The National Health Insurance Scheme (NHIS) has been dogged by several crises since the appointment of Prof. Usman Yusuf, as the Executive Secretary (ES) by President Muhammadu Buhari, majorly as a result of long-drawn battle him and the Minister of Health, Prof Isaac Adewole, Health Maintenance Organisations (HMOs) as well as staff of the agency. AJUMA EDWINA OGIRI writes on the drama surrounding the Yusuf’s suspension and reinstatement
Genesis of the crises
Prof. Usman Yusuf, was appointed as the Executive Secretary (ES) of the National Health Insurance Scheme (NHIS), by President Muhammadu Buhari, in August 2016. Since his resumption in office, there has been disharmony between him and Minister of Health, Prof. Isaac Adewole; stakeholders in the sector; the Health Maintenance Organisations (HMOs), and workers at NHIS.
Trouble started for the ES when he accused the HMOs of collecting money without delivering on services, adding that “they have caused human sufferings and deaths from their actions and inactions.”
He further said, “As part of the need to increase coverage and deploy resources to get healthcare services directly to the people, there is need to cut off the middleman.
“Health financing in Nigeria is composed of National Health Insurance as a regulator, the HMOs as the middlemen. The HMOs are the ones NHIS give money to on behalf of the patients. Essentially what the HMOs have done is they have corrupted the system.
“NHIS gives them money on behalf of the enrollee three months ahead. So, I do not see any reason why our patients should be maltreated in hospitals; they are not treated with the dignity they deserve.”
A petition by the Young Alliance Against Corruption (YAAC), led to a directive by Vice President Yemi Osinbajo, directing the health minister to investigate the allegations of mismanagement of levelled against Yusuf.
Prof Adewole raised an 18-member panel and placed the NHIS boss on a three-month suspension for a hitch-free investigation to take place while the investigation lasted.
The ES was accused of buying a Toyota Sports Utility Vehicle (SUV) marked NHIS 12Y-01 FG for N58 million. He was alleged to have overshot his N2.5 million spending limit without the permission of the health minister.
The Economic and Financial Crime Commission (EFCC), was also said to be investigating the ES for over N919 million frauds, involving the award of contracts without following due process.
After investigating the allegations, the 21-member administrative panel set up bey the ministry of health also found Yusuf culpable of the allegation of fraudulent use of N860 million for staff training without due process.
According to the committee, “the total number of staff in NHIS is 1,360 as indicated in their nominal roll; however, the members of staff trained by the scheme based on the payment vouchers were 1,992, while the figure submitted by NHIS was 2023.
“The procurement department was not involved in the engagement of consultants; some payments were also made without supporting documents; no single payment voucher was raised in favour of the training consultants. Instead, their payments were lumped with participants training allowances and a composite voucher raised in the name of one of the participants, making it look like a normal staff claim.
“All the training programmes were approved by Yusuf and ratified by the Executive Management Meeting, which has no statutory approval authority. All the costs of the training programmes conducted by the respective firms were above the approval threshold of the NHIS Executive Secretary.”
The panel also observed that the N28 million payment for the e-library equipment was made before the execution of the project, while the actual amount appropriated for the project was N35.5 million and another N35.2 million for the procurement of project vehicles.
The panel recommended that the EFCC be invited to help recover N48 million paid to consultants alongside N590.379 million.
However, after investigation by the panel, Yusuf’s suspension was extended to indefinite by the minister, pending the President Buhari’s final take on the case.
N19m allowance for 21-Member probe c’ttee
The recommendation of the ministerial investigative committee set up to probe the ES was, however, brought to question following allegations that they were paid N19 million from NHIS as sitting allowance, for the three weeks sitting.
Analysis of the official documents obtained by Blueprint Weekend revealed that 21 members of the committee were paid N19,184,000 from the Treasury Single Account (TSA) of the NHIS on September 14, 2017.
The payment details in the document showed that the immediate past Permanent Secretary of the Ministry of Health, Hajiya Binta Adamu Bello, who was the chairperson of the committee, was paid N1,280,000, and each of the 13 directors on the committee were paid N960,000, while the four assistant directors received N640,000 each and N2,464,000 for stationaries used during the probe.
Efforts to get the reaction of spokesperson of the supervising ministry, Mrs Boade Akinola, was unsuccessful, as she neither responded to our correspondent’s phone call, nor replied a text message sent to her.
However, in her earlier response to a national daily on the same allegation, Akinola said: “They sat for 30 days and the membership was drawn from various places; not the federal ministry of health alone.
“The committee members were paid their entitlement and this shouldn’t be a big deal. The ministry couldn’t have paid it because it was not budgeted for, hence NHIS had to pay.”
Brawl over Yusuf’s reinstatement
Yusuf was reinstated through a presidential directive dated February 5, 2018, despite facing allegations of misconduct by the Economic and Financial Crime Commission (EFCC).
