One year may be a short time to make tremendous progress in a public institution once bedeviled by leadership crises; but not so for this change agent, writes Solomon Obuns
Once upon a time, the National Health Insurance Scheme (NHIS) was a battleground; a theatre of war in many ways. If it was not the helmsman and staff at daggers drawn, it was the leadership of the institution at war with health minister over a needless superiority contest.
While all the bitter battles lasted, work at the Scheme took a back seat, the mandate of the agency suffered lack of attention, while the intended beneficiaries of the Scheme – enrolees – experienced severe neglect.
This was the state of affairs at the NHIS when President Muhammadu Buhari, GCFR, head-hunted and appointed Prof. Mohammed Nasir Sambo to take over the Scheme as Executive Secretary and Chief Executive Officer a year ago. Specifically, while his appointment was formally made on July 1, 2019, Prof. Sambo took over and began his work at the Scheme on July 15, 2019.
His is one appointment that could fittingly be described as a square peg in a square hole! For, since he took charge as ES/CEO of the NHIS, the organisation has rapidly reclaimed its lost grounds and is now well focused on delivering on the mandate it was established to implement.
But beyond every success that Professor Sambo has recorded since he was appointed the Executive Secretary and Chief Executive Officer (ES/CEO) of the National Health Insurance Scheme (NHIS) one year ago, nothing compares with the peace, tranquillity and harmonious environment he has brought to the Scheme.
To the eternal credit of Professor Sambo is the testimony that staff and management now work as one, better focused to achieve the mandate of the foremost healthcare financing institution in the country.
To demonstrate this new found synergy among the entire team at NHIS, on July 15, 2020 which marked the first year anniversary of Professor Sambo as ES/CEO at NHIS, the Top Management Committee (TMC), while observing the new order created by COVID-19 pandemic, celebrated the ES/CEO where they poured encomiums on him for the achievements so far attained, chief among being bringing peace and harmony to the Scheme.
To say that Professor Sambo has done marvellously well in one year, is an understatement. And this much was expressed by members of Management on behalf of all staff of the Scheme.
As a Change Agent, Professor Sambo has led the NHIS out of the doldrums and today’s NHIS is a stable, vibrant, focused and result-oriented Federal Government agency.
According to members of the Management staff of the NHIS, “Under his leadership and, in just one year, our cherished Scheme has been restored, reinvented, reinvigorated and renewed. And once again, we have our pride restored.”
In their joy of hearts, they enthused that, “the foundation laying is completed. And the work just began, as we resolutely pursue our mandate with vigour and purpose!”
At his appointment last year, the burden of restoring the NHIS to the path of glory fell on the laps of Professor Sambo, one of the country’s foremost technocrats of health policy and management whose area of special interest is health care financing.
What are the landmarks of the past one year of Professor Sambo’s leadership at the NHIS? Several, to answer it mildly.
In January this year, under Professor Sambo’s watch, the NHIS introduced the innovative conceptual framework of Health Insurance Under One Roof (HIUOR) as a tool to reduce the bottlenecks occasioned by fragmentation in the health insurance system in Nigeria. This laudable programme has as its overall objective to ensure that health insurance operates under one system with proper coordination, regulation and unified data.
By February, as a way of guaranteeing buy-in by stakeholders in the sector such as State Social Health Insurance Schemes (SSHIS), HMOs and healthcare providers, and adjunct interests including international donor partners involved in system strengthening and improving healthcare delivery across Nigeria, Professor Sambo, at a 3-Day retreat organised by the NHIS, held in Goshen Centre, Nasarawa State, communicated with great efficiency his vision of Health Insurance Under One Roof concept.
He said the initiative became necessary as a result of lack of coordination, fragmentation and operational disunity that exists in the health insurance segment.
As a result, Professor Sambo emphasised: “we are looking at some innovative financing options to cover the vulnerable group and we are going to determine who to cover the group.”
The ultimate goal of the Health Insurance Under One Roof is to achieve Universal Health Coverage (UHC) for citizens and inhabitants of Nigeria.
Standing up to the sudden pressure of COVID-19 on the health management system of the country, Professor Sambo and his team at the NHIS quickly responded to the demands of the pandemic when the NHIS in March released upfront payment covering the period of April to June for Enrolee Care. This was a strategic move to ensure that no enrolee of the Scheme is turned back for lack of payment of their premium while they seek care during the pandemic.
Professor Sambo also took a bold step to put a permanent end to the disruptive and often contentious issue of indebtedness of Health Maintenance Organisations (HMOs) to Health Care Facilities (HCFs) resulting from unpaid bills. This singular problem has been at the head of most service failures in the experiences of the enrolees under the Scheme.
The NHIS embarked on a reconciliation exercise which was designed as a clearing house for areas of disagreement between HMOs and the facilities over unpaid bills. The move is also to guarantee that stakeholders abide faithfully with their obligations under the Operational Guidelines of the Scheme, as well as the restoration of full stakeholder and public confidence in NHIS.
