Expanding access to health insurance

The Delta State Contributory Health Commission (DSCHC), with support from United Nations Children Fund (UNICEF), has developed a draft position paper that highlights financial and programmatic steps towards expanding reforms in health insurance arrangements at the sub-national level in Nigeria and its multiplier effects on wellbeing of Nigerians.

DSCHC and UNICEF at a policy dialogue session, which was held in Delta, Asaba via Zoom, reviewed key recommendations in the draft position paper and explored additional areas for further considerations in the expansion of health insurance coverage at the sub-national level in Nigeria.

A Harvard-trained health insurance expert and Director General, DSCHC, Dr. Ben Nkechika, called on the public and government to financially capacitate healthcare facilities in the state and country. He also added that DSCHC has set up an online registration app for a seamless operation that includes Information Communication Technology (ICT) system. He spoke about the “Smart Agenda” that consisted of strategic wealth creation initiatives and the provision of jobs for all. He also explained the meaningful peace-building platforms aimed at political and social stability, agricultural reforms, industrialisation and transformation of the environment through massive urban and rural re-engineering.

Nkechika said Delta State Contributory Health Scheme (DSCHS) is the healthcare financing system established to ensure access to affordable and quality healthcare services for all residents of Delta State, irrespective of their socio-economic status and geographical location. He said the DSCHS is the main vehicle responsible for driving the aspiration of the Delta State Government towards the achievement of Universal Health Coverage (UHC) by the year 2030.

On the relationship with UNICEF, Nkechika explained: “Sequel to the DSCHC progress towards achieving UHC through expanding health insurance coverage for the vulnerable population, especially pregnant women and children under five years, UNICEF has established a partnership relationship with the DSCHC to enhance the Delta State Model as a template for Expanding Health Insurance Coverage at the Sub-National Level. Nigeria is estimated to be one of three countries, alongside India and the Democratic Republic of Congo, to experience the most significant increase in people under the poverty line due to COVID-19 and increases in a range of multi-dimensional deprivations, including food insecurity and malnutrition.

“As part of this collaborative effort between the DSCHC and UNICEF, a Position Paper on the Expanding Health Insurance Coverage in Nigeria was developed relating the Delta State Model to lessons from Rwanda, Philippines, Malaysia. Following the Position Paper was a review of the document at a Stakeholders Policy Dialogue session, which took place, last week, at the DSCHC office at Asaba.”

Chief Economic Advisor to the Delta State Governor Dr. Ifeanyi Okowa, Dr. Kingsley Emu, emphasised the consequences of a bad health sector on a country. He insisted that Primary Health Care (PHC) is the most accessible healthcare in Delta state. Emu called for strong private sector partnership because the government cannot do it alone. He encouraged religious leaders to be involved and invest in human capital development and that every single Nigerian must have access to PHC.

Founding partner, Health Systems Consult Limited, Dr. Nkata Chuku, who was present virtually, hammered on the need to properly market health insurance. “Not just telling people to insure their health, we need to look at health insurance as a product that can be sold,” he said.

Chukwu also spoke about how public financing should and could aid Delta State Contributory Health Commission.

Country Director, PharmAccess Foundation, Dr. Ndili Njide, also gave her contribution in the policy dialogue session on expanding health insurance coverage in Nigeria, saying the private sector is eagerly waiting to fill the gap of the public sector in health. She talked about the advocacy and documentation that can be shared to other states by Delta. Njide informed the audience that partners were waiting to partner with the private sector because it brings transparency and accountability.

Health insurance is an important mechanism to prevent financial hardship in the process of accessing health care. Since the launch of Nigeria’s National Health Insurance Scheme (NHIS) in 2005, only five per cent of Nigerians have health insurance and 70 per cent still finance their healthcare through Out-Of-Pocket (OOP) expenditure. Understanding the contextualised perspectives of stakeholders involved in NHIS is critical to advancing and implementing necessary reforms for expanding health insurance coverage at national and sub-national levels in Nigeria.

A recent study published in the journal, BMC Public Health, concluded: “Sub-national governments should create legal frameworks establishing compulsory health insurance schemes at the sub-national levels. Effective and efficient platforms to get the informal sector enrolled in the scheme are desirable. Community-Based Health Insurance (CBHI) schemes and the currently approved state-supported health insurance programmes may provide a more acceptable platform than NHIS, especially among the rural informal sector. These other two should be promoted. Awareness and education should also be raised to enlighten citizens. Stakeholders need to address these gaps as well as poverty.”

The study is titled “Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare and insurance providers.”