More than two months after the presidential panel set up to probe the crisis rocking the National Health Insurance Scheme (NHIS) submitted its report, nothing has been heard on the controversy. VINCENT IKUOMOLA writes on the findings of the panel and the delay in implementing its recommendations.

What is the outcome of the Presidential Investigative Panel on the leadership crisis that has been rocking the National Health Insurance Scheme (NHIS) in the last few years?

This is the question begging for an answer in and outside the health sector.

To resolve the incessant crisis and mistrust in a scheme that is critical to the attainment of universal health coverage in the country, the Federal Government set up a probe panel, which included the Prof. Usman Yusuf-led management team and the NHIS board, led by Dr. Eyantu Ifenne.

That was not the first time the NHIS boss would run into murky waters. He was first suspended and queried by the Minister of Health, Prof Isaac Adewole, which led to accusations and counter-accusations. The outcome of the panel instituted by Prof. Adewole at the instance of Vice President Yemi Osinbajo, then Acting President, did not see the light of the day.

Much to the chagrin of watchers of the unfolding drama in the sector, Prof Yusuf, who was placed on indefinite suspension, was recalled by the administration of President Muhammadu Buhari without any recourse to the outcome of the panel.

Rather than fizzle out, the matter escalated, as the embattled NHIS boss’ second coming soon drew another round of controversies when he engaged in a running battle with the scheme’s board.

The board and Prof Yusuf were embroiled in the faceoff for months over the scheme’s budget. Prior to the suspension of Yusuf, the board had refused to approve the budget for the running of the scheme following a disagreement on the proposal put forward by the suspended executive secretary. This led to his suspension and investigation by a committee set up by the board, opening another floodgate of accusations and counter accusations.

Yusuf did not accept his suspension by the board, claiming that the board lacked the power to suspend him.

When it was thought that peace had returned to the scheme, the bubble burst again. What started like a smoke soon snowballed into a fire; Yusuf was sent on his second suspension within 15 months. He was suspended on allegations of fraud, insubordination, criminal breach of Procurement Act, self-aggrandisement, and arbitrariness, among others. The romance between board and Yusuf only lasted three months, before the N25 billion planned investment for the scheme tore them apart.

According to The Nation investigation, before Yusuf’s reinstatement in February, the then Acting Executive Secretary, Mr. Attahiru Ibrahim, raised the idea of investing N25 billion of the scheme’s fund, on which he got the approval of the minister as there was no board in place then. However, a memo from the Ministry of Finance advising the Minister of Health against the idea was forwarded to the management of the scheme, nullifying the initial approval.

But on resumption of office, Yusuf was alleged to have dusted the file and without recourse to the second memo from the minister, went to the board for approval. The board, it was learnt, found out about the other memo and felt bad that the executive secretary failed to let them know about the second memo. Then came the issue of budget for the running of the scheme. The budget submitted to the board was rejected five times on the grounds that it was unrealistic; hence, the executive secretary was asked to adjust it to reflect what was agreed by the board.

The chair of the board, Dr. Ifenne, argued in a memo to NHIS boss, which was exclusively obtained by The Nation, that any attempt to approve the budget as presented would be misconstrued as a conspiracy to defraud the scheme. The board chair, therefore, implored Yusuf to reflect the council’s positions on the contentious areas as enumerated and re-present same for authorisation.

The scheme, responsible for the regulation of the health insurance scheme in the country, did not have a budget to drive its 2018 operation two months to the end of the year. The management revised the budget submitted to the board, proposed revenue/income of N44.92 billion and expenditure of N64.73 billion, with a budget deficit of N19.81 billion, which was rejected as not reflecting the outcome of the board deliberations. The board rejected the budget on the ground that the deficit was unacceptably high at 30.6%. Besaides, the board pointed out that the revised budget was embellished with some suspicious duplication of expenditure items worth N264.9 million.

Other observations by the board included the non-reflection of the N64 million allocations from the Federal Government in the revenue projections of 2018.

No doubt, the feud has impacted negatively on the activities and responsibilities of the scheme, with enrollees bearing the brunt.

However, to get to the bottom of the issues and reposition the scheme, the Presidency stepped in and set up a panel to look into the matter and come out with implementable recommendations. The panel, inaugurated on November 2, 2018 and charged with a five-point terms of reference, including the responsibility for examining all governance issues challenging the scheme, was given two weeks to submit its report. However, the assignment had to be extended due to the nature of the work and the need to address core issues on a lasting basis.

Finally, after about two months, the panel turned in its report, precisely on December 24, 2018. More than two months after receiving the report, nothing has been heard from the government while the scheme is still being run by an acting Executive Secretary. However, it was gathered that one of the recommendations made by the committee was for the government to set up a draft white paper committee on the implementation of most of the report.

Besides, it was also gathered that the outcome of the panel on the leadership crisis in the NHIS may not be favorable to Yusuf. According to findings, the panel noted that Yusuf was unable to work harmoniously with stakeholders, which impacted negatively on the scheme. The panel, it was learnt, also established cases of infractions of the public service rules against the embattled executive secretary. The panel therefore recommended for Prof Yusuf’s removal and also urged the Federal Government to set up a draft white paper committee on the implementation of suggestions of the panel to restructure the scheme.

Besides, the panel, it was learnt also frowned against Yusuf’ failure to explore internal administrative remedies before filing a suit in court against the Federal Government.

The panel report  stated: “Leadership problems: In view of the unhealthy relationship between the executive secretary and other stakeholders, (management staff, local unions, HMO’s Health care providers) as well as infractions of the extant rules and regulations, recommended that the executive secretary be relieved of his appointment.”

The panel also established cases of infractions of the provisions of the procurement Act, sections 16(6) and 32(7), also rules 3125 (I) (a) and (b) of the financial regulations. Also, the panel recommended that the office of the Accountant General of the Federation should undertake an in-depth inspection of the scheme account books to determine current financial status of the scheme and also to take financial system review. To avoid a vacuum and ensure a smooth running of the scheme, the panel also recommended an interim management team with six months life span.

The panel, which was set up by the Secretary to the Government Federation (SGF) following the suspension of Yusuf by the NHIS board, also recommended a total audit of the scheme. Receiving the report of the Presidential Independent Fact-Finding Panel on NHIS, the Secretary to the Government of the Federation, Boss Mustapha, said that government regards the scheme as critical to its promise to Nigerians that they would enjoy qualitative and affordable healthcare.

He noted that government also regards healthcare delivery as a cardinal programme on which huge investments have been committed because a healthy nation is a wealthy nation.”I receive this report with deep sense of appreciation and I assure you that the report would be expeditiously processed for implementation. I must thank you most sincerely for all the sacrifices made to ensure that this healthcare scheme which also borders on our security as a nation is made to stand firm on its feet and remain beneficial to all Nigerians.

“Finally, let me assure you that the decision of government on the recommendations of the panel will be made public at the appropriate time. I also want to assure all Nigerians that this government remains very committed to making life worth living,” Mustapha said.

Would Prof. Yusuf survive the latest suspension? Would he escape another sword of Damocles? Would he come out of the fire unhurt as he did in the first suspension saga? These and many more questions are waiting to be answered.

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