By Sola Ogundipe
Recently, a group of stakeholders from the National Institute for Policy and Strategic Studies, NIPSS, in collaboration with the Development Research and Project Centre (DRPC) through Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale) carried out a study tour of health facilities in Lagos State.
They had one agenda—to evolve a realistic and sustainable funding arrangement for Universal Healthcare Coverage.
They visited various institutions and had interaction with key stakeholders and heads of strategic institutions including the Lagos State University Teaching Hospital, LASUTH, and primary healthcare centres in Palmgrove, Mushin and Lagos Island.
Their mission was clear and justified. The Acting Director of Studies at the NIPSS, Dr. Nasirudeen Usman, who led the delegation remarked that the focus was on how Nigeria can evolve the best funding arrangement that can bring about universal healthcare coverage in the country.
It is an established fact that participants in NIPSS programmes are expected to embark on national, continental and intercontinental study tours on critical issues to the country’s development aspirations with a view to making actionable recommendations on best practices.
It is also no secret that Nigerians have not had it smoothly in healthcare delivery over the years particularly at the primary healthcare level even as the lack of a reliable referral system has only complicated matters.
Technical advisor, PACFaH@Scale, Dr. Stanley Ukpai, said the study tour was meant to help participants to find out how to strengthen the primary healthcare system to achieve Universal Health Coverage in the state. Through the tour, the delegation obtained useful feedback on challenges and opportunities within the primary healthcare system towards realising the goal of Universal Health Coverage for the State.
In the views of Dr. Jide Idris, technology would be the stronghold of the scheme to ease the application process for enrollees. Idris who was the State Commissioner for Health, during the launch of the Scheme in December 2018 by former Governor Akinwunmi Ambode, said a lot of awareness was being created about enrolling people into the scheme.
The law setting up the Lagos health Scheme makes it compulsory regardless of financial or educational status. Already, 120,000 persons have enrolled, however, full implementation would commence as soon as the bottlenecks are sorted out to avoid pitfalls of the National Health Insurance Scheme, NHIS.
The Lagos State health Scheme is one of a kind. To avoid the pitfalls of the NHIS, the Scheme is mandatory for every resident in accordance with global practice.
The Lagos health scheme aims to provide financial protection against illnesses and attendant uncertainties inherent in out-of-pocket payment system. Besides being projected to reduce health issues or mortality rate in the state by at least 10 per cent, Ambode said it will deliver significant economic benefits to the state.
“Beyond ensuring a healthy population, the scheme will foster inclusion and an increase in the utilisation of hospital services, thereby creating employment opportunities for medical professionals. This will definitely have an impact on the economy of the state,” Ambode stated.
The Scheme is specifically established to meet the gaps identified from existing health insurance Schemes in the country. The main pillars of accessibility, equity, quality and financial protection were taken into consideration when it was being put together.
The Scheme came about through a law enacted in 2015 that makes health insurance mandatory for every resident of the State.
The main objective was to provide quality healthcare services which is accessible and affordable to the residents of the State and in so doing, reduce, if not eliminate the financial catastrophe that arises from huge medical bills.
The Scheme covers common ailments that make people go to the hospital and that can actually cause financial burden.
Currently, what is being pushed forward is a single health benefit package plan that cuts across at a premium of N40,000 per annum for a family of six, that is, the mother, father and four children under the age of 18 years.
Enrolling every additional family member below 18 years attracts N6,000 per person per year. However, if the person is above 18 years, it attracts additional premium of N8,500 per person yearly. For single individuals, it is for N8, 500 per year, but this can be upgraded any time after marriage with additional charges.
For employees in the state public service, the state takes care of 75 per cent of the premium, while each civil servant pays 25 per cent.
Obioma Obikeze, a consultant for DRPC, expressed concern over the payment arrangement for civil servants, stressing that workers at the lowest rung of the ladder will be disadvantaged if every state employee, irrespective of status, pays 25 per cent premium.
“We are also meeting the key stakeholders in the informal sector, which constitutes about 65 percent of the population because if you don’t enroll these people, this Scheme will fail. We know the informal sector constitutes a huge chunk of the population, and that’s where the real work is.
“We have mapping which has details of everyone in the informal sector. Luckily, we have an agency of government dealing with them. We have met with the various union executives, and they have expressed interest. We also need to continuously reach out to them through persuasion. Some of them are already on one scheme or the other, but whether that scheme is better or not, it’s a matter of them knowing what we are offering,” Idris said.
And for the poor who genuinely may not be able to afford the premium, the state said an equity fund has been set aside to cater for them by subsidising the premium 100 percent for the vulnerable. “That is why the law establishing it says a minimum of one percent of the consolidated revenue fund of the state will go into a pool, which is an equity fund basically to address people who cannot afford to pay. That is to guarantee a financial protection for them. The contribution of the poor will be paid from that equity fund,” he explained.
According to the Provost, Lagos State University College of Medicine (LASUCOM), Prof Anthonia Ogbera, the Lagos State health scheme would take care of common adult and childhood ailments, maternal and child services, preventive healthcare services, selected non-communicable diseases and surgeries.
The Oba of Lagos, Oba Rilwan Akiolu, who was part of the delegation, urged government to improve budgetary allocation to the health sector in line with recommendations of the World Health Organisation (WHO).
Although the failure of the National health Insurance Scheme, NHIS, has been largely attributed to activities of Health Management Organisations, HMOs, Lagos State is still utilising their services in belief that they have vital role towards overall success of the Scheme.
In the views of the Chief Medical Director, Lagos State University Teaching Hospital LASUTH, Prof Adetokunbo Fabamwo, 10 HMOs are to be engaged, each assigned its catchment areas.
“Registration is state-wide and that is why we decided to allocate HMOs to certain areas for ease of capture. If an HMO is said to cover Mushin for example, they will go out there and capture all the citizens of the area into the scheme because the higher the enrollees, the higher their capitation fee.
“If you tell people in Mushin to look for any HMO and join, enrolment will be slow. For the formal sector, we gave them a choice of HMOs to choose, but for informal sector, we allocated HMOs to them so as to achieve 100 percent coverage,” he said.