After the Executive Secretary of the Nigerian Health Insurance Scheme, Professor Usman Yusuf, was suspended on October 18 followed by his dramatic return to office a few days after, we approached the Board for an interview, but the Board declined. One week later, we approached Yusuf, and he obliged. This is his first interview since he assumed office – and it came only few hours before he was asked to proceed on “administrative leave.” It’s a bombshell: This is the first part…
You have been the head of NHIS for two and a half years now. What do you think you have achieved?
Remember I was here, my first coming was for 10 months. And then I am back again now, this is the
10th month. So, it’s how many months now? Twenty months. So, 10 months is the magic time. What have we achieved? You need to find out what we found, what we found before you appreciate what we have achieved.
When I first came to the NHIS like many CEOs in this country, in this government, none of us applied for this job. None of us lobbied for this job. And many I have spoken to have never met our principal, the President. We came here on the recommendation of those that think we can add value to this country.
We left whatever we were doing to come and join this government for one reason and one reason alone – because we believe in the message of this President, especially on ridding this nation of the cancer of corruption.
This is why we left whatever it was we were doing and accepted positions in this government. When I came, what did I find? This agency has been around for the last 12 to 13 years. Its mandate is clear, universal healthcare coverage.
What universal healthcare coverage means is that every Nigerian, all 180 million of us should be covered by this agency so that when we go to the hospital, this agency pays for it. But the biggest mandate is that this agency should reduce the out of pocket spending for our people.
If you go to hospitals now, we pay 60 or 70 percent of whatever you are charged. And if you are not on NHIS, it comes out of your pocket. Another thing is to protect people and give them a net cushion from financial risks associated with major illnesses. Many of us, including yours sincerely, we get seriously ill. God forbid, it wipes away our life savings.
The NHIS is there to give this financial risk protection; that is what it is supposed to do. Many of us; just go back to our ancestral homes, get out of Abuja, Lagos or the urban areas. Who have we left behind? Those we have left behind are the ones we call the vulnerable, the aged, widows or widowers, women and children and the poor.
Many, when they are sick, don’t go to the hospital, not because they don’t want to. They don’t go to hospital because they cannot afford to go to hospitals. That is what NHIS is supposed to do, to help people go to hospitals.
I am a pediatrician, I am acutely aware of the fact that largest population of this country are women and children. And I see the sufferings of our people, children, especially children under five. Many are dying daily, pregnant women dying in childbirth in spite of all our human and natural resources.
We must do something. We do not have the luxury of time. There is this thing that Martin Luther King called the fierce urgency of now, that I don’t see the fire in people. Our people are dying. And we have an agency that the federal government has put money in trust on behalf of our people to pay for them.
This is the story of the NHIS. What I found was shocking. I came from the academia and of course we ask questions. I was carrying files and spending sleepless nights to find out about this agency. What has come into the NHIS over the last 12, 13 years, what has it achieved? Who has benefited?
Have we achieved our mandate? If not, why? Where are the problems and how can we solve the problems? These are the questions I have been asking and these are the questions many interest groups in this country do not want me to ask.
That is why I am here. What I found, instead of 180m Nigerians we say we should be covering, we have covered three million. And that three million, nobody can lift his holy scripture, be it the Bible, the Torah or the Quran and swear by that number. Why?
Because this number has been falsified and padded to the advantage of HMOs. I came from the United States, the land of HMOs. That is where they copied it and brought it here. When they copied it, they pasted it to their advantage, to the disadvantage of the little guy. And I have said it, do not copy if you don’t know how to paste. They copied and pasted it to their advantage.
Universal health coverage is failing in America. Do you think it is possible in Nigeria? Is it possible in Africa?
What that tells you is that it is not the resources but how you manage the resources. Health indices in Cuba are better than that of the United States. So, it is how you manage the resources, not the money.
I have seen how much money has come into the NHIS and the result. Is it achievable? Can we do better? Yes, you bet, absolutely. We can do a lot better than this. Now people are talking about UHC just like a song.
We were young in medical school when they said healthcare for all by the year 2000. We are 18 years beyond and we are not there yet. Now UHC, they are making it into a song. It is not a song. It is a very serious and solemn promise to our people that every person is entitled to good quality healthcare.
It is not only a human right, but it is a tool towards poverty alleviation, but people are talking UHC without knowing what it entails. It is a huge responsibility I feel everyday of my waking hours, on this chair. I am at an agency that could have impactful difference in the lives of our people.
If, and only if that potential is harnessed. It has not been. We are trying to clean the system and make it work for all our people.
“We left whatever we were doing to come and join this government for one reason and one reason alone – because we believe in the message of this President, especially on ridding this nation of the cancer of corruption. This is why we left whatever it was we were doing and accepted positions in this government.”
Coming from the academia and the outside world, do you think you fit into the way things work in Nigeria?
Nigeria is home. Wherever I go in this world, wherever anybody goes in this world, I feel more at home here than anywhere else in the world. It’s my root. It’s where my people are. It is where I want to make the most difference to our people.
The Nigeria I left several years ago is a different Nigeria. But every general goes to war with the troops he has. This is what I met, this is what I will do. Our goal in whatever place you find yourself in the world, do the best you can and make a difference.
You are offering a service that is out of reach for most Nigerians and appears to be designed that way. Was NHIS created to meet the needs of only a few?
No it wasn’t. It was very noble. When it was created at that time, honestly, it was a noble idea. Everywhere in the world you go to, health insurance is meant for the rich to subsidise the poor, the strong to help the weak and for those who are healthy to help those who are not. Because if I am healthy or rich, I contribute into this scheme for thirty to forty years.
I am not using it, somebody else would, a pregnant woman somewhere, a child somewhere, an aged woman somewhere. Everywhere in the world including the United States, a very capitalist country, the rich subsidize for the poor.
