December 06, (THEWILL) – As part of its mandate, the National Health Insurance Authority (NHIA), has taken newly accredited health care providers (HCP) through their operational modalities at a forum, which was held in NECA House in Ikeja, Lagos.
The forum with the theme: “Efficient Gatekeepers As Caregivers”, was attended by a large number of newly accredited health providers in their register.
Healthcare providers are persons or entities that provide medical care or treatment. They include doctors, nurse practitioners, midwives, radiologists, labs, hospitals, urgent care clinics, medical supply companies, and other professionals, facilities and businesses that provide such services.
Speaking at the forum, Director, NHIA Lagos Zone, Mrs Modupe Ogundimu, said that the forum was organised to inform the newly accredited healthcare providers about the operations of the Authority.
Describing the primary health care providers as gatekeepers, Mrs Ogundimu pointed out that their training has become necessary because they are the first point of contact for the enrollees, adding that the training programme is a continuous process.
She said, “Training, teaching, education is a continuous thing. This is one of the many interactions that we will have with them and so we have started something with them which will be continued. Next, it may not necessarily be a forum, we have other channels of educating them and we are going to send them the presentations. Those things may erupt questions from them. We can also reach out to them through emails and phone calls. And we will always invite them to other of our forums. This one is specifically for them.”
Emphasising that the Authority has scaled up its enforcement surveillance, the Director said that their enforcement rate has improved from what it used to be in the past following some empowerments that have been given to them through the Act.
Pointing out that where you have regulations, you must have enforcement, Mrs Ogundimu added, “By what they signed with us, what they are providing is actually social services. We have sanctioned and we have blacklisted some, the only thing we have not been able to do because it’s outside our mandate is to recommend or block people from the programme but we have done all that we can do to take a few facilities off the NHIA by virtue of not doing the right thing.”
On the choice of the theme, she said: “The primary provider in the NHIA space is the gatekeeper because he is the one who sees the patient first. It is better to enrol with health providers close to you. Let your health providers be close to you, They will manage you and make referrals. So the primary provider is the gatekeeper and the one that opens the door to the health insurance programme and you can’t jump to the secondary if you have not seen the primary provider. He decides whether you need to be referred out or whether it is something he can handle. It is the model we have adopted.
The zonal director noted that though the health care providers don’t need to attend the forum, she however, advised them to attend such engagements as they would come out more educated and informed than the ones that didn’t come.
“It is better for them to come for such a forum or send representatives so that they can be more informed about NHIA and even the new things that are coming on board”, Ogundimu advised.
Also speaking at the forum, the Lagos State Coordinator, NHIA, Ikeja Office, Dr Bethuel Kasimu Abraham said they have gathered the newly accredited health providers so that they get the right information directly from the Authority.
“After this meeting, we are going to share the presentations as we have promised them. One thing that our becoming an Authority has done is that in integrating health insurance in Nigeria, which is one of our mandates is that every health care provider as an HMO or health scheme we use must be accredited by us. These HMOs can approach them to use them to provide care for the enrollees they manage. Those that are not accredited by us are not expected to provide health care for Nigerians through them. The reason for this in that integrating role is to have one tight-knit system where information would be shared across the board, where anybody that has a complaint will know where it would be taken care of. Where anybody that goes against the provisions of the law will know that something would be done against that person”, Dr Abraham said.
“We have over 100 that have been accredited. As I am talking to you, we have a new list of those we have inspected a month or two ago that have been accredited. So we will start planning to bring those ones too to another orientation class.”
In her presentation on GIFSHIP, “Leaving No One Behind”, Assistant General Manager, Programme Unit NIHIA, Ikeja, Mrs Chika Amahalu said the Group, Individual and Family Social Health Insurance Programme(GIFSHIP) is a basic programme for NHIA which provides access to quality and affordable health care services to all.
According to her, it is a health insurance that is taken up and paid for by groups, individuals and families not covered by other NHIS coverage platforms.
She, therefore, advised individuals, constituencies, organisations and other members of the public to log on to the programme.
Similarly, Pharm Temidayo Arabi made a robust presentation on “NHIA Enforcement Protocol”, where she revealed how the Authority goes about its enforcement programme.
Anthony Awunor, is a business correspondent who holds a Bachelor of Arts Degree in Linguistics (UNILAG). He is also an alumnus of the Nigerian College of Aviation Technology (NCAT), Zaria Kaduna State. He lives in Lagos.