The new management of NHIS as a part of its rebranding agenda which is anchored on value re-orientation, transparency and accountability, and attainment of Universal Health Coverage (UHC), had in December last year issued a public notice inviting healthcare facilities accredited by the Scheme to submit claims of unsettled bills standing against the HMOs.
The allegation has been that some facilities in the country were withholding care from enrolees over unpaid capitation and fee-for-service by HMOs, in spite of receiving funds timely from NHIS for those purposes.
Not a man given to flippant talk and a no-stranger to challenging and seemingly daunting tasks, Professor Sambo still holds tenaciously to his 3-Point Rebranding agenda which was the springboard of his administration at inception 1 year ago.
Indeed, the three-point agenda has since been deepened with each point further developed into various elements to facilitate the process of implementation. It is notable that the implementation has since gotten under way, with various remarkable results already showing.
Value Re-Orientation: Restoring a Value System that will transform NHIS into a credible result-driven organisation:
To achieve this aspect of the reforms, processes were laid out to achieve good work ethics, unity of purpose and direction, synergy between the NHIS and collaboration with critical stakeholders as essential elements as quickly as possible.
Other items that will ensure the success of the first point of the agenda are restoring teamwork and team-spirit among workers, putting in place an effective communication and information management system, creating an excellent work environment which will include office space and improved working tools; and, when management has played its part, efficiency, which is result-oriented could be expected. And, through proper records keeping, as an equitable organisation, there would be an appropriate rewards system and sanctions for inactive and unproductive members of staff but; in all, emphasis is placed on equity and fairness for all concerned.
The second aspect of the 3-Point agenda is Engendering Transparency and Accountability in the entire operations of the Scheme.
Perhaps, this singular item has been at the bedrock of the myriad problems that have plagued the NHIS over the years. Professor Sambo therefore established that for transparency to thrive as the guiding principle of the NHIS, openness in the Scheme’s operations cannot be compromised; and this can only be accomplished through evidence-based working system, whereby the NHIS at all times would endeavour to provide adequate information to all stakeholders, engage regularly with stakeholders in its decision making process, enthrone effective administration and financial management systems in the context of an Information and Communication Technology-driven NHIS.
And the third aspect of the agenda is, Accelerating the drive towards achieving universal access to quality healthcare for all Nigerians.
As an insider who has been in the forefront of the establishment of effective national health management programme, he was the First Zonal Coordinator, of South West zone of NHIS, the first National Coordinator of Community-based Social Health Insurance that developed the 6-pilot community-based Social Health Insurance Programmes in the country and the former Head of Health Maintenance Organisations Division of NHIS that registered the first five HMOs in the country; Professor Sambo therefore understands that health insurance and primary health care system are cardinal towards achieving universal health coverage.
So, NHIS under his watch would make conscious effort to consolidate and strengthen existing programmes of the agency, and make innovation through the development of a comprehensive matrix that will ensure that no population segment of the country would be left behind in the quest to achieve Universal Health Coverage (UHC).
It is to the continual fulfilment of the various aspects of these three pronged self-imposed mandate that the management and staff of the NHIS recommitted themselves during the one-year anniversary of the institution under the guidance of Professor Sambo.
For a man who is noted for the depth of his research works, Sambo’s 3-Point Agenda is a product of thorough appraisal of the situation at the NHIS, task at hand and everything that went wrong with the NHIS in the last few years. His rapid assessment of the scheme led him to the conclusion that only a deliberate and planned effort will bring out the scheme from its lacklustre performance.
To achieve any meaningful result, Professor Sambo realises that only an NHIS which puts the well-being of the people of Nigeria uppermost is worth pursuing. He did not mince words when he announced this objective to the staff of NHIS from the first day.
At that inaugural meeting with staff, he made an individual promise as the 11th Executive Secretary of the NHIS to do his best to return the lost glory of the organisation, with a clear objective to reposition the scheme and make it realise its core mandate for the purpose of national development.
According to Sambo, “I am here to unite and not to perpetuate division; I am here to build bridges and not to destroy, I am here to work and not to joke, I am here to contribute my own quota towards national development.
“I know that NHIS is a system comprising of many stakeholders who are interdependent and the success of each stakeholder depends largely on the others.
“Therefore, I shall make sure I carry every stakeholder along in the process of decision making,” thus he declared in that inaugural address to staff.
A man of many parts, Professor Sambo is an alumnus of the World Bank Institute in Health Sector Reform and Sustainable Financing and he is reputed for his gifted capacity to turn around ailing institutions. This he eloquently demonstrated in the course of his sterling service at ABU in Zaria. His track records of elucidating successes can be also be found in such places as the Kaduna State University where he served as Provost of the College of Medicine. This is specifically the story at the Medical School of the Ahmadu Bello University where he served as Deputy Dean, Faculty of Medicine.