I was in the UK. We were taxed every month. And it’s our taxes that fund the NHS for the unemployed, for the poor and that is what it is supposed to do. We all owe a responsibility to others. That is what insurance is about.
The idea was noble. It still is. This agency has a huge potential to help our people. Has it been harnessed, no. Is it going to be harnessed, we are trying our best and we will do our best while we are on this chair.
“What I found was shocking. I came from the academia and of course we ask questions. I was carrying files and spending sleepless nights to find out about this agency. What has come into the NHIS over the last 12, 13 years, what has it achieved? Who has benefited? Have we achieved our mandate? If not, why? Where are the problems and how can we solve the problems?”
What impact can the scheme really have considering that health services in the country are poor?
Let me tell you, in spite of all the failings of NHIS, and there are many. I am the first chief executive in this place to draw the curtains and tell the world, this is not how it should be. In spite of all our failings, and I am not going to rattle that here, I have said that severally.
I will tell you the positive things NHIS has done.NHIS has increased access to healthcare to all people. Those who were in Abuja long before I came, long before NHIS will tell you how the NHIS has increased access for our people to go to the National Hospital. I was in Ilorin.
One private practitioner, he owns the largest private practice in Ilorin, sought to see me in my hotel room. He told me, and it was very good to hear, that sir, you are doing God’s work. You will appreciate that because you are a pediatrician.
Let me tell you this, he said the five biggest killers of children, we know as pediatricians are severe malaria, diarrhea illnesses, respiratory illnesses, illnesses that can be prevented by immunization and malnutrition.
But we know, common malaria does not kill children. What kills children are complications from malaria. Cerebral malaria, malaria of the brain, malaria that gives a child diarrhea and vomiting, malaria that gives a child anemia or malaria that gives a child kidney problems.
He said before the advent of NHIS, what I use to see was death from severe malaria for children. But now sir, the death from malaria in my practice has gone dramatically down. And he said sir, the reason is one and one alone. Now, mothers know they have access. They bring these children earlier on in the disease than previously when they brought them in the throes of death.
“in spite of all the failings of NHIS, and there are many. I am the first chief executive in this place to draw the curtains and tell the world, this is not how it should be. In spite of all our failings, and I am not going to rattle that here, I have said that severally. I will tell you the positive things NHIS has done.”
Tell me why they have access considering that most mothers are not part of the scheme?
It is not that most mothers are not part of the scheme. And I will tell you how they are part of the scheme. Everybody thinks that NHIS is only for government employees. No, it isn’t. We have a program in a NHIS called VCSHIP, Vital Contributors Social Health Insurance Program.
What it is, is for N15,000 per annum. Anybody can access healthcare as I would. If they are charged a million naira, NHIS will pay. You can pay for many people back home, I can. So, access to healthcare, access to NHIS is not restricted to government employees.
We are talking about what good NHIS has done in spite of all the beatings it has gotten. It has increased access. Nobody can deny that. It has reduced the cost of healthcare in this country. If you are NHIS enrollee, you go to a hospital, they charge you for a drug N1000, you pay only 10 percent.
NHIS pays for 90 percent. NHIS in this country sustains all federal hospitals, all state hospitals, all military hospitals, all police hospitals and all major private hospitals. If NHIS was to pull out, all these hospitals will collapse.
So, the survival of NHIS has national security implications for a very simple reason. We cover our gallant men and women in uniform and their families. While we send them to harm’s way, we cover their families.
The police is the largest beneficiary of NHIS or the army or the navy or the Air Force, they are out there in harm’s way for you and I to sleep with our two eyes closed. So, NHIS has increased access. NHIS has reduced the cost of healthcare.
NHIS sustains all federal, state tertiary hospitals, military hospitals and state hospitals. The sustenance and continued survival of NHIS has national security implications. Have we done well? We are trying. We have a lot more to do.
The activities of NHIS have been crippled in the last few weeks over your suspension by the governing council. Is that a concern for you?
They’ve not been crippled because I haven’t left the NHIS. It was on October 18 that the governing council purported to have suspended me. I never left my seat. Work continued as usual. There were people out there dancing.
Did you see them when you came in? They got tired. And that is it. Public service in Nigeria is like contact sport. You take the heat and the bruises and stand up and move on. Previously it used to bother me.
You have stolen this, you’ve stolen that. I used to not take some papers home because my wife gets worried when she reads it. I don’t care anymore because I am here to do God’s work. And I am doing it.
Nothing has been crippled in the NHIS, work continues. We continue to pay for services of our patients out there in hospitals across all six geopolitical zones. When you came in, did you see any protest at the gate? They got tired and left.
And if they want to shake me or intimidate me, they’ve chosen the wrong person. I am here to work and I will.
“It was on October 18 that the governing council purported to have suspended me. I never left my seat. Work continued as usual. There were people out there dancing. Did you see them when you came in? They got tired. And that is it. Public service in Nigeria is like contact sport.”
This isn’t the first time you have been suspended. The health minister carried out a similar action last year. The issues he raised have remained unresolved. Is he still your supervisory minister or do you report directly to the Presidency?
No, who am I to report to the Presidency? The honourable minister of health, when people start personalising it, they do a great disservice to the issue. It is not about me or anybody. It is about our people.
I have no reason in this world to be disrespectful to the honourable minister. He is my elder both in age and professionally. His achievements in life are achievements I want to attain. He is my supervising minister.
We are academics. Also, we argue for the sake of patients. It doesn’t mean it is personal. It has never been personal with me and my honorable minister and he continues, whether he is the minister, whether I am here or not, he will always deserve my respect.
So, people should not personalise it. It is not personal, or we will lose sight of the real issue. The real issue is our people. He will always be my supervising minister as the honourable minister of health.