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Accelerating progress towards UHC in Nigeria – the example of Delta State [Blog]

For reasons ranging from lack of funds and conflicting needs to long wait times and complicated registration processes, the average Nigerian prefers to self-medicate or go to the neighborhood pharmacy or pharmacy when does not feel well, rather than see a doctor.

Very few Nigerians can afford the services of private hospitals, let alone have health insurance. This means that when medical emergencies arise, they end up paying out of pocket. Available data showed that in 2016, direct health expenditure in Nigeria represented up to 7.7 billion naira. These factors can have a negative impact on the health-seeking behaviors of the population, especially women and children.

According to world BankUniversal Health Coverage (UHC) aims to ensure that all individuals and communities have access to the health care they need without suffering financial hardship. One of the targets of Sustainable Development Goal (SDG) three (3.8) aims to “achieve universal health coverage, including protection against financial risks, access to quality essential health services and ‘access to safe, effective, quality and affordable essential medicines and vaccines for all. ”In addition, SDG1, aimed at“ ending poverty in all its forms everywhere ”, could be at risk without UHC, because nearly 90 million people are impoverished by health spending each year. Nigeria, the urgency to achieve universal health coverage is even more pronounced with 76.6% of the country’s health expenditure coming from out-of-pocket expenses. It is in a country where nearly 83 million people live below the poverty line, which means that much of that health spending ends up pushing Nigerians deeper into poverty.

The National Health Insurance Scheme (NHIS) in Nigeria was established in May 1999, with the vision of “achieving financial access to quality health care for all Nigerians”. In part, the law states that the purpose of the scheme is “… to provide health insurance, which gives insured persons and their dependents the right to receive good quality and cost-effective prescribed health services. cost-effective … ”The NHIS was created as a tool to achieve UHC, but so far only 5% of the population (mostly in the formal sector) has been enrolled since its inception. Currently in the process of being repealed and reconstituted to be renamed National health insurance agency, the NHIA bill awaiting presidential approval focuses more on regulation as well as improving funding for vulnerable groups. To accelerate the achievement of UHC, the National Health Act of 2014 provided legislative support for states to establish their own contributory health insurance plans. From january 2020, 34 states and the CTF have signed social health insurance plans, with states such as Delta, Kaduna, Kano, Tray, Lagos, Oyo, Yobe, etc. are making significant progress in enlisting lives.

The Delta State Contributory Health Plan

The Delta State Contributory Health Scheme was established in 2017 to provide quality, affordable health care to all residents of the Delta State. The scheme is managed by the Delta State Health Contributory Commission (DSCHC).

The program has registered more than one million lives since its inception. The enrolled pay an annual premium applicable to the plan they choose, allowing them access to quality health care in approved institutions under the scheme at no extra cost.

The program offers four plans designed to meet the needs of all residents of Delta State, regardless of their social or financial status. The plan for the formal sector is for officers and employees of the organized private sector; for the plan is for individuals in the informal sector, such as artisans, merchants and laborers, registrants pay a flat rate 7,000 NGN per person each year; as part of the equity plan, the state government pays the premium for vulnerable citizens such as pregnant women and children under 5; and to subscribe to the Private package, subscribers pay a small supplement to take advantage of more services.

Comrade Bolu Martin, Director of Administration and Human Resources of the DSCHC, gave an overview of the internal functioning of the system and the progress it has made so far. “The program is designed to improve the health system and to build the capacity of health facilities so that people can get quality care. Hospitals are paid in two ways, one of which is what we call capitation. Each month, a stipulated amount of money is given to hospitals, whether patients come or not. This means that there are always funds available to the hospital when the need for treatment arises. Health facilities can also use funds from this reserve to improve their facilities. “

The program’s equity plan plays a major role in increasing positive maternal and child health outcomes, one of the program’s goals. People who fall into this category are pregnant women, children under 5, men and women over 65, and people with physical or mental disabilities. The program built on the state’s existing free maternity and under-5 program to achieve this. The state government ensures the sustainability of the equity plan through investment partnerships with the Bank of Industry (BOI) and set aside a percentage of the budget to fund the plan with contributions from donor agencies.

What are the factors responsible for these encouraging figures?

Delta State has enrolled around one million of its more than 5 million citizens, or about 17% of its citizens. Obasa Lilian Chineyeye, health maintenance organization (HMO) Coordinator for Good Christian medical center, Asaba, reflecting on the impact of the program, said the number of enrollees who chose Good Christian medical center because their main installation went from 5 in 2017 to 3,644 in 2021.

One of the factors responsible for the increased enrollment of people of Delta State is advocacy and commitment continuing the community. The meeting DSCHC municipal unions, alumni and stakeholders in the community, and the political groups to raise awareness of the benefits of enrolling in the program. The testimonies of the beneficiaries are another powerful tool for membership. Sir Tony izuka, an official, was reluctant to enroll because he feared the health facility was substandard. He was pleasantly surprised to find that this was not the case, as he received excellent care. Mr. Izuka now encourages other officials to join the public health insurance scheme. The process of registering, claiming, paying and reporting is handled by artificial intelligence (AI), which has made the user interface easier and removed the element of human error. The registration process is end-to-end encrypted to ensure the confidentiality of registrant data. The scheme was named a “contributory health scheme” with the term “insurance” removed, to overcome the bias associated with insurance schemes in the region.

To ensure effective coordination, the Director General of the Commission, Dr Ben Nkechika, has established several teams, including Technical Compliance, Process Monitoring and Technical Integration teams to oversee the process and correct the course over time. gradually. These teams are all locally staffed and the program is run without development aid or support, which further promotes ownership.

Clinton Ekaeze, technical assistant to the Commission DG underlined that access to funding programs has enabled health establishments to be fully operational 24/7 in neighboring communities, where this was not possible. possible before. Mr. Ekaeze also noted that partnerships with pharmaceutical companies have facilitated access to quality medicines. Ekaeze and Martin both agree that developing tailor-made solutions to solve unique condition problems, rather than simply copying what others have done, has greatly contributed to the program’s nascent success.

The impact of the DSCHC underlines the essential role of public-private partnerships (PPP) in the delivery of health care. A good example of the PPP landscape in Delta State is the Medical credit fund made possible in part by the contribution of partners including PharmAccess, a technical advisor who helped increase access to funding programs, supported by Bank of Industry.

What needs to work?

While guaranteeing access to quality health care is one of the main objectives of the Scheme, it has been a constant struggle to achieve it, as the actual functioning of health establishments is not completely under the influence of the government. Diet. For example, according to Dr. Owuigho Oghene, the strike actions of health personnel prevent beneficiaries from accessing quality health services 24/7, despite the payment of capitations to health facilities. According to comrade Bulu Martin, there were also cases where beneficiaries had to pay for certain services such as blood transfusion even though the insurance premium covered them, due to the duplicity of the agents of the health establishments.

Collaboration and cooperation between health workers and health facilities remains a challenge that must be met in order to make full progress towards universal health coverage. In addition, key DSCHC stakeholders report that although some progress has been made in registering the informal sector, it has not happened as quickly as needed to ensure that more residents have access to quality and affordable health care.

While the road traveled so far has not been without challenges, DSCHC is proud of the progress of the program so far and is ready to do even more. According to Dr Ben Nkechika, the state is looking to achieve an additional 20% coverage over the next four years.

Of the 34 states that have passed health insurance laws, different levels of progress have been observed in progress towards universal health coverage. As we mark World UHC Day in a few days, we encourage states to continue to collaborate and learn from each other to improve access to care.