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    Thursday, September 21, 2023

    Revolution of Health Insurance in Nigeria

    The five major revolutions: English (1649), American (1776), French (1786), Russian (1917), Chinese (1949) and indeed others, have a thread running through them-they upturned moribund status quo and re-established a new working order.

    Prof Nasir Sambo has engineered a revolution in Nigeria’s health insurance ecosystem.

    Before he assumed office as Chief Executive of the National Health Insurance Scheme (NHIS), as it then was, four years ago, the foremost health insurance regulator, seemed to have derailed from its original objectives.

    Before The Reforms

    One of its former Chief Executive Officers(CEO) was furiously considering spending contributors’ funds on building hospitals nationwide. This is a complete departure from the demand side mandate of the agency.

    To boot, the agency was imploding. Local trade unions were perpetually at daggers drawn with their CEOs while members of management split into several camps.

    The agency’s long, drawn-out battles with key stakeholders were a worrisome defining corporate character. Every National Assembly CEO appearance held the prospect of yielding unpleasant banner headlines.

    Accusations and counter-accusations of graft were the organization’s contribution to media development in Nigeria. Not least, international and local development partners kept a respectable distance from the agency, effectively conferring a pariah status on the organization.

    In its twenty-four-year existence, it has had a dreadful turnover of CEOs-12.

    Analytically, a CEO went down every two years without completing a term of office, let alone securing a renewal.

    At the peak of its crisis, the Federal Government deployed security forces to the agency to keep the peace. A long-standing turbulence preceded security forces ‘occupation’ of the agency’s Corporate Headquarters.

    Some staff who were ‘opposition’ to the then CEO barricaded its corporate headquarters prompting the Executive Secretary to mobilise his ‘supporters’, who were also staff, to force his entry into the office. On that occasion, tear gas canisters were freely deployed by the Police to break up the standoff.

    Wind Of Change Through The Three-Point Agenda

    This was the agency the professor of health policy and management with a bias in health financing inherited on July 15, 2019.

    A frightening assignment in every leadership contemplation.

    A Ten-Point Presidential Directive attached to his letter of appointment demonstrated the government’s determination to halt the health sector embarrassment that NHIS had mutated into.

    Nonetheless, the former provost of Kaduna State University (KASU) College of Medicine began his tenure on a cerebral note, holding strategic meetings with relevant internal and external stakeholders and presenting his roadmap for *stability and advancement*.

    These engagements were meticulously put together to procure buy-ins for his reforms encapsulated in a *Three-Point Rebranding Agenda (3PRA).

    The reforms are firmly anchored on three pillars- _Value Re-Orientation,_ _Transparency and Accountability_ in the organisation’s entire operations and _Accelerating the drive towards attaining the original mandate- Universal Health Coverage (UHC)._

    With stakeholders’ acceptance of the roadmap came industrial harmony and stability within and without the organization, crystalizing into a new era of trust and confidence across the health insurance ecosystem.

    Implementation of NHIA Act 2022

    He began strategically implementing the various diligently fashioned-out initiatives, having brought key stakeholders to have a cordial handshake in the same room.

    Arguably the most extraordinary feat of this former Deputy Dean of the Faculty of Medicine, ABU, is the signing into law of the National Health Insurance Authority (NHIA) Act 2022 by President Muhammadu Buhari on Thursday, May 19, 2022.

    Sambo pulled all the stops, working frenetically with his bosses, the then Minister of Health, the Minister of State for Health and the leadership of the National Assembly Committees on Health, to pull it off. The background to this development is worthy of recall.

    Since the establishment of National Health Insurance in Nigeria in 1999, Stakeholders have cited the repealed legislation as the single most significant albatross in the neck of the attainment of Universal Health Coverage in Nigeria. The defunct law made health insurance voluntary, amongst other loopholes.

    Predecessor CEOs tried to secure its repeal, but their efforts failed.

    Sambo also made two initial attempts. However, he remained undaunted and resilient until the third attempt produced the all-important breakthrough.

    The significance of the NHIA Act is that it makes the attainment of Universal Health Coverage nearer now than when Nigerians first heard it, in the light of mandatory health insurance and the implementation of the Vulnerable Group Fund (VGF).


    One of the groundbreaking initiatives under his watch is the most critically acclaimed in digital transformation of healthcare system in the subregion- the e-NHIA.

    The system is premised on the advantages of technology in driving health insurance.

    e-NHIA automates the business processes while ensuring an end to end integration of health insurance ecosystem. The process includes but not limited to digital enrolment, payment tracking, data analytics, claims and encounter management.

    The eNHIA has received the ISO 27001 certification and the Office of the National Security Adviser (ONSA) classification as National Critical Infrastructure.

