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NHIS Delists 23 HMOs Over Failure to Meet Standards

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NHIS delists 23 HMOs

By Dipo Olowookere

No fewer than 23 Health Management Organisations (HMOs) have been de-registered by the National Health Insurance Scheme (NHIS) for failing to meet up with the minimum operational standards expected of them.

Chairperson of the Board of NHIS, Mrs Enyantu Ifenne, while addressing newsmen on Thursday, disclosed that out of the 57 HMOS operating in the sector, only one scored 100 percent from the validity test conducted by the agency.

According to her, the only HMO that scored 100 percent has been given permission to operate, while the 33 others have been granted provisional accreditation.

She said these HMOs would only receive full accreditation when they meet all the conditions spelt for them.

All HMOs operating in the scheme are expected to renew their accreditation every two years.

Mrs Ifenne explained that the HMOs were scored based on aggregation of criteria and at the first cut, only 11 out of the 57 HMOs scored over 70 percent, 40 HMOs scored between 50 and 70 percent while 6 HMOs scored below 50 percent.

“The committee re-examined this and reduce the score further from 70 to 50 percent but only the Defense HMO fulfilled met most of the conditions.

“But if we apply the law, none of the 57 HMOs fully met all the NHIS requirements for accreditation.

“We have advised that the 11 HMOs that were recommended for provisional re-accreditation should comply with specific critical condition within two to three weeks before they can be fully accredited,” she said.

Mrs Ifenne further explained that the 46 HMOs who score below 70 percent were disaggregated depending on the critical condition they did not fulfil adding that the six HMOs which score less that 50 percent were removed from evaluation.

“That means they are not being considered for re-accreditation,” she said.

The NHIS chairperson said another score they used as a critical irreducible minimum was the adequacy of payoff shares capital.

“The payoff share capital for National HMOs is N400 million, zonal coverage is N200 million and the state coverage is N100 million. And this is a critical requirement because the Payoff capital share of a company is a requirement for accreditation and evidence of their financial stability,” she explained.

She also said HMOs were also required to submit their audited financial report from 2014 to 2016 but with criteria, six did not meet the requirements and one did not submit audited financial report and corporate affairs commission document, therefore removed from further consideration.

Mrs Ifenne gave some criteria considered for accreditation as; registration with cooperate affairs commission, adequacy of payoff share capital, current asset including fix asset, shareholders composition, company reserve, integrity of shareholders, composition of Board of Directors, current tax clearance of companies, current tax clearance of all Directors, appointment of audit fund and submission of audit account to NHIS as and when due, compliance with Pension PENCOM Act among others.

She charged the HMOs to do their business transparently and accountability while making profit, assuring them that the reaccreditation exercise was not meant to cripple any HMOs.

“With this shift, the healthcare providers will be held to account not only for the quality care but also for the humanity because from the information we have most in the scheme are treated as second rate patients.

“So, we all NHIS, HMOs and healthcare providers have to work so that the enrolle is at the tip of the value chain and the enrollee becomes the first in the universal coverage,” she said.

“We are going to redefine the processes and focus NHIS to stand up to its regulatory function. The failure to meet our regulatory function is the reason why this plague has being spread, not validated and no punitive action taking. We want to change that, we must change that.

“The HMOs as you can see are doing their best but they have not been regulated appropriately, we must apply the tools. They are willingly to subject themselves to regulations if we stand up to our duties.

“I don’t think any of them, except may be a few rascals want to ruin this game. Similarly, the healthcare facilities beam torchlight all the time. I believe that many of them would rather deliver quality service, they are in position to do just that,” she added.

On his part, Executive Secretary of NHIS, Mr Usman Yusuf, pledged that he will ensure that NHIS does the right thing moving forward and serve the people better.

“For a very long time, we have not being doing the right thing. I pledge as the Chief Executive of this agency, that I will do all I can to put the enrollee at the Centre rather than in the last position.”

He also denied the allegation of investing the fund of the scheme in business without due authorization, saying no Penney of the fund was invested anywhere in the country or outside the country.

Besides, he said the scheme has the right to invest its fund according to the law but it has not done that as the board has put a hold to the idea.

Dipo Olowookere is a journalist based in Nigeria that has passion for reporting business news stories. At his leisure time, he watches football and supports 3SC of Ibadan. Mr Olowookere can be reached via [email protected]

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WHO Signals Alarm: DRC’s Ebola Spreading Across Central Africa

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ebola dr congo

By Kestér Kenn Klomegâh

Health authorities in the Democratic Republic of Congo (DRC) and the Africa Centres for Disease Control and Prevention (Africa CDC) have bitterly complained over their inability to track down new cases of Ebola, which has spread into the Republic of Uganda. An estimated 1,635 Ebola cases have been confirmed, and 127 people have died from the dangerous infectious disease in the DRC.

