The most effective method to make NHIS work

A lot has happened at the National Health Insurance Scheme (NHIS) since it was created by the government of President Olusegun Obasanjo in 2005. The NHIS is charged by law to promote access to quality and affordable healthcare in Nigeria through the provision and regulation of health insurance. At the launch of its formal sector programme in 2005, then President Olusegun Obasanjo mandated NHIS to achieve universal health insurance coverage in Nigeria within ten years, which means that all Nigerians should have health insurance coverage by 2015.

Since 2005, NHIS has done a lot to achieve this mandate. Federal Government’s employees and their dependents have been covered almost 100%. Also, close to two million private sector employees have enrolled under NHIS. The Scheme has also designed imaginative programmes to include Nigerians outside the formal sector. These include the Community Based Social Health Insurance Programme (CBSHIP), the Voluntary Contributors’ Social Health Insurance Programme (VCSHIP), the Tertiary Institutions Social Health Insurance Programme (TISHIP) and the NHIS-MDG Programme for Pregnant Women and Children under Five Years.

As remarkable as these achievements are, most Nigerians are still not under the Scheme. In fact, a recent survey stated that only 7.5% of Nigerians have health insurance covers. The capacity of NHIS to provide health insurance for all Nigerians has been constrained by some challenges. And one of them is the turnout of chief executive officers of the scheme in the past six years after Dr. Dogo Muhammad was denied reappointment despite his sterling performance. I would like to state that the NHIS under Dr. Dogo Muhammad experienced phenomenal growth. Why? Dr. Dogo Muhammad rose through the ranks in the civil service, and when crisis rocked the NHIS, he was called upon to the federal ministry of health to head the scheme. And his tenure can be termed a huge success.

This piece is not about Dr. Dogo Muhammad, but rather making a case for an insider to be appointed Executive Secretary of the NHIS. Naturally, this would require referring to the Dogo Muhammad era at the NHIS. After Dr Dogo Muhammad left, a general manager Dr. Muhammed Sambo was appointed acting executive secretary and he stabilised the system, but again he was asked to leave the position for an “outsider”

The NHIS has not had it all rosy with chief executives. And the reason is simple. The government has brought two people from outside the scheme as executive secretary and the only achievements you could associate with them was that they awarded frivolous contracts to their cronies and helped themselves with NHIS funds.

I will start with Dr. Femi Thomas. He came and left unceremoniously after helping himself with NHIS funds to the detriment of impacting lives. Dr. Femi Thomas was an “outsider”, who needed to learn, and in the process, he got carried away, and the rest is history. Then came Mr. Femi Akingbade, a general manager at the time and acting executive secretary. He did his best. Again he was replaced by an “outsider” in the person of Professor Usman Yusuf, who was suspended by the minister of health bordering on allegations of corruption.

Has the government learned a lesson? Common sense stipulates that an agency as sensitive as the NHIS ought not to be left in the hands of newcomers. Yes, it can be argued that the position of executive secretary is political, but again, after two failed experiments, won’t there be a need for a change in strategy?

The change in strategy is simple. The government should look at what it is that “insiders” are able to manage NHIS effectively and why “outsiders” have all messed up the place and should look inwards towards appointing a new executive secretary for the NHIS. Unless there is an argument that there are no qualified people in the NHIS. In my opinion, I am not sure the argument of no qualified personnel in the NHIS can hold water. I will give an example. The acting executive secretary of the NHIS, Mallam Attahiru Ibrahim was the general manager contributions before his appointment as acting executive secretary. As a stakeholder in the health insurance sector in Nigeria, I have interacted with Mallam Attahiru Ibrahim for upward eight years in the course of work. He is not only a through—breed; he is a consummate professional that understands the concept of health insurance.


Let me also add that you can’t questions his integrity and he is not one that would compromise. I know this because we have worked closely on a couple of projects and this attribute stood out. Despite being the most senior general manager in the NHIS, he was transferred out of the head office to head the north central zonal office, a position he held for about 8 years. But when and where his inputs are needed he was always called upon. That tells the quality of his debates and the strength of his character.


