Jan. 28, 2015

Dr. ‘Femi Thomas


Dr. ‘Femi Thomas

Executive Secretary & CEO, National Health Insurance Scheme


Prior to his appointment as Executive Secretary & CEO of the National Health Insurance Scheme (NHIS), ‘Femi Thomas was a Consultant Cardiothoracic Surgeon at the Lagos University Teaching Hospital (LUTH), two-term Commissioner for Health in Ekiti state and a lecturer at the College of Medicine, University of Lagos, where he is an Associate Professor of Surgery. He holds a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree from the University of Jos and his postgraduate qualifications include an MBA in Financial Management, and Fellowship of the West African and International Colleges of Surgeons.

What reasons are the reasons for the low insurance penetration in Nigeria?

The National Health Insurance Scheme (NHIS) came into law in 1999. Then in 2005 the federal government commenced its formal sector programs, which involved health insurance coverage for federal government workers nationwide. Since then, 10% of federal workers' salaries have gone into the scheme. We also have a program to address the specific needs of pregnant women and children under the age of five, having thus far covered approximately 4 million people. Having said that, of those 4 million lives, only 1.9 million are being taken care of right now under the scheme. The NHIS' total coverage is about 8 million people in both the formal and the informal sector programs, but it is still voluntary. Health insurance is hard to enforce as you are asking someone to pay for something that they do not need immediately, and that is not legally mandatory for anybody. This leaves us with a significant need for advocacy and marketing. In 2013, the President directed us that we should cover at least 30% of Nigerians by the end of 2015. We actually set a target of 40% ourselves and have developed our strategy for reaching that. We hired the consulting firm PwC to help us rework the processes. Based on their report, we have been able to achieve considerable mileage over the past few months. Firstly, we have restructured and refocused our department, especially in terms of marketing. Secondly, we have set up offices in every state of the country. That has manifested positively, because we have increased our coverage by two to three million since January 2014. Beyond that, we came up with our own four-point strategy for leapfrogging. First, we launched a community-based health insurance scheme that mainly addresses the needs of poor people in our area and in the informal sector of the economy. From October 2014, we will be enrolling all 24 million pupils in public primary schools nationwide. We have also enrolled students in tertiary institutions nationwide, which amounts to roughly 2.9 million. Beyond that, we have just launched mobile health insurance. Nigeria has the highest mobile phone per capita ratio in Africa, and we are leveraging that penetration. In 2013, all Nigerians owning a mobile phone were targeted by our scheme. The benefits of the platform are numerous. People can register and access it from anywhere in the country as long as they have a mobile network. It is also a convenient payment platform. You can pay NGN12,000 once a year, NGN1,000 monthly, or NGN250 weekly. With this you have a guarantee of protection against at least 80% of the diseases in this environment. That is what we are trying to achieve. We also have an adoption platform, with which we tap into our innate sociology in Nigeria. You can pay for your loved ones or for anybody else. This platform is so robust that you can be specific and refer to your loved ones, or non-specific (meaning random vulnerable people). We have close to 1 million Nigerians ready to be adopted, and expect 5 to 10 million adopters. If we look at the facility level, the story is also that of success. We have accredited more than 7,000 health facilities nationwide, and intend to accredit an additional 3,000 before the end of 2014. All of these facilities will be provided with the necessary telecommunications equipment to be in contact with health organizations in real-time, whereby the health organizations will be able to monitor the facilities and interact with them.

How are you tapping into the informal workforce?

The community-based health insurance is a platform where we enroll people in rural areas. These people usually have one thing in common; either a religious or healthcare facility not too far from them. We use that to gather them together and interact with them and we lead them to one facility in the environment, which we call a mutual association. All the men and women in the informal sector belong to cooperative societies, which are governed by a national body. In partnership with this national body we enroll them through the empowerment process. The cooperative empowers them, and then negotiations are made for health insurance. So we are expanding the community-based health insurance to that level. There is another group, broken up into four sub-groups, that we are meeting with right now, namely road transport workers; a sector of around 16 million people. We want to enroll this group for community-based health insurance.

What is your take on the development of the health sector over the coming five years?

One has to look at infrastructure, manpower, and materials to service the scheme. But the single most important thing is the ability to pay for services, which will create demand that in return increases supply. Because we are creating demand, our facilities will improve, new facilities will be built, and people will have the confidence to invest in the health sector because they are assured that payment for their services will deliver real outcomes. I strongly believe that the health sector in Nigeria will be able to move to a national position of being among the first-rate economies of the world. I also expect the health sector to be competing at that level within another five years going by what we are doing. The beauty of this is that we are working at a level of public-private partnership. We are involving Nigerians in the various sectors by assisting them to come together and work out a plan for themselves even without adjusting the legislation. Even when on a voluntary basis, we utilize all available materials to penetrate the various segments of society to make health insurance more embracing, and have had a positive response to this.