By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

AS National Health Insurance enters the second month in which primary healthcare services are provided to enrolled Bahamians, no formal management structure exists to manage the programme.

A National Health Insurance Authority (NHIA) board has not yet been established.

It remains in limbo along with a decision on the establishment of a public insurer, the finalisation of NHI regulations and the release of a request for proposal for a company to provide IT services in connection with NHI.

None of this has stopped representatives of the NHIA from entering into contract arrangements with staff and medical providers, however, or from ensuring that primary healthcare services are provided to enrolled Bahamians, a fact that has caused some private sector stakeholders to question the propriety under which the NHIA is functioning as well as their role in the scheme.

The Christie administration took the view that the National Health Insurance Act gives the minister responsible for the NHIA broad power to steer the direction of the institution, despite the mandate for a board.

It’s not clear how the new administration views this.

Health Minister Dr Duane Sands said yesterday that this will be examined by the Office of the Attorney General.

Nonetheless, he shared the concern of stakeholders over the lack of a formal structure managing NHI.

“There is no legal authority for the NHI Secretariat to be doing what they are doing,” he said. “You have to question the legitimacy of anything that has transpired in the absence of the enabling structure.”

According to the NHI Act, the board of the NHIA is the governing body of the authority and is empowered to appoint a managing director as chief executive of the NHIA as well as other officials and staff.

In the absence of a board to execute this function, Dr Delon Brennan, project manager at the NHI Secretariat, is functioning in the role of acting managing director of the NHIA, The Tribune understands.

He does not formally have that role, however, because he has not signed a contract relating to it, this newspaper was told.

Likewise, other figures, including the legal advisor and financial controller, have also not entered into contracts with the NHIA.

They are, however, employed through the NHI Secretariat.

In the meantime, lower-level workers of the NHIA have been engaged on short-term contracts that will be ratified once the NHIA board is established.

The intention had been for the NHIA board to be established after the universal healthcare (UHC) steering committee and stakeholder advisory council were disbanded.

It was expected that some members from the advisory committee would have transitioned onto the NHIA board once the NHI Act came into force and the board was established.

But after the May 10 election, this plan was put in limbo.

“Recommendations were sought from the private sector for members of the board,” said Emanuel Komolafe, president of the Bahamas Insurance Association (BIA). “A number of representatives are supposed to be on that board but that board has not been established. Even though the Act is enforced, what is the formal constitution of the NHIA in terms of the establishment of a board of directors and subsequent to that the engagement of a management team and staff? It’s about proper governance of the entity. You’re getting into agreements with service providers but under which authority? And in the absence of a fully functional managing team, a board, a public insurer, registered health administrators, and regulations for NHI, we in the insurance industry are not clear what model is being used for NHI.”

Although regulations for NHI were expected to be released months ago, they never were.

The delay could be prolonged now following the change in the governing administration, a source familiar with the matter suggested to The Tribune, as officials must now align NHI with the priorities of the Minnis administration and its focus on providing catastrophic care coverage to Bahamians.

The absence of regulations is seen by some stakeholders as a hindrance to the involvement of some potential regulated health administrators (insurance companies) and medical providers.

Despite concerns about the management structure of NHI, Dr Sands said the Minnis administration has no plans to halt NHI.

“Given the fact that people participated in good faith in the process based on information they received from the government, notwithstanding the challenges, we have to set them right,” he said.

He said the predicament the government now finds itself in is due to the Christie administration’s decision to go ahead with its NHI plans close to the general election, knowing that a number of key decisions would have to be made after the vote.