Dawn of a new era as new heads of NHIS and NACA appointed

Dawn of a new era as new heads of NHIS and NACA appointed

Professor Mohammed Nasir Sambo, the new Executive Secretary of NHIS is not new to the NHIS having spent many years of his early career years working there.

He started as the Principal Manager, rising to the position of Assistant General Manager in the NHIS, and was the first Zonal Coordinator in the NHIS South West zonal office based in Lagos.

He was seconded to the National Primary Healthcare Development Agency (NPHCDA) where he was the Assistant Director and Zonal Coordinator for the North West in 2000, based in Kaduna.

He was then recalled to NHIS to set up the community health insurance programme.

He left the NHIS in 2004 for academia, starting from the Department of Community Medicine at the Ahmadu Bello Teaching Hospital in Zaria, where he rose to the rank of Professor and Head of Department.

He was then called to be the Provost of the new Kaduna State University where he served until his recent appointment.

the battles between the previous Executive Secretary, Professor Usman Yusuf, sections of the staff of the agency, Health Maintenance Organisations (HMOs), the Minister of Health and finally with the Board of the agency.

A critical National Health Insurance Bill that would have repealed and replaced the National Health Insurance Scheme passed third reading at the Senate in April 2019, however by midnight on the 29th May 2019, President Muhammadu Buhari had not assented to the bill.

One of the key amendments in the bill would have made health insurance compulsory in Nigeria. As a result of this setback, the process will have to re-started by the 9th National Assembly with the new Senate Committee on Health.

Nigerians have argued for a long time that the dual functions of the NHIS, managing funds and regulating the health insurance sector should either be separated or at the very least sequestered in two parts of the organisation that are managed independently, without any undue influence on either side.

Resolving this issue will be critical to the success of Professor Sambo’s tenure in his new role.

However, the rapid growth of State Health Insurance Schemes has been one of the bright lights in the sector, inspired by the introduction of the Basic Health Care Provision Fund (BHCPF), successfully implemented under the leadership of the Chairman, Senate Committee on Health and former Minister of Health.

Not enough Nigerians have access to healthcare

Professor Sambo certainly has his work cut out for him; a review of some of his previous publications and lectures provides some insight into his thoughts on health financing.

At a public lecture at the Bayero University Kano in 2017, he called an innovative approach termed “a basket collection”- a financial contribution from philanthropists, individual savings accounts, where every salary earner contributes 4 percent of his/her salary to a healthcare fund.

At present, less than 1% of Nigerians are covered under the NHIS, even this figure is still an estimate and the true number is still unknown.

This could be one of the key tasks that Prof. Sambo takes on when he starts his tenure as was done when the HIV prevalence rate was redefined.

Now is the time to bring life back into one of the most challenged parastatals in the Nigerian health sector, but also one of the biggest opportunities to transform the health insurance market.

“The most important reform for the health insurance industry is TRANSPARENCY, supported by the adoption of technology for identification and validation of access to healthcare for patients.

Standards for pricing and quality of care must be urgently defined for sustainability in the sector, so all parties – patients, providers and payers – are clear what to expect from health insurance” – Obinnia Abajue, Chief Executive Officer, Hygeia HMO Limited.

As if to pre-test the leadership and scientific skills that would be required for his new appointment as the Director General of NACA, Dr Gambo Aliyu successfully led the implementation team of the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), the largest population-based single country HIV prevalence survey in the world, delivered in Nigeria in February 2019.

Dr Gambo Aliyu is a graduate of the Ahmadu Bello University, Zaria where he obtained his MBBS in 1995 and finally a Postdoctoral in Pharmaco-Epidemiology from the University of Manitoba, Winnipeg, Canada in 2015.

He returned to Nigeria in 2017, working as a Research Associate at the Institute of Human Virology (IHV) at the University of Maryland School of Medicine (UMSOM), the institution selected to lead the $100 million NAIIS to measure the reach and impact of HIV programs in Nigeria.

The landmark study, completed in a record 9 months showed that the HIV prevalence is 1.5% among people aged 15-64 years old. The result of the survey has also redefined the HIV epidemic in Nigeria and will shape its response into the future.

Dr Gambo Aliyu will have to forge new alliances, try new approaches and strengthen strategies to reduce the burden of HIV in Nigeria, among our growing population.

In addition to his recent engagement as part of the NAIIS team, Dr Gambo Aliyu has a long history of engagement with HIV prevention in Nigeria, conducting research on critical issues that confront the HIV epidemic, from counselling and testing of hard to reach populations, through vaccine trial preparedness to the impact of acutely infected patients on transmission.

This level of depth of understanding of the complexity of the HIV epidemic in Nigeria, puts Dr Gambo Aliyu in a strong position to carry on with the great work started by Dr Sani Aliyu, the previous Director General of NACA.

Since the first AIDS cases were diagnosed in 1985, this led to a flury of activity in Nigeria. The first decade of the HIV response was marked by initial hopefulness for a vaccine that never came.

This was followed by despair due to the non-availability and high cost of treatment for millions of patients in African countries. The denial of HIV by governments in African countries had exacerbated access to treatment at the time.

The turning point was the XIII International AIDS Conference, held in Durban in 2000, helped by a strong turnout of activists who drove home the issue of the glaring inequality in access to HIV treatment.

Following the global push for more access to lifesaving antiretroviral therapy (ART), Nigeria was one of the first countries to order ARTs for 10,000 adults and 5,000 children in 2001.

Nigeria continues to face unique challenges that amplify the risks of HIV. We have a large and rapidly growing population, while at the same time facing serious challenges in financing our current healthcare needs.

This means that despite the lower HIV prevalence figures, the absolute number of those infected and who require treatment is still very high.

Our large young population and challenging socio-economic indicators mean that things can get worse very quickly.

The NAIIS results also showed that the epidemic is very diverse and complex, with some parts of the country affected more than others and so impacting the requirements of the differentiated response rates.

Why are all these issues important? Leadership of the NHIS and NACA will not only require health financing and scientific leadership, but will also require a clear understanding of the political economy of global health, as well as advocacy at the grassroots to drive change.

However, one of the most important attributes that will be needed by both leaders as they take up their new positions, at the helm of the NHIS and NACA will be compassion for the people they have been called to serve – we the Nigerianpeople.

They will also need a resilient “can-do” attitude that is anchored on a spirit of collaboration with all stakeholders in the health sector.

The team at Nigeria Health Watch wish them well and we look forward to seeing them deliver on their mandates for the Nigerian health sector.

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Chuka Francis

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