The Ebola outbreak is increasingly impacting social interaction and people-to-people movements, as scepticism toward the disease appears to accelerate among the population, and cross-border movements are being controlled daily. Alarm was sounded last week as the virus moved into new areas of the DRC. In some instances, patient routinely escapes, and limited contact tracing undermines containment efforts. Contact tracing coverage has plummeted to 56.5 per cent, a sharp decline from the 95 per cent target, Health Ministry officials said.

“We remain committed to supporting affected countries until transmission is stopped. We call on partners and donors to urgently mobilise resources to strengthen the response and save lives,” Jean Kaseya, director general of the Africa Centres for Disease Control and Prevention, said on Sunday.

Shortage of Medical Kits

The World Health Organisation (WHO) reported that the three major laboratories, in South and North Kivu, have run out of Ebola testing kits, as infections continue to rise daily. Teams are working through a large backlog of samples from suspected Ebola patients, many of which were collected several weeks ago, to confirm or rule out the presence of the deadly virus.

In a situation report released earlier this week, the global health agency said the labs in major cities including Bukavu and Goma were awaiting the arrival of reagents–substances ​ required to run the tests–to resume work on the backlog of samples.

“Running out of Ebola testing reagents during an active outbreak is a serious setback,” Dr Krutika Kuppalli, associate professor in the division of infectious diseases at the University of Texas Southwestern and former WHO officer, told The Telegraph.

“Diagnostics are the foundation of outbreak control; if cases cannot be rapidly confirmed, this may lead to delays in isolation, treatment, and contact tracing, which can allow transmission to continue unchecked,” said Dr Kuppalli.

The Race for Vaccines

Vaccine candidates are racing to fill the gap. The Coalition for Epidemic Preparedness Innovations (CEPI)—a multinational nonprofit organisation that finances vaccine development for emerging infectious diseases—has so far prioritised several vaccine candidates for development.

Two are Ervebo-like prototypes aimed at recognising Bundibugyo’s specific blend of glycoproteins, a platform that showed experimental potential years ago. In 2013, an early version of the vaccine protected 100 per cent of monkeys infected with Bundibugyo. However, because most Ebola outbreaks didn’t involve this species, the vaccine didn’t get the investment needed to become licensed. That’s an outcome CEPI aims to remedy with its latest investment.

The International AIDS Vaccine Initiative and Public Health Vaccines are developing the vaccines, which, like Ervebo, also rely on the vesicular stomatitis virus. WHO called this technology the most promising of the candidates.

VSV-based vaccines are front-runners because the weakened version of the virus used to produce them is so good at replicating itself inside humans—including the small chunk of whatever germ it’s been hybridised with—without causing harm. As a result, a single dose typically leads to a strong immune response.

Another candidate, called ChAdOx1, operates using a similar concept: A virus shows the immune system part of a pathogen to generate a protective response. However, it uses an adenovirus that causes colds in chimpanzees—and is also harmless to humans—that University of Oxford scientists modified to keep it from replicating.

There’s also a vaccine candidate based on Moderna’s mRNA science, which was also used to produce the company’s COVID-19 vaccines. This vaccine employs tiny fat bubbles to deliver genetic instructions to cells on how to produce a small part of the Bundibugyo virus. The immune system generates a protective response, and the mRNA degrades quickly without causing lasting changes to cells’ genetic codes.

US-Backed Kenya’s Quarantine Centre

Health Cabinet Secretary Aden Duale has consistently defended the establishment of US-backed health centres in Kenya. The US says it will quarantine citizens exposed to the virus but not showing symptoms in a facility it is building in Kenya, and ‌will not bring them home if they develop symptoms, instead sending them to ​a third country.

The CDC imposed temporary travel bans last month on people who have ​been in the DRC, Uganda, or South Sudan, including ​green card holders, who are typically exempt from such bans. It is also screening Americans travelling from those ‌countries at three US airports. The strategy marks a sharp break ​from past practice as President Donald ​Trump’s administration seeks to keep all cases out of US territory.

There are 13 US treatment centres in a government-funded hospital network for severe infectious diseases ready to handle Ebola patients. Public health experts have, however, called on the government to bring any sick ​Americans home for treatment, and local protests at ‌the Kenya site have led to at least two deaths. A Kenyan court has ordered a halt to the ​construction.

WHO Appeals for International Community Support

In a rapid and comprehensive response to WHO’s appeal to marshal resources for support of Ebola prevention, the United States has provided an additional $38 million. The additional funds brought the total amount committed ‌by the U.S. to more than $200 million in direct funding, the State Department said in an official statement.