He was before then Head of Department of Public Health where he introduced far reaching reforms and attracted a lot of collaborations and grants to the department and the university, including the University of Aberdeen, UK and Centre for Disease Control, Atlanta, USA, among others.
In just 100 days of assumption of office last year, Professor Sambo’s had accomplished more than what most of his predecessors could not achieve in years, such that his good works have innovative policies and strategies had virtually obliterated the negative image of the NHIS, and projected new and brighter prospects.
For instance, among his first major assignments on assuming office which was also a way to revamp the appalling morale of the workers of the Scheme, was that he immediately caused the conduct and payment of the arrears accrued as a result of the 2018 promotion exercise of the Scheme.
He began deliberate interactive sessions with some of the critical government agencies whose need for the services and collaboration with the NHIS should not be taken for granted. Among these are, the management of the Nigerian National Petroleum Corporation (NNPC) whose Health Maintenance Organisation (HMO) had been pending for years for approval.
He either visited or received in his office, agencies like the Independent Corrupt Practices Commission (ICPC), Inspector General of Police, Police HMO, Management of the NNPC, Chair of the Senate Committee on Health and other related committees (where he addressed the subject of the Changing Landscape in NHIS and urged the legislators to ensure the speedy passage of the NHIS Bill to make health insurance mandatory, among other amendments).
Within the same period, the ES/CEO of NHIS engaged with stakeholders and enrolees, MDAs etc, to discuss issues such as poor service from health care providers and HMOs, as well as inadequate complaint submission and redress mechanisms by NHIS, among others.
Sequel to the meeting with enrolees, another engagement was held with Health Care Providers which also had in attendance The Guild of Medical Directors and Committee of Medical Directors of Teaching Hospitals, Honourable Minister of Heath, Dr. Osagie Ehanire and the Honourable Minister of State for Health, Dr. Adeleke Olorunnimbe Mamora. And issues surrounding delay in payments by HMOs and low NHIS tariffs, were discussed by the providers.
On September 10, 2019; the Executive Secretary hosted the event where the Health Minister, Dr. Osagie Ehanire officially disbursed the First Tranche of the NHIS Gateway of the Basic Health Care Provision Fund (BHCPF) to State Social Health Insurance Agencies with the Minister of State for Health, Dr, Olorunnimbe Mamora in attendance. A total sum of N6.5 billion was disbursed to 15 states and the FCT at the occasion.
Today, donor agencies that hitherto distanced themselves from the activities of the NHIS on account of poor leadership, are joyfully opening their doors to the establishment. And this is because a round peg has finally been inserted into a round hole.
For instance, early in September 2019; the ES/CEO held a meeting with Clinton Health Access Initiative (CHAI) Health Financing Team to discuss moving the health environment in Nigeria to the next level. He had earlier held a similar meeting with the Bill and Melinda Gates Foundation (BMGF). Other global agencies like the World Health Organisation (WHO), USAID Nigeria, etc; also reaffirmed their commitment to supporting the development of Nigeria’s health sector.
Professor Sambo understands that a virile health system requires extensive collaboration across board. His collaboration with these agencies and support groups will assist with capacity building, technical and financial support.
As the chief image maker of the NHIS, he has continued to represent the scheme at various events and initiatives. These include National Council on Health held in Asaba, Delta State capital, NCDC NFELTP Annual Scientific Conference, Abuja; 50th Anniversary of National Postgraduate Medical College of Nigeria, 2nd International Scientific Conference of the Medical Rehabilitation Therapist Board, NHIS Stakeholder Meeting with State Social Health Insurance Agencies with the Theme: Shaping the Future of Health Insurance Expansion in Nigeria through SSHI, held in Kano; he was also present at the e-Government Executive Summit by NITDA and Oracle Nigeria held in Turkey.
Other strategic meetings the ES/CEO of NHIS has been involved in include: Inauguration of the Committee to Develop the Health Sector Agenda 2019-2023. The ES/CEO is represented on this committee by Mrs. Modupe Ogundimu (GM Enforcement); he was at the 9th edition of Medic West Africa Conference held in Lagos, in October, 2019.
Meanwhile, it is not only to correct past ills among various stakeholders of the industry in the country, Professor Sambo often demands results. The new NHIS which is result-oriented, has directed that provisions of its Operational Guidelines which is the standard of procedure in the industry, must be strictly adhered to, at all times.
And understanding the need for a harmonious working relationship with the Federal Ministry of Health, NHIS under the leadership of Professor Sambo has remained an uncompromising ally of the Minister of Health and the ministry, in actualisation of the Next Level Health Sector Agenda. At every opportunity, this outstanding technocrat has emphasised that his agenda is in tandem with that of the Federal Government under the Presidency of President Muhammadu Buhari.
Quietly making a difference where most have been disillusioned in the past, Professor Sambo promises that the years of unsteady footsteps are over at the NHIS; the Scheme now matches forward with sure-footedness, towards the fulfilment of its founding mandate – providing easy financial access to quality healthcare for all.
Professor Sambo knows only this mandate as his call.