By Chioma Obinna
Barriers to health care remain an important predictor of child survival, reduction in maternal mortality, improved life expectancy and general improvement in health indices. All over the world, countries and governments have striven to improve access to adequate health care through the elimination of barriers to access.
One major intervention to address these barriers is health insurance, a programme that covers or shares the expenses associated with healthcare of individuals or families. It was on this basis that the National Health Insurance Scheme (NHIS) was established under Act 35 of 1999 by the Federal Government to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems. Sadly, 14 years after, less than 5 percent of Nigerians are covered by NHIS.
According to experts, Social Health Insurance, SHI, in low and middle-income countries that have been successful, is based on individual mandatory enrolment practice. And reports from countries like Uganda and Rwanda, among others, have shown a positive impact on resource mobilization. These and more were the reasons behind some states like Oyo in Nigeria taking the bull by the horn to check out–of-pocket spending as well as increase access to affordable and quality healthcare and chart a way towards achieving Universal Health Coverage, UHC.
Sunday Vanguard writes on how the 18 months old Oyo State Health Insurance is improving health service utilization and providing financial protection against huge medical bills.
“I have always prayed for seamless healthcare. I am glad my dream came to pass two months after I got married,” says Mr. Olufemi Kola Ajayi, a beneficiary of the Oyo State Health Insurance Scheme.
Olufemi, a teacher, like many other Oyo residents, had prayed for stress-free access to healthcare even before he got married. Like a dream come true, he was lucky to be enrolled into the scheme a few months after he got married.
At first, he never believed that with just N8, 000 per annum, his wife could have a successful caesarean section without paying through his nose.
“I registered about two months after I got married and the initial payment was made two months after. Luckily, my wife got pregnant and gave birth and, since then, I have been paying less to nothing. It may not be 100 per cent success but I am happy with the programme.”
Also, five months old pregnant mother, Abimbola Ahmed, could not help but express her joy. Ahmed says, “I paid only N2, 400 the first time I came and, since then, I have not paid any other money. I am happy with the scheme.
“You see many women in our community don’t have money but since the government introduced free delivery, many of us have been coming. You can see that many people are here now.
“I joined the scheme in March last year. This programme is very good because they take care of us. They give pregnant women all the attention they need. After you delivery, you be given a bed free of charge”.
Another beneficiary, Mr. Adebayo, who narrated his story, told Sunday Vanguard that his wife was on admission for two weeks after major surgery and was treated free of charge.
His words, “My wife did not pay a kobo in this place. All the tests and surgery were done free of charge. This is why I told the doctor to always invite me anytime they are having a sensitization programme to testify. “If they write drugs, I will go to the pharmacy and they will give me free of charge. I cannot lie because I am a pastor. When it was time for us to be discharged, I was expecting to be given a bill but I did not get one. “The programme is good and saving lives”.
Olufemi, Abimbola and Adebayo are among the 100,000 beneficiaries covered under the Oyo State Health Scheme.
They shared their experiences during a field trip to the Agbongbon Primary Health Centre, one of the operational 270 Primary Healthcare Centres, PHCs, out of the 538 PHCs, 109 health clinics and 45 health posts owned by Oyo State government.
The Centre is also one of the facilities offering the state Health Insurance Scheme.
Paying at the point of accessing care was the norm in the state until 18 months ago when the state government changed the narrative by operating the health insurance under the provision of Section 16, Sub Section 1 of the Oyo State Health Insurance Agency, OYSHIA, Law of 2016.
Under the compulsory scheme, civil servant enrollees are expected, from level 1 to level 12, to pay the Standard Plan of N8, 000 as premium per annum inclusive of N200 registration /service fee while, from level 13 and above, will be on the Standard Plus Plan of N13,500 premium per annum.
Confirming the increase in the number of patients, Assistant Record Attendant, Health Records at the Agbongbon PHC, Mrs. Adekola Atinuke, told Sunday Vanguard that, every month, the Centre takes 40 deliveries a month and can be more in sometimes.
“In the past, we used to have 20 to 22 deliveries a month, but last month alone, we had 36 deliveries”, Atinuke said.
“Last year, we had 905 pregnant women in our record. But in the first five weeks of this year alone, we have over 108 on the list already.
“Although some women are still going to Traditional Birth Attendants, TBAs, the introduction of OYSIA has continued to increase antenatal uptake here and the number of other patients at the Health Centre. More women are now delivering here since they know they will not pay. Sometimes, money can keep them away”.
Speaking, the doctor in charge, Fasan Desimola, said she has 600 enrollees under her care out of which government caters for 400 while the remaining 200 are private enrollees.
“It has not been easy getting people out to come and enjoy this programme but the programme has given more people the opportunity to access care”, Desimola said.
“I also have a lot of pregnant women and children under five who registered free and they are being catered for by the state government.
“Also, many elderly ones are here. It is easier for them to access care here because their children can pay from wherever they are.
“I have a lot of hypertensive and diabetic patients. I have never had any reason to complain. There is nothing more disturbing than when you manage a patient that cannot afford the cost of treatment, as a doctor you cannot be happy. For that, I am very grateful for the opportunity to serve under the scheme. My patients are happy and I am happy”.
Speaking during the visit facilitated by United Nations Children’s Fund, UNICEF, and Oyo State Health Insurance Agency, the Executive Secretary of the agency, Dr Olusola Akande, said the scheme is targeting to capture 450,000 residents of the state with 2 percent of its consolidated fund from the state internal revenue.
According to him, under two years, the scheme has made remarkable achievements which include over 80,000 enrollees from 33 LGAs, 350 vaginal deliveries and 78 caesarian sessions, over 10,000 children under 5 years and pregnant women covered, creating employment opportunities for residents, upgrade of 3 fully upgraded OYSHIA accredited PHCs and 7 others at various stages of completion, as well as institutionalization of engagement platforms for various stakeholders.
Stating that 100,000 civil servants had been captured, Akande regretted that despite the success so far, there are still challenges such as beliefs, attitudes and customs of people on insurance policies, adverse selection, attitude of health-workers and enrollees, subsidy and cross-subsidy for the vulnerable groups and the poor, limited resources for advocacy, publicity and enlightenment, and inadequate and untrained manpower logistics.
He disclosed that even farmers and others who cannot afford to pay the N8, 000 are encouraged to pay with their farm produce to the agency in lieu of cash.
“Many people who would have loved to enrol in our health insurance programme but lack the financial capacity to pay the premium voluntarily agreed to give us yams and palm oil and other farm produce in lieu of cash to be paid for the premium”, he stated.
“In the agency, we have set up a marketing section that is helping us to sell the yams and palm oil and other farm produce and when we sell them, we help the owners to keep the money until it is enough to pay the premium and enrol them”.
Akande said the goal of health insurance was to provide quality healthcare services for the people of the state without experiencing catastrophic health expenditure.
He expressed worry that many people are still not aware of the activities of OYSHIA and sought the support of the media to propagate the importance of health insurance to the people so that more people would enrol.
“OYSHIA has been rated very high in terms of performance. We will not relent in making sure that the people of the state enjoy quality healthcare without expending their entire savings on medical bills,” he stated.
To him, it has become imperative for people to visit their doctors as occasion demands with the aim of determining their health status. According to him, health insurance remains protection against financial hazards, spreading of risks and pooling of risk to ensure that people remain healthy with a little financial resource.