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How Delta is championing comprehensive contributory health insurance ~ Truth Reporters

By Pius Mordi

Speaking on September 23, 2019 when United Nations member-states adopted a high-level political declaration to protect people from suffering financial ruin due to health costs, António Guterres, its Secretary-General, said high cost of healthcare impoverished approximately 100 million people globally. He stated that the right to accessible, high-quality, affordable care, including during conflict and humanitarian crises is also an inalienable right. Of the 100 million impoverished annually while seeking quality medical care, 95 per cent are in developing countries where effective contributory health insurance scheme is lacking or does not exist at all.

For Nigeria, many people have been driven to financial ruin while seeking quality orthodox medical care. Many more have been forced to patronise unorthodox or traditional health care that often lead to complications that ultimately prove fatal. The statistics could have been much worse until 2014 when Ifeanyi Arthur Okowa, a medical doctor and then Senator, representing Delta North in the 7th Senate, sponsored and ensured the passage and signing into law of the country's venture into nationwide health insurance. The National Health Act sets out a legal framework for the provision of health services which is a strong potential to transforming health care provision in Nigeria through the Basic Health Care Provision Fund (BHCPF) by extending primary health care to all Nigerians. The Act is the roadmap to Universal Health Coverage (UHC), which is expected to be domesticated at state level.
On becoming the governor of Delta State on May 29, 2015, Okowa leveraged on his experience as the author of the National Health Act to fast-track the process of making Delta the first state in the country to adopt BHCPF and UHC. Barely three weeks after taking office, precisely on June 22, 2015, he transmitted the Bill to establish Delta State Contributory Health Commission (DSCHC), Delta State Contributory Health Scheme and other Matters Connected Thereto as well as a Governing Board for the Commission, which will regulate, supervise, implement and ensure effective administration of a Mandatory Delta State Contributory Health Scheme for all residents of the state to the House of Assembly. The Bill scaled the legislative hurdle on December 9, 2015 and was signed into law on February 4, 2016.

Generally acknowledged as the biggest mandatory health insurance scheme in Nigeria at the moment, the DSCHS has enrolled no fewer than 670,000 subscribers, and has a mandate to enroll all residents of the state into the scheme in no time. It is a drive that has captured more than 30 per cent of the state's adult population, an achievement that even the governor’s critics have acknowledged as spectacular given the fact that the commission began running the scheme only in 2017.

Prior to beginning enrolment into the scheme, the DSCHC undertook a baseline survey to determine the key household demography and health seeking behaviour of Deltans to guide planning for expanded health insurance coverage. The survey also determined current household spending on health, health insurance coverage needs and willingness to pay for health insurance in the state. In addition, the survey addressed the proportion of Delta residents in the lowest socio-economic category, to guide decisions on subsidy and or exemptions from payment. This enabled the commission to assess the availability, capacity and readiness of health delivery facilities in the state to deliver the proposed health insurance services across all 25 local government areas in the state.

According to Dr. Ben Nkechika, Director-General/Chief Executive Officer, DSCHC, the Commission also undertook a statewide health service quality improvement initiative with visits to healthcare facilities across the state and held advocacy meetings with the Hospital Management Board, Primary Healthcare Development Agency, Private Healthcare Providers Association, local government chairmen and coordinators of Primary Health Centres in all the local government councils as well as various formal and informal sector associations and relevant stakeholders.
The commission began the enrolment with pregnant women and children under-five years of age that belong to the vulnerable group as approved by the state Executive Council as part of the Equity Health Plan. The formal sector group comprises the organised private sector and the public sector through collection of their contribution and enrolment into the scheme. The informal sector groups were enrolled after paying their premium. 

Given the fact that the informal sector constitutes over 60 per cent of the population, and Okowa's desire to broaden the reach of the programme and further stem the burden associated with out-of-pocket payment for medical care, he approved an annual premium of N7,000 per individual. With this highly subsidised premium, enrollees in the informal sector now enjoy quality, affordable and accessible healthcare while family registrations are further given at a discounted rate.

