide approach, entailing just one plan and one form of accountability for the system. “He articulated a very clear vision of what he wanted the health system to be. This, together with Mr President’s full backing for our journey towards UHC, provided the strategic direction. This ended the chaos that we met.”

Indeed, one of the things Ohiri appears to have found most exciting about his job is the luxury of his agency being under the Federal Ministry of Health and Social Welfare led by Muhammad Ali Pate, a former professor of public health leadership in the Department of Global Health and Population at Harvard University and director of the Global Financing Facility (GFF) for Women, Children and Adolescents at the World Bank Group.

Dr. Ohiri cherishes the support from President Tinubu, coupled with the backing he has from the minister of Health and Social Welfare.

He says there’s always room to improve the system. “I’m sure there will be better ways of doing it in the future. I don’t have the arrogance to think that what I do is going to be the way to go. Somebody is going to come up with far better ways to do it.”

In the same spirit, he concedes that his predecessors tried their best. He says his successors will have every right to dismantle what he builds and improve on the system “as long as that financial protection for Nigerians continues”.

He challenges Nigerians to be in solidarity with the concept of health insurance, saying, “It means that at every point in time, those who are well subsidise those who are sick. That form of solidarity is at the heart of what citizenship means in a country. If we continue to maintain that solidarity without being too political about it, then indeed, we are showing that cohesion that we want. Because every time I pay my premium, whether I’m sick or not, it’s going to cover somebody else and pay for somebody else’s healthcare. And that’s the beauty of health insurance. I was coming from a meeting of the cooperative society of NHIA; the cooperatives work in that same way. We all put in money; somebody might need it and pull from it, but we all contribute so that when we need it, it is there for us to pull from. That’s the whole principle behind insurance. If there’s one word to describe it, it is solidarity. The Southern Africans call it Ubuntu – “I am because we are.” On his part, he says, “I would say to Nigerians to subscribe to health insurance because it’s the strongest form of solidarity they can show to not just their family but to fellow citizens in the country,” he counsels. “That’s what I would ask them to do.”

Indeed, he doesn’t feel health insurance should be optional, nor should it be politicised. “It’s a human right. I hope that we can demonstrate the value of financial protection in healthcare that is sustainable.”

What legacy would he want to leave behind? He says, “First, in life, things change. Legacy is not to leave things and then expect it to stay the way you left it because you want things to improve and to be better. I would hope that people continue to get financially protected from the cost of health care, in whatever form it takes. Whether it is through social health insurance, formal sector health insurance, or government tax-financed insurance, I hope that the consistent policy drive of understanding that financial protection from the cost of health care continues to endure. And that we have left it in the minds of Nigerians that this is something we must pursue and must continue to hold governments accountable for; that the poor and other Nigerians need financial protection from the costs of healthcare.”

Hassan is general manager for Abuja and Northern Nigeria of BusinessDay newspaper.