    The World Bank Institute Of Health Financing alumnus is convinced that technology holds the key to a transparent system and ease of operations. So, In a Government to Government partnership with NIGCOMSAT, equipment have been deployed nationwide linking NHIA with State Health Insurance Agencies and other stakeholders.

    In addition, the system has the capacity to host huge health data equivalent to the entire West African subregion.

    At its optimum, beneficiaries under NHIA will conduct their transactions electronically. Complimentarily, a 24-hour Client Service Management Centre, has been established to respond and resolve issues in real time. The call centre has the capacity to handle 200 calls all at the same time.

    The Horizon

    For an agency that was in dire need of direction, Sambo inspired the development of a 10-year Strategic Plan providing details in the build up to achieving Universal Health Coverage (UHC) in Nigeria.

    Its ongoing implementation will ultimately culminate in every Nigerian receiving access to quality and affordable health care. The document outlines a phase by phase performance implementation and monitoring and evaluation protocols.

    Medicine Supply Initiative

    To address complaints around quality and out-of-stock syndrome of drugs, an NHIA Medicine Supply Initiative (NMSI) is scheduled for unveiling in due course. Under this arrangement, NHIA collaborates with Pharmaceutical companies to manufacture drugs for dispensing in accredited hospitals. This move is aimed at ensuring quality, affordability and availability of medicines at healthcare facilities. The emblem of this initiative is branding of dispensed medicines, giving beneficiaries the much needed assurances.

    Also within this context, NHIA is partnering with Swiss drug manufacturing giant, _Roche_, to manufacture oncology drugs. Under the partnership, Roche and NHIA will bear 50 and 30 percent of the cost of drugs respectively, leaving the beneficiary with 20 percent of the cost of dispensed drugs. This initiative has come on stream in some tertiary health institutions across the geopolitical zones of the country. Plans for expansion are on.

    Strategic Infrastructure Investment

    Apart from its Corporate Headquarters, the agency has been tenant in all the states of the country until lately. Annual budget for office accommodation gets unfriendlier year on year. Prof Sambo daringly embarked on strategic infrastructural investment by way of construction of prototype offices in the states. In addition, construction of a befitting edifice as its Corporate Headquarters is progressing rapidly. The real value of these investments will be felt in years to come with savings made on money that would have gone into rents.

    Other Initiatives

    Under his watch, a plethora of system-changing initiatives are ongoing.

    This includes the relief-bringing Decentralized Reconciliation System that has yielded huge funds that have been ploughed back into facilities; the implementation of the Basic Health Care Provision Fund (BHCPF) for purchase of care at Primary Health Care levels under which at least N14b has so far been disbursed under the NHIA gateway; the professionalization of the agency’s human resources, massive capacity building undertaken locally and Internationally, collaboration with partners. Deserving mention is collaboration with the Mahidol University, Thailand leading to the offer PhD scholarships to three qualifying staff and a further scholarships for Masters degree programmes, the improvement of the financial system to be consistent with IPSAS and NCoA as required by government.

    Sambo inherited a five-year backlog of unaudited accounts which he ensured was promptly cleared in line with dictates of transparency and accountability.

    Health Insurance Under One Roof

    Within the context of coordinating health insurance in a decentralized environment as Nigeria, he established the Health Insurance Under One have Roof (HIUOR) integration mechanism that gives coordination and regulation to the ecosystem.

    Leadership programme

    Aimed at strengthening capacities, he facilitated the NHIA Leadership Development Programme in collaboration with development partners. Under the programme, staff of the Authority and CEOs of State Social Health Insurance Agencies (SSHIAs) have received trainings to prepare them for critical roles within the ecosystem. In addition, NHIA is implementing a Research Agenda which makes the decisions of agency evidence-based.


    Under his leadership, NHIA has earned a number of awards such the Servicom Award for Best responsive agency and the Best Interoperability agency by NITDA.

    The Health Care Providers Association of Nigeria (HCPAN), a collegiate of proprietors of private health facilities, honoured him with their highest award, Semper Fidelis- A Consistent Fellow In A National Course .

    Significantly, the Independent Corrupt Practice and Offences Commission (ICPC) has scored NHIA high in its latest transparency index assessment.

    Recently, his efforts attracted international attention with the conferment on him of the honour of *Fellow Through Distinction of the UK Faculty of Public Health by the Royal College of Physicians in London*.

    It is worthy to note that by his third year in office he had achieved the entire 10 Presidential Directives handed down at his appointment.

    Implementation of the NHIA Act

    Presently, Prof Sambo has tasked himself with the implementation of NHIA Act with a single goal- that every Nigerian may have access to affordable and quality healthcare. In one of his media interviews he summed up his work ethic. “We will continue to work until NHIA becomes the pride of all Nigerians”

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