A top government source was quoted in the media as saying that Yusuf was reinstated because the Presidency believed that the allegations which formed the basis of his suspension by the minister of health, remained largely unsubstantiated.
It was reported that the government’s position was that the committee constituted by the minister to investigate Yusuf was neither independent nor free from bias, adding that 20 of the 23 allegations levelled against the NHIS boss were not backed with evidence, while others appeared concocted because of evident alterations and mix-ups in dates.
Since his reinstatement, protests and counter-protests have crippled activities at the NHIS, and split members of staff. Protesters under the aegis of Association of Senior Civil Servants of Nigeria, (ASCSN), led by Branch Chairman, Mr. Razak Omomeji and the Joint Health Sector Union urged the President to reverse the reinstatement, which according to them “is a smear on his administration’s anti-graft war”.
He said: “The current NHIS boss who is just reinstated is still under investigation by EFCC and ICPC. Is it proper for him to return to work here? Investigation is supposed to follow the rules and the rules of investigation have to be properly followed.
“How can a government official being investigated for a whopping sum of N919 million fraud by the EFCC be reinstated by the government that came to power promising to sanitise the system?
“This is very unfortunate. We, therefore, urge President Buhari to rescind his action and allow Prof. Yusuf to leave the system in peace. Thus, if Prof. Yusuf resumes as the Executive Secretary of NHIS, it will amount to passing a vote of no confidence on the minister.
“What type of a government are we claiming to be running that anyone who is close to the President will become lawless; will not obey public service rules; nor report to the supervisory minister and running a government agency as his personal estate because he is close to the powers-that-be?
They vowed not to resume duty offices adding that the President should take a critical look at the allegations level against him and reverse his reinstatement.
He explained that there is a missing link on the reinstatement of Yusuf, adding that some of the staffs that have gone to testify before the anti-graft agencies have been marked as whistle-blowers and ready to victimize them.
The protesters called on the Head of Service of the Federation to apply the civil service rules, which stipulates that a civil servant cannot remain in the office when he/she has a case to answer before any anti-graft agency.
Omomeji, who vowed that the staff would continue the protest until Usman was removed, said: “Yusuf has bastardized the scheme and his return would only worsen affairs at the agency”.
However, a pro-Yusuf group under the aegis of Unity Group and Concerned NHIS Staff arrived the premises of the building, wielding placards with various inscriptions in support of the embattled secretary.
Addressing journalists, the leader of the group, Dr. Uchenna Ewelike, said that Yusuf’s appointment was to sanitize the decayed and inefficient system in the organization.
He noted that the protesting members of the union are beneficiaries of the rot in the system and resistant to change.
“We all know that Prof. Usman Yusuf has already brought to bear his expertise and wealth of experience acquired over the years, home and abroad to address the lingering problems of the scheme. We must all, therefore, give him all necessary support he may require to achieve this mandate for the benefit of all” Ewelike noted.
Yusuf’s supporters further called for the termination of the ongoing investigations against the embattled executive secretary by the EFCC and Independent Crime and other offence Commission (ICPC).
Police were also on ground at the NHIS office to forestall law and order while the protesters continue protest.
Why Yusuf was reinstated
Chairman, House of Representatives Committee on Heath Services, Hon. Chike Okafor, APC, Imo state, said President Buhari reinstated the suspended NHIS Executive Secretary, Prof. Usman Yusuf, in respect of a resolution of the legislature.
The lawmaker told newsmen that the development would restart a healthy relationship between parliament and the executive arm of government.
He added that with Yusuf’s recall, investigation into the activities of health insurance providers, particularly the HMOs, halted following Yusuf’s suspension by the minister of health will be resumed.
“We will continue with the investigations. And I will tell you that we have suspended the investigations because we didn’t recognise the fact that he was suspended. And he was not in the office for us to continue investigating the activities.
“Resolutions by the National Assembly were badly respected. And by the minister and the ministry as in this case. I think the President stepped in and asked that the man should be recalled. For me, it’s a good thing and it’s a new thing for our democracy.
“The National Assembly, House of Representatives in particular, came up with a resolution and it should be respected and the man has resumed.
“And I can tell you quite frankly that the man has resumed. So, it’s a vindication that I was right in the first place to have asked for his reinstatement.
“And I’m glad to learn that part of the reasons the presidency adduced, was being the fact that the House of Representatives also called for his reinstatement.”
He further stated: “We didn’t know he has been having issues with the minister. There was no proven case of corruption until the House of Representatives committee had that public hearing where we were investigating the activities of the National Health Insurance in relationship with the HMOs vis-a- vis the inability to deliver to those who enrolled.
“The man (Yusuf) came and made some damning revelations, and the minister was also present at that public hearing and also agreed that the HMOs need to be investigated for us to know what they do with the billions paid to them every month,” he explained.
How its all plays remains to be seen, however, expectations are that the issues would be resolved and speedily too, to avoid beneficiaries of the scheme and other stakeholders being caught in the middle of the crossfire.