Hot SourceOnyebuchi Ezigbo in Abuja
In continuation of its renewed focus on improving quality of service to enrolled Nigerian patients, the National Health Insurance Authority (NHIA) sanctioned 49 erring healthcare facilities (HCFs) and 47 health maintenance organisations in 2024 in accordance with its operational guidelines.
The agency said that it was able to resolve 2929 complaints sanctions including issuance of warnings, refunds, suspensions and delisting.
A statement signed by Acting Director Media and Public Relations, Emmanuel Ononokpono, said sanctions imposed on the healthcare facilities followed investigations into complaints received from patients enrolled into the state and national health insurance schemes.
Among the complaints were: unavailability of medicines, denial of services, out-of-pocket payment for covered services and non-provision of payment narrations.
” For the HMOs, the issues related to delays or denials of referral authorization codes, delays in settlement of agreed reconciled payments, refusal to monitor quality assurance in facilities etc.
“These are some of the highlights of the 2024 Annual Complaints Report produced by the Enforcement Department of the NHIA under Acting Director, Enforcement, Dr Abdulhamid Habib Abdullahi,” it said .
Ononokpono said the report was issued in compliance with the NHIA Act 17 of 2022 which requires NHIA to establish mechanisms for receiving and resolving complaints by members of the Schemes and Health Care Facilities.
“In all, a total of 3507 complaints were handled during the period, out of which 2929 complaints (84 percent), majority of which were against HCFs, were resolved. A breakdown of the distribution of complaints reveals that 2273 were reported against HCFs, 1232 were against HMOs. Only two reports were recorded against enrollees by providers,” he said..
Ononokpono said that based on the outcome of investigations, various sanctions were imposed on erring healthcare providers where indicated.
“Eighty-four formal warnings were issued to HCFs, while 54 enrollees received refunds of N4,375,500 from 39 HCFs. Four HCFs were suspended and six others were delisted. Also 35 HMOs got warning letters and directives to institute corrective actions while 12 HMOs were directed to refund a total of N748,200 to 15 enrollees,” Ononokpono added.
According to the report, in 2024, all complaints were fully investigated and responded to within the standard response time of 10 to 25 days. The average complaint resolution time for complaints that required investigation was 15 days. The complaints resolution rate (within timeline) was 84 per cent.
Where issues could not be resolved within the timelines an explanation was provided to complainants while the resolution process continued.
The complaints received in 2024 were submitted through the following routes: in-person, written letters, email, telephone, the NHIA call center and other channels.
The NHIA Complaint and Grievance Management Protocol establishes clear policies and procedures for complaints management and provides that complaints must be responded to in a timely manner. It also provides escalation procedures for complex or serious complaints.
Speaking on the development, NHIA Director General, Dr Kelechi Ohiri, described the NHIA’s complaints management process as organic to the agency’s efforts to enhance accountability, rebuild trust and improve quality of care.
“This will ultimately drive higher enrolment by encouraging providers to offer current enrollees an enhanced quality of service.
“Enrollees deserve the best care and we will continue to do our best to ensure they get it. The sanctions are meant to send a clear message that the NHIA will not tolerate substandard service for enrollees,” he said.