Lest I also forget, he was at a time the general manager research, planning, and monitoring of the NHIS. If you called the research, planning and monitoring department the hub of the activities of the NHIS, you wouldn’t be wrong. As a fact, that was where our paths crossed. We argued and argued. I won in some cases, and he also won in some cases. But the takeaways from some of our arguments were that at least there was someone with a grasp of the issues confronting NHIS. I recall a particular incidence during a seminar organized by the NHIS for health management organizations and hospitals towards ensuring that care is given to NHIS enrolees as at when due.


On that occasion, the HMO’s were all prepared to lay the blame on the NHIS, but trust me, when Mallam Attaihiru Ibrahim mounted the podium, he churned out statistics, cited cases back with verifiable evidence and suggestions on the way forward. After his speech, I recall there was pin drop silence in the hall. Only a few murmured. Initially, we all thought he was a consultant or something; it was after an exchange of pleasantries at the end of the event that we realized he was a staff of NHIS. And you could easily feel the wow on the lips of everybody.


The crux of this piece is simple. The government should look inwards if it is desirous of making the NHIS work. Nigeria does not have the luxury of time. Recalls that Nigeria ought to have attained universal health converge since 2015. But here we are with less than 10% coverage when countries like Rwanda and Ghana have made considerable progress towards achieving universal health coverage for its citizens.

These are my thoughts towards solving the leadership crisis at the NHIS. And it is only hoped that those saddled with the responsibility of making appointments should not make the same mistake for a third time by appointing an “outsider” to head the NHIS. And moving forward, the system should be setup in such a way that substantive executive secretaries should come from the system and not outside the system. And as they say, charity begins at home.
Love, not hate, started crises in my novel – Richard Ali

