The Tribune

By NATARIO McKENZIE

Tribune Business Reporter

nmckenzie@tribunemedia.net

CONCERNS remain over ministerial powers to unilaterally change the corporate governance framework of the National Health Insurance Authority (NHIA) according to Bahamas Insurance Association (BIA) chairman Emmanuel Komolafe, who said that stakeholders are seeking a “robust” governance structure that reduces the possibility of perception of political interference or abuse of power in the management of the NHI scheme.

Commenting on the NHI Bill tabled in Parliament last week, Mr Komolafe said that the government ought to be commended for continuing to make the expansion of Universal Health Coverage (UHC) in the Bahamas a priority. “National Health Insurance (NHI) is only the funding mechanism for UHC adopted by the Government and in this regard the tabling of the NHI Bill is no doubt a milestone in our UHC journey,” he said.

“Ideally, the process for the development of the UHC framework should have entailed the preparation of a UHC Green Paper, UHC White Paper, UHC Policy Paper, NHI Policy Paper and drafting of legislation and regulations (in that order). There is no doubt that we are now trying to catch up, albeit considerable work and research has been conducted on this subject over the past three decades. It is our understanding that the UHC Policy is a work-in-progress and the NHI policy has been approved by the Government even though the latter has not yet been made available to stakeholders.”

He noted that Section 2 of the NHI Bill defines the minister as the “Minister with responsibility for national health insurance”.

“This definition is vague and does not identify or declare which Minister will have oversight of this important portfolio. It remains unclear how the ministerial responsibility for this monumental initiative will be allocated; in essence, whether a new ministerial post will be created or additional responsibility will be given to a Cabinet Minister with an existing portfolio.

“Section 4(5) of the NHI Bill reads: “The Minister may by Order amend the First Schedule” Section 4(4) of the draft legislation notes that “the provisions of the First Schedule shall have effect as to the constitution and procedure of the Board and otherwise in relation thereto”. A review of the First Schedule will show that it lays out the constitution of the board, appointment of secretary, tenure of members of the Board, vacancies, termination of membership on the Board, remuneration, meetings of the Board, voting by Board members, disclosure of interest, confidentiality and limitation of liability vis-à-vis the NHI Authority. The effect of Section 4(5) is that while stakeholders’ recommendations vis-à-vis constitution of the board were recently incorporated into the revised NHI Bill that was tabled, the Minister responsible for NHI can unilaterally change this and any other aspects of the corporate governance framework of the NHIA by Order,” Mr Komolafe noted.

He argued that this provision vests significant powers in the NHI Minister without the requisite checks and balances to promote transparency and accountability. “There is currently no requirement to have the NHI Minister obtain the approval of Parliament in order to amend the very important First Schedule. It follows therefore that all the concessions given or revisions incorporated into the revised Bill (in relation to the corporate governance structure of the NHIA) based on the recommendations of stakeholders could be arbitrarily and unilaterally reversed or eliminated by Order of the Minister; presumably at the stroke of a pen without the approval of Parliament.”

Mr Komolafe noted that this concern is shared by the Bahamas Chamber of Commerce and Employers Confederation and the Government’s independent consultant, KPMG. According to the NHI Draft Bill Stakeholder Feedback document, KPMG had recommended “that any amendment to the governance structure of the constitution and procedures of the Board as laid out in Schedule 1 would be required by means of an amendment of the Act and not subject to powers of the Minister only”.

“Other stakeholders would have expressed similar sentiments in relation to the powers of the Minister to unilaterally change the corporate governance framework of the NHIA,” said Mr Komolafe. “This convergence of views shows that there is a common concern in this regard and a genuine desire among stakeholders for a robust governance structure that reduces the possibility, perception or appearance of political interference or abuse of power in the management of the NHI scheme.”