He came, he transformed and he went. A journey of the “authentic Prof” as Director General/CEO at the National Health Insurance Authority (NHIA), Nigeria from July 2019 to October 2023. A journey crossing visible milestones with remarkable landmark achievements that are no hoaxes. His appearance at the helm of leadership at the NHIS now NHIA was a breath of fresh air for an agency that was at its abyss and entangled in a web of leadership quagmire with distorted vision on actualizing its mandate.
Professor Mohammed Nasir Sambo will write his own memoire but of note is the authenticity of his depth of knowledge and professionalism in shaping the agenda for the entire health insurance ecosystem towards universal health coverage goal during his stint at the NHIA. His 3-point agenda of value reorientation, transparency and accountability, and accelerated drive toward UHC are visionary and are now mantra in the entire ecosystem.
The aim of his value reorientation agenda for a result-driven organization was to restore a value system that instilled good work ethics, unity of purpose and direction, and team work and team spirit. The other key elements of the value reorientation strategic objective that made the difference included effective communication and information management, excellent work environment, efficiency, and appropriate rewards and sanctions.
For accelerated drive towards universal access to quality health care for all Nigerians, Prof. Sambo entrenched consolidation of existing NHIA health insurance programmes with innovations on programmes designed to cover those currently not covered by any form of health insurance.
To engender transparency and accountability in the entire operations of the Authority, Prof Sambo led the Authority to adopt openness in operations, working with evidence, providing adequate information to all stakeholders, engagement of stakeholders in decision making, and established an effective administration and financial management system. The game changer under his transparency and accountability agenda was the implementation of the e-NHIA to define an ICT driven NHIA.
There is evidence that the implementation of the 3-point agenda at the NHIA have yielded positive results visible enough for the blind to see, audible enough for the deaf to hear, and convincing enough for the most ardent critics to acknowledge. There is unprecedented transformation in the physical work environment as envisioned in the value reorientation with a new headquarters seven-story building nearing completion, six state offices at various stages of completion, and renovations and furnishing carried out at state offices nationwide.
In programmes design and in decoupling of the health insurance implementation, the authentic Prof has further empowered the state health insurance agencies and encouraged private sector participation in the health insurance coverage under the concept of Health Insurance Under One Roof. This concept has led to the resolution of areas of conflicts in health insurance implementation amongst players in the ecosystem. Innovations also resulted in developing the Group, Individual and Family Social Health Insurance Programme (GIFSHIP) and its variants.
The flagship project of Prof. Sambo is the implementation of the digital NHIA masterplan called the e-NHIA. What the Prof. met on ground in 2019 was the engagement of a South African company that was having the challenge of implementing an e-NHIS Enterprise System. The company provided batched processing solution where forms were filled at enrolment locations nationwide and collected in bags from states to the Forms Processing Centre at the NHIS Headquarters in Abuja. This inefficient process went on for over a decade before the company developed an offline enrolment application and a limited record management portal with hosting services based in South Africa.
This out-of-country hosting exposure of sensitive enrollee information including that of security personnel, in violation of Nigeria Data Protection Regulation, further became an issue. The NHIA was also inundated with complaints from the stakeholders on inefficiency of the limited technology solution provided by the South African company and there were serious concerns in the ecosystem that the solution would not take NHIS to the realization of the UHC goal in record time.
To evolve into a more robust and effective digital solutions environment, the Prof. Sambo led NHIA dusted up the e-NHIA masterplan with a reset on the ICT vision of a simple, secure, scalable, centralized, but connecting the entire Nigerian Health Insurance Ecosystem for health data aggregation, and for health information exchange. Armed with this vision, the Prof and his team approached the National Information Technology Development Agency (NITDA), the Bureau of Public Procurement (BPP), and Federal Executive Council (FEC) for consideration of the digitization architecture and approval for authority to incur expenditure in 2020.
The digitization architecture that has earned the NHIA the most interoperability compliant agency of government in 2021 included technologies for digital biometric enrolment, staging infrastructure for enrolment and supporting portal platform, connectivity infrastructure, data center upgrade and disaster recovery at three geo-locations in the country, modular health insurance business process automation, call management system at call center, and enrollee ID card production.
These digital components that constituted the content of the e-NHIS project scope and award are being implemented in phases. The first phase was the complete migration from the inefficient and hostile legacy environment to a temporary hosting state. The second phase was the deployment of the connectivity and data center infrastructure. The current third phase is the consolidation and integration of stakeholders’ digital systems to the e-NHIA environment. The final phase envisaged in 2024 is the self-service phase where all stakeholders will have digital interfaces with the e-NHIA environment that are independent of user endpoints devices, (phones, laptops, desktops, notepads etc).
The engagement of local content in the implementation of the e-NHIA has not only saved Nigeria over N10billion naira in alternative foreign solutions, it has also achieved more in value for money. It is in line with National ICT Policy, Local Content Policy, and in compliance with the extant Executive Order 005 on the Planning and Evaluation of Projects, Promotion of Nigerian Contents and Science Engineering and Technology as well as Executive Order 003 on “Support for Local Content in Public Procurement by the Federal Government”.
The established data centers and upgraded ones are physical assets to see. The connected terminal equipment at each of the 79 locations in the country are there to see, the software applications and portal platform supporting enrolments are there to see. Enrolment is now done remotely both in online and offline modes and they have been tested, delivered and are in use. Enrollees and other stakeholders’ complaints in terms of service experience in the ecosystems have significantly reduced. What is recurrent are the annual renewal of licenses and bandwidth subscriptions that could be challenges due to delays in government procurement processes and may impact business continuity.
For some tributes to say that Prof. Sambo is a transformational leader and a great patriot is to say the truth. To say that he stabilized the turbulence at NHIS and transformed it to a new NHIA, is to say the truth. It is also true that he intervened in the supply side of healthcare delivery through the Medicine Supply Initiative where he brought pharmaceutical firms together to produce generic drugs for the Nigeria Health Insurance Ecosystem, ensuring availability of quality, cheaper drugs, and minimizing possibility of out-of-stock syndrome as well as the menace of fake and counterfeit drugs.
On staff welfare, Prof. Sambo was fair in ensuring that the exit package that was an addition to staff pension and was queried by the Auditor General Office for lack of necessary approval got the approval from the National Salaries Income and Wages Commission (NSIWC). Staff were trained as at when due especially when deployed to new assignments.
Every reform has it challenges and Prof. Sambo met his own at the NHIA. The restructuring of departments and zones that mandated the availability of vacancies at each promotion window was disliked by those affected especially at the directorate cadre. Yet, it was a problem that needed to be solved now or later. That his leadership decided to solve it rather than defer it is another sign of a transformational leadership that he exemplified at the NHIA.
When Prof. Sambo was coming to the very turbulent NHIA at the time, he came with an unusual 10-point objectives as directive from government that he was to accomplish. As he leaves, there is no doubt in the minds of the ardent cynics that he delivered on those objectives and surpassed them by several milestones. His legacy of 10-year strategic plan, result-oriented culture, transparency and accountability in the health insurance ecosystem, and setting the stage for accelerated drive towards universal health coverage in Nigeria are imprints that the incoming leadership and the industry will find useful now and in the future.
Dr. Nasiru Ikharo
e-Health Consultant & Former Head of ICT, NHIA.
NHIA digital Professor moves on
