At least 23 out of the 57 Health Management Organisations (HMOs) have been delisted from the National Health Insurance Scheme (NHIS) having failed validity test carried out.
According to the newly inaugurated governing council of the scheme, the HMOs were blocked from having access to the NHIS scheme after they failed to meet up to the minimum operational standard of the program.
NHIS deals with two major components: Health Maintenance Organisations, HMOs and Health Service Providers, HSPs.
The HMOs sit between the beneficiaries of NHIS and the service providers (hospitals), they are also managers of the scheme’s funds.
The scheme, which is the regulatory body, monitors and regulates the activities of the HMOs and the service providers.
During a press briefing on Thursday at Abuja, the chairperson of the board Enyantu Ifenne, disclosed that only one out of the 57 HMOs apparently scored up to hundred percent during the test, and is thereby granted accreditation to operate.
Present at the briefing include; The Executive Secretary of the scheme, Usman Yusuf, as well as other members of the board.
According to Ms. Ifenne, 34 HMOs were accorded provisional accreditation until such a time when they are able to fulfill all the conditions for the reaccreditation process, while 23 were denied reaccreditation as they failed to satisfy the conditions of minimum standard of operation as expected of them.
Ms. Ifenne, a paediatrician said amongst the conditions expected is the renewal of accreditation by the HMOs for every two years, as some of them have their last accreditation in 2013.
She further explained that Decree 35 of the scheme gives the council the power to re-accredit HMOs and also lays out clearly the condition and processes through the operations and guideline that were drawn down by the Act.
She expressed worry over low coverage of the scheme right from inception, adding that the scheme has mapped out plans on how best to expand enrollee coverage by 10 per cent every year.
“We have a plan to expand coverage of the scheme at least by 10 per cent every year. We can do better but that’s the modest goal.
“We can achieve that by providing support to states to enable their own law and establish their own front. We have a lot (of) social capital in the non-formal sector that we have to activate. We are targeting universities, NYSC members, less-privileged, pregnant women and children. We are worried that countries like Ghana and Rwanda are doing much better.
“The fact that health facilities are reluctant to accept NHIS enrollees is an indictment on NHIS as public entity because what we see with this reaccreditation is accumulation of regulatory failure.
"Accreditation should not be the only time we know that the company is bankrupt or nonexistent or sold to (a) South African entity. If we were up and doing and on our toes in applying the regulatory powers giving us under the law, this should not happen.”
"She said the current value chain the scheme operates ”which puts the NHIS at the top, the HMOs, the healthcare providers at the centre and the enrollee at the bottom is wrong.”
“Elephants have been fighting, the grass gets hurt. The grass here is the people we call enrollee. I hate that word. Enrollee just makes it look as if they were conscripted. They have no choice but to take poor service whether they like it or not or opt out.”
She also said the board has made plans to change the current trend and put the enrollees at the top of the ladder; noting that the satisfaction of the enrollee is key to the operation of the board.
Also speaking, a representative of the HMOs, Lekan Onaikan, said the HMOs are ready to comply with all regulatory guidelines mapped out by NHIS.