Richard Ali: Writing flows inevitably from reading a lot and I have always been a reader, right from primary school. Eventually, you realize that you too can create these very real contexts of words that your favourite writers create. So, you try your hand at it, a paragraph here and there, and sometimes poetry. These are the very first experimentations with craft. Sometime in senior secondary school, I decided to write a novel about a boy called Osita who runs away from home. I managed to fill out five sixty-leaf notebooks! I’m not quite sure what became of the notebooks but I don’t imagine it was a great loss, except for sentimental value, of course. Years later, at the time of the ‘ethno-religious’ crises in Jos, I decided to write a proper novel which became ‘City of Memories’.
Bookshelf: How did ‘City of Memories’ come to life?
Ali: I had this simple idea-what if the crisis we faced in Nigeria, and in my native city, Jos particularly, had started not as enmity and hatred but as a love affair? That was the story of Ummi al-Qasim who becomes the mother of Faruk in the novel. She showed up originally in a short story, a very long short story of about 10,000 words. I wrote it sometime in my second year at Zaria, where I was active in the Creative Writers Club. So when I left Zaria, it was easy to decide to write a novel based on the earlier short story. In the novel, of course, Ummi al-Qasim is already dead and four new characters flounder in the aftermath of her death and its significance.
Bookshelf: The characters, Eunice and Ibrahim are an children of your imagination, so to speak. How do you feel about them?
Ali: Very strongly. Eunice is particularly fascinating. When I was growing up in central Nigeria, we had these larger-than-life female politicians and public figures. I remember particularly the late Ngo Hannatu Chollom. There was also the late Catherine Hoomkwap. In the fields of politics, public service and non-governmental activism, these women had unparalleled influence and power in my imagination. So, they fed the archetypes of Eunice Pam. Perhaps the most public example of that sort of effective female politician would be Mrs. Pauline Tallen? I admire them all and from there, devised Eunice Pam. On the other hand, Ibrahim Dibarama is Eunice’s foil. I wanted to create someone who would be just like her but not make the fatal mistake she made-which is to equate entire people for the wrongs of individuals. So, I feel strongly about them. But beyond these two are their children, Faruk and Rahila, whose love forms the central conflict of the book and whose insistence on love points, to my mind, to a way forward.
Bookshelf: Where do you draw inspiration from and what is creativity to you?
Ali: From life, of course. The view of the street as I walk or through a car or office window, the news in the dailies, happenings in far-off places or to other people recounted in bars over a beer or two. I write fiction and some people have wondered, where do you get these ‘people’ from? The truth is that a fiction writer watches the world with a mind, and a special genetic ability perhaps, of ‘stealing’ from other people what is story-worthy. And this forms the core of the material, the inspiration for the writing. It really is life, with conflict and a few other tricks thrown in.
Creativity, for me, is essential to life itself. It is also an indicator to settled-ness in a sense-we create art, whether it is the Fulani woman decorating her calabashes in Gembu, or the village poet in Nsukka coining witticisms and beauty or the novelist writing his book, because we are able to find a place in order and calm within a mad, mad world. So long as we can still create, it’s not so bad for man on earth yet. But imagine the day when the level of chaos is so great that there can be no poems, no songs, no writing anymore. Imagine that.
Bookshelf: What are those challenges you have faced as a Nigerian author and how have you been able to overcome them?
Ali: The usual ones; electricity and rubbish internet access. The more unusual challenge would be the true weight, the inexorable burden of being a Nigerian in a country where there is so much pressure on the individual because so much, so many systems, do not work. It’s the combined pressure of senseless bureaucracies and corrupt officials from immigration to police to PHCN who want bribes for services they still will not provide. It’s the transport system that is unpredictable, the city of Abuja where you are toast if you’re caught in rain or sun. It’s never being sure how much of the petrol you paid for was actually put in your car and if what was put in will not cause engine trouble. It’s mechanics you can’t trust, neither their competence nor their words. All these things build up and the quiet necessary for literary creation becomes hard to find. Yet, the artist must create. This is the fundamental tension. All these add up, these are the challenges.
Bookshelf: What do you think contributed to your success as an author and what makes your writing unique in your own eyes?
Ali: My brilliance, my genius and my somewhat colourful personality perhaps? (Laughs). Seriously, it is impossible to assess ones success and even more so to put a finger to the why of it. Success is relative, and when we ask, “compared to who or what”, that’s often the recipe for misery. I like to think I am a man of actions, and that I have done stuff and that’s all. I try to come to situations with the best of my ability and talent and experience so that, subjective as these are, I can discharge myself after acting by not having a single doubt that I did the very best I could. The things often considered successes are merely things I did, in a line, hopefully long, of many more things I will do. It would be nice to give some bother to historians down the line but it really does not matter.
On my writing, I try to bring sensibility and a certain sensitivity to it. So, it really is unveiling yourself to the world knowing there are some, a few, who will read carefully and understand you. With these, one shares a dangerous confidence.
Bookshelf: Can you describe the feeling you get after you finish writing a book, to the point that is it published, being sold in bookstores and readers enjoy your work?
Ali: In the early days, there was with the feeling of elation a feeling of something akin to fear. You wonder, “Are people going to return the book and demand their money back?” for example. No one has done that yet, and it’s been four years since ‘City of Memories’ came, but that was my fear then.
It’s quite impossible to say when a book is finished. If you mean the first draft, yes, that must feel like giving birth, the sense of something potential in its ‘shapeshiftingness’ having been created. But several rounds of editing follows right up to the minute it goes to press. The minute you hold the first copy of your book in your hands is a spiritual moment though. I know no other word. There’s also the gratitude to the many people involved in getting the book out-in my case creatives like Abdulkareem Baba Aminu who gave me my first cover design, my partner at Parresia, Azafi, the writers Jude Dibia and Uche Peter Umez as well as the early critics from Dr. Passy Amaraegbu to social media friends.


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