Health
NHIS Delists 23 HMOs Over Failure to Meet Standards
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.
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.
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.
By Aduragbemi Omiyale
The National Agency for Food and Drug Administration and Control (NAFDAC) has announced the recall of a sexual enhancement product known as WAP Sensual Enhancement Capsules.
In a statement on Monday, the Nigerian agency disclosed that the recall is due to “undeclared pharmaceutical ingredients” in the product, whose country of origin is unknown, but is marketed and distributed online in the US through eBay.
It was emphasised that the recall is being “voluntarily” made by the manufacturer, Best Supplements Best Prices Company.
The detection of the undeclared pharmaceutical ingredients was made by the US Food and Drug Administration (FDA).
Laboratory analysis by the US FDA revealed that the product contained undeclared sildenafil, tadalafil, and flibanserin, which were not mentioned on the product label. Such substances may include phosphodiesterase type-5 (PDE-5) inhibitors or related compounds commonly used for the treatment of erectile dysfunction, the statement by NAFDAC stated.
Sildenafil and tadalafil are ingredients in FDA-approved prescription drugs used to treat erectile dysfunction.
It was noted that these undeclared ingredients may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.
Flibanserin is the active ingredient in an FDA-approved prescription drug used to treat low sexual desire in women. Flibanserin can cause drowsiness, sedation, dangerously low blood pressure, and fainting, especially when combined with alcohol.
Consumers have been encouraged to report compromised products (medicines or medical devices) to the nearest NAFDAC office, call 0800-162-3322, or send an email to sf******@********ov.ng.