To drive efficiency of the programme, increase fund availability, spur creativity and ensure visible health impact, the state government sought the collaboration of the private sector. Consequently, PharmAccess Foundation, a private sector organisation and the Bank of Industry (BOI) partnered the government to revitalise 25 defunct primary healthcare facilities as part of efforts to ensure that the growing number of enrollees in the scheme is able to access healthcare through a memorandum of understanding.

“With this agreement, the private sector will have access to funds at a single digit interest loan from the Bank of Industry to fix and run the abandoned health centres.
``This innovative product will ensure availability of 24 hours quality healthcare services across Delta for the state contributory health scheme, ensure continuity of healthcare services during strikes and other industrial disputes as well as provide more healthcare service options for residents of Delta,” Nkechika explained.

So far, a total of 267 primary health centres have been upgraded for the scheme. There are 23 facilities under the access-to-finance programme, 66 government clinics, one federal facility, seven mission hospitals, 59 private hospitals and five clinics. They are supported by PharmAccess Foundation and BoI. The goal, according to Nkechika, is to ensure that such private facilities can be run as world standard clinics. He also said that DSCHC also has the additional mandate to run cottage hospitals in hard-to-reach rural and riverside areas and enroll residents of such communities in the health insurance scheme.

On a visit to the Umuagu Health Centre in Asaba the state capital, we spoke with the following beneficiaries of the informal sector enrollees.

Some informal enrollees of the programme lauded Okowa’s administration for the initiative, describing as ``highly humanitarian and demonstrating a government with human face.

According to Mrs Blessing Nkedinma, who resides behind NTA in Asaba, Okowa has relieved me of the stress of looking for where and how to treat my children.

"The major benefit of this programme is that we no longer have to crack our brains on how to raise money to take the children to the hospital for treatment whenever they fall ill. I am delighted to say that my family and I are beneficiaries of this good initiative of universal health coverage by the Okowa government,’’ she said.

For Delight Okonji Delight, it is a lifeline to many families, especially the downtrodden.
She said "let me say without any equivocation that this programme is very laudable because we are now being attended to at the health centre promptly and at no cost. I thank the state government for this gesture which will go a long way in improving the health and wellbeing of the people."

Mrs Blessing Ngugu of Umuonyia Street, Asaba, who was delivered of a bouncing baby boy on Sunday, said she was discharged without paying a dime.

"I am excited at the fact that this delivery, which didn't cost me a dime, could have cost me a fortune if I had gone to a private health facility. I commend the Okowa-led Delta State Government for this laudable initiative. Everybody, every family is enjoying it and praying for him," she said.
Those in the mainstream public service were also appreciative of the scheme. For instance, Mrs Ona Iyeh, a Confidential Secretary in the Directorate of Government House and Protocol, Asaba, was one of the first members of staff to activate her enrolment and utilise the insurance scheme. According to her, since I enrolled, I've not had to pay for health services. When my husband took ill some time ago, my hospital rendered prompt services at no cost. My children are also covered.

Similarly, Isaac Ogerugba, an Information Officer in state Ministry of Information, has been enjoying comprehensive healthcare with his young family. "It's a fantastic package. For a little deduction from my salary, the insurance scheme has taken the burden of paying hospital bills away. It's what every family needs and I can affirm that it is working," Ogerugba stated.

In spite of the impressive increase in the number of enrollees within the public and organized private sectors, the commission is looking to enroll every household into the scheme. That is in keeping with the injunction of the governor to the commission, and having already achieved nearly 100 per cent enrolment with the organised sectors, individual private adults are the target as the state hopes to sign on every household into the scheme.

The primary goal of the DSHCS as the trail blazer in the country is to have a healthcare service financing system that ensures that any resident of Delta, irrespective of socio-economic status or geographical location, is able to visit a healthcare facility when in need of quality service and obtain such service seamlessly and promptly.

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