CDC model scenarios show that without strong public health interventions, the outbreak of the Bundibugyo strain of Ebola in ​the DRC ​could become as large as, or even larger than, the 2014-2016 West ​Africa outbreak, the agency said.

In modelled scenarios where the ‌isolation of patients is limited, the outbreak could become one of the largest ever documented, said Jason Asher, director of the CDC’s Centre for Forecasting and Outbreak Analytics.

From Addis Ababa, the Africa Centres for Disease Control and Prevention (Africa CDC) also said it had received a €11.5 million renewed commitment from the European Union Commission (EU) to support a stronger preparedness and coordinated response to the Ebola outbreak. Dr Jean Kaseya, Director General, Africa CDC, described the partnership with the European Union as respectful and without any conditionality, a type of partnership the continent needs.

The package is aimed at reinforcing the EU Commission’s support through the Africa CDC emergency response to the Ebola crisis, within the long-standing and comprehensive AU-EU health partnership. This demonstrates the central role of Africa CDC in coordinating the continental response to health emergencies, as well as the EU’s action as the world’s largest humanitarian contributor.

This includes €6.5 million to strengthen the Africa Pathogen Genomics Initiative, to help equip frontline teams, train healthcare workers and improve surveillance through diagnostics and an in-kind contribution of €5 million worth of testing equipment, including rapid diagnostic devices and lab test kits, to be deployed quickly where they are needed most. The EU’s partnership with Africa CDC spanning technical expertise, capacity-building, and policy dialogue continues to play a key role in building resilient health systems.

Ebola epidemic at G7 summit

Amid the horror of the Ebola epidemic, world leaders gathered at the G7 summit in France were urged to find the “political will” to push through the final part of the Pandemic Agreement on Monday. In a joint letter, Brazil’s President Luiz Lula da Silva and WHO chief Dr Tedros Adhanom Ghebreyesus urged leaders gathered on the shores of Lake Geneva to get the “benefits sharing” annex of the deal signed with a “sense of urgency.”

The Pandemic Agreement, which seeks to ensure the world is better prepared for the next global outbreak, was agreed last year but a vital element of it was deferred because of arguments over its wording. It is unclear, and perhaps unlikely, that a truly global agreement on benefits sharing can be reached.

Nevertheless, an agreement between the remaining 192 member states of the WHO is possible and would represent a major step forward. “Every month this annex stays unfinished is a month the world is less ready than it could be, and people are less safe than they deserve to be,” say Mr Lula da Silva and Dr Tedros. “Finalising this Agreement, through a shared commitment to one another, is our collective promise to protect humanity.”

The epidemic, caused by the rare Bundibugyo strain of the virus, for which there ‌is no approved vaccine or ​specific treatment, was declared on May ​15. It has since ​spread across Ituri, North Kivu and South ‌Kivu, regions marked by insecurity, displacement ​and cross-border ​movement.

The Democratic Republic of the Congo (DRC), also known as the DR Congo, is situated in the central African region. With a population of around 124 million people, it shares borders with the Republic of Congo and Angola to the south, the Atlantic Ocean, and the Central African Republic and South Sudan to the north, and also with Uganda, Rwanda, Burundi, and Tanzania (across Lake Tanganyika) to the east, and Zambia and Angola to the south.

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NHIA Says 22 million Nigerians Now Have Health Insurance Coverage

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National Health Insurance Authority NHIA Health Insurance Coverage

By Adedapo Adesanya

The National Health Insurance Authority (NHIA) says the number of Nigerians enrolled in health insurance has risen to more than 22 million.

The Director-General of NHIA, Mr Kelechi Ohiri, said this resulted from the implementation of the mandatory health insurance, which has gained momentum nationwide.

He said this on Wednesday at the Annual General Meeting of the Nigerian Association of Insurance and Pension Editors (NAIPE) in Lagos.

Mr Ohiri said enrolment had increased to 22.03 million, representing a 35 per cent year-on-year growth, attributing this to stronger collaboration with state social health insurance agencies, ministries, departments and agencies, organised labour, employers, the private sector, and the gradual implementation of the mandatory health insurance provisions of the NHIA Act.

He said that the country had moved beyond policy formulation to delivering measurable improvements in healthcare access, service quality and consumer protection in line with the federal government’s health sector reform agenda.

According to him, Nigeria already has the necessary policies and legislation to achieve Universal Health Coverage, positing that the key challenge was effective implementation.

“The decisive variable is now implementation- consistent, rigorous and accountable execution that converts political commitment into healthcare access for real Nigerians,” he said.

Mr Ohiri said that the transition from the former National Health Insurance Scheme to the NHIA had strengthened regulation, consumer protection, accountability and strategic purchasing, while providing the legal and operational framework for achieving Universal Health Coverage.

