By Iyoho Emmanuel
ABUJA — The Centre for Social Justice (CSJ) and the Independent Corrupt Practices and Other Related Offences Commission (ICPC) have called for sweeping reforms in the operations of the National Health Insurance Authority (NHIA), including stronger oversight of Health Maintenance Organisations (HMOs), improved financial controls, enhanced monitoring of healthcare providers and urgent measures to protect the rights of enrollees.
The recommendations are contained in the System Review Report on the NHIA conducted by the ICPC in collaboration with the CSJ and recently presented in Abuja by the Lead Director of the CSJ, Eze Onyekpere.
The report urged the NHIA to strengthen reconciliation mechanisms with the Central Bank of Nigeria (CBN), the Office of the Accountant-General of the Federation (OAGF) and relevant financial agencies to resolve outstanding discrepancies, while developing a medium-term financial sustainability plan to reduce dependence on contribution funds.
It also called for the full harmonisation of the NHIA Conditions of Service with the Office of the Head of the Civil Service of the Federation and strict adherence to approved operational frameworks.
The report further recommended the proper constitution and repositioning of the Anti-Corruption and Transparency Unit (ACTU) of the Authority to guarantee its independence and effectiveness.
On staffing, the review recommended merit-based recruitment to address imbalances in state representation while ensuring compliance with federal character principles and equitable representation.
The report also identified the need for stronger regulatory oversight of HMOs and healthcare facilities, recommending the establishment of a centralised monitoring portal capable of tracking approval codes, insurance turnaround time, compliance indicators, claims and service delivery.
It urged the NHIA to enforce timely settlement of claims to healthcare facilities and impose appropriate sanctions on HMOs that fail to comply with established regulations.
On enrollee protection and service delivery, the review called for sustained nationwide sensitisation and public engagement to ensure that beneficiaries understand their rights and available benefits.
It also recommended urgent measures to address drug denial and other challenges confronting enrollees through improved monitoring of healthcare facilities and stricter enforcement of approved benefit packages.
The report specifically urged the NHIA to intervene in the situation at the Lagos University Teaching Hospital (LUTH) to ensure that Public-Private Partnership arrangements do not undermine the rights and benefits of NHIA enrollees.
It further recommended an immediate audit of capitation funds at the University of Nigeria Medical Centre, with corrective measures to address and refund outstanding failed registrations.
Similarly, the review called for the resolution of communication challenges associated with the Group Individual and Family Social Health Insurance Programme (GIFSHIP) and the refund of funds relating to failed registrations.
To strengthen operational efficiency, the report recommended the activation of the quality improvement module of the NHIA Quality Tool and the speedy development of an integrated HMO/HCF operational dashboard capable of providing real-time monitoring of code approvals, claims and service delivery.
The report also advocated the institutionalisation of early budget preparation and timely submission in accordance with the NHIA Act, 2022, to ensure that annual budgets are approved early enough to facilitate effective implementation of programmes.
According to the report, the system review was undertaken in line with the ICPC’s preventive mandate under Section 6(b-d) of the Corrupt Practices and Other Related Offences Act, 2000.
It built on the 2019 system study and corruption risk assessment of the NHIA, which examined the Authority’s operational, financial and governance structures.
The latest review assessed the level of implementation of the recommendations contained in the 2019 report, identified compliance gaps and examined progress made in strengthening transparency, accountability, efficiency and service delivery in line with the NHIA Act, 2022.
The review also identified emerging risks, operational bottlenecks and systemic vulnerabilities capable of undermining the Authority’s mandate to provide accessible, affordable and quality healthcare to Nigerians.
The report acknowledged several initiatives undertaken by the NHIA, including the operation of the Vulnerable Group Fund (VGF) to subsidise health insurance premiums for vulnerable Nigerians.
Other initiatives identified include the NHIA Fistula-Free Programme, which provides comprehensive obstetric fistula care and post-treatment insurance enrolment; financing access to comprehensive emergency obstetric and neonatal care for women with maternal complications; and financing emergency care for small and sick newborns.
The review also highlighted the Authority’s strategic purchasing and bundled/fee-for-service payment mechanisms aimed at improving the quality and efficiency of healthcare delivery.
It noted efforts to integrate health insurance into the social safety net to provide long-term financial protection for beneficiaries, as well as the use of the National Identification Number (NIN) for beneficiary verification and improved programme integrity.
However, the report concluded that despite commendable steps by the NHIA towards strengthening financial governance, improving operational frameworks and aligning its activities with regulatory standards, significant gaps remain.
It identified weak oversight of HMOs and healthcare facilities, alongside persistent service delivery challenges affecting enrollees, as major risks to the attainment of universal health coverage.
The report, therefore ,stressed that addressing the identified challenges would require sustained institutional commitment, stronger accountability mechanisms and targeted reforms that prioritise transparency, financial discipline and the welfare of enrollees.
It was optimistic that with deliberate action and strict implementation of the recommendations, the NHIA could significantly improve its performance and effectively deliver on its mandate under the NHIA Act, 2022.