He added that improving the experience of enrollees remained central to the Authority’s reform agenda.

According to him, NHIA has strengthened its complaints management system, introduced faster resolution timelines, and intensified compliance monitoring of Health Maintenance Organisations (HMOs) and healthcare providers.

He further added that NHIA had sanctioned facilities that failed to meet the required standards, adding that his organisation had resolved 3,878 complaints, representing an 87 per cent resolution rate, while 95 per cent of the cases were concluded within prescribed timelines.

Mr Ohiri noted that more than N14.2 million had been refunded to enrollees, while non-compliant healthcare facilities had been sanctioned.

He said NHIA had also introduced service standards, including a one-hour treatment commencement target for enrollees requiring urgent care, to improve access to timely and quality healthcare services.

The NHIA boss further disclosed that capitation payments to healthcare providers had been increased by 93 per cent.

He said fee-for-service reimbursements rose by 378 per cent to enable providers to invest more in personnel, equipment and infrastructure.

According to him, 7,592 healthcare facilities have been assessed under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement across the country.

Mr Ohiri also highlighted interventions targeted at vulnerable groups, including support for more than 48,500 pregnant women, expanded maternal and newborn healthcare services, the Vulnerable Group Fund, and improved access to healthcare for pensioners and retirees.

He said Universal Health Coverage could only be achieved if every Nigerian, regardless of income or location, had access to quality healthcare services.

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SUNU Health Backs NHIA’s One-Hour Authorisation Policy

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One-Hour Authorisation Policy

By Modupe Gbadeyanka

The new one-hour authorisation response time ultimatum policy introduced by the National Health Insurance Authority (NHIA) has received the full backing of SUNU Health Nigeria Limited.

This policy was introduced by the agency to ensure enrollees get prompt approval codes to access care.

Healthcare service providers have been urged to report any Health Maintenance Organisation (HMO) that violates this initiative through an email, with the HMO in copy and a timestamp attached as evidence of the request. They may proceed to offer services to enrollees thereafter.

Speaking at the company’s second-quarter Providers’ Forum for the Lagos-Ogun region in Lagos recently, the chief executive of SUNU Health, Dr Moyosore Olomola, expressed optimism that this policy would improve healthcare delivery in the country, especially for enrollees, who crave quality service.

At the event themed Improving Quality and Access to Care Through Stronger Provider Network, and held at the Nigerian Institute of Medical Research (NIMR) in Yaba, Lagos, Mr Olomola reaffirmed the HMO’s commitment to operating within legal and operational frameworks to guarantee adequate care for enrollees.

“Access to care and quality of care remain key priorities in our healthcare systems. We know quite well that deliberate collaboration, strategic partnerships, and a shared commitment to excellence are required to achieve these priorities.

“A strong provider network is doubtless the backbone of any effective healthcare system. It ensures that our mutual enrollees receive the right care, at the right time, in the right place, and at the right price,” Mr Olomola, represented at the programme by the organisation’s Chief Operating Officer (COO), Dr Faith Nwachi, stated.

He further assured that SUNU Health would strictly adhere to the one-hour authorisation limit, stressing that this aligns seamlessly with one of the organisation’s core values—promptness and its corporate slogan, Humanity is the centre of our initiatives.

In a bid to further improve access and quality of care, SUNU Health also demonstrated its new operational software and Mobile app, aptly named SUNU Legacy.

Also speaking at the event, the NHIA Lagos State Coordinator (Ikeja), Dr Bethuel-Kasimu Abraham, noted that the forum’s expected outcome is to significantly reduce delays in accessing medical care.

Other key expectations include ensuring continuity of care, improving patient outcomes, and strengthening accountability among HMOs.

Addressing specific pain points faced by enrollees, the NHIA Ogun State Coordinator, Mr Dare Adefeso, acknowledged that the agency had received complaints regarding out-of-stock drugs and the discrimination of enrollees by certain providers.

He affirmed that the NHIA is actively addressing these issues, stressing that moving forward, every facility must ensure enrollees are properly catered to regardless of their status, provided they have an active health insurance plan.

Corroborating the long-standing legacy of SUNU Health, the Ogun State Director of the National Orientation Agency (NOA), Mrs Aishat Tiamiyu, shared that her agency is responsible for public information dissemination and has been enrolled with SUNU Health for over 25 years.

Commending the HMO’s stellar service over two decades, she called for the immediate enrollment of new NOA staff into the scheme.

The Providers’ Forum remains one of the strategic channels employed by SUNU Health to consistently engage healthcare providers, understand their operational challenges, introduce new software updates, and solidify partnerships aimed at fostering premium healthcare delivery across Nigeria.

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