Making health insurance functional
•How Delta adopted ICT integration to ramp up advocacies, enrollees, by Nkechika
Until now, despite efforts by the Federal Government through the National Health Insurance Scheme (NHIS), now National Health Insurance Authority (NHIA), it is estimated that only 10 per cent of Nigeria’s population of about 200 million (20 million people) have one kind of pre-paid health insurance or another.
In fact, a study, Nigeria Health Sector: Market Study Report, put the figures for health insurance penetration rate at about 5.1 per cent (10 million Nigerians.)
The study, published this month, was commissioned by the Embassy of the Kingdom of the Netherlands in Nigeria and put together by PharmAccess Foundation’s Nigeria Office (PAF).
The NHIS was launched in 2005 as a mechanism to engender universal health coverage (UHC) by helping to bridge the healthcare financing gap in Nigeria.
The NHIA (formerly NHIS) is the regulator for health insurance activities in Nigeria and the leading social health insurance agency at the national level. The body is a receiving channel/gateway for 50 per cent of Basic Health Care Provision Fund (BHCPF) through which it supports state health insurance schemes (SHIS) at the sub-national level across the country as per the provisions of the National Health Act.
The BHCPF was established under section 11 of the National Health Act (NHA 2004) as catalytic funding to improve access to primary health care (PHC).
TO address the issue of weak demand and enrollment as well as other challenges, health insurance in Nigeria is now mandatory through the provisions of the NHIA, unlike the former NHIS. Also, NHIA and several experts including the World Health Organisation (WHO) recommend the integration of Information Communication Technology (ICT) into social health insurance programmes to ramp up advocacies and enrollments.
According to a recent publication, “Nigeria Health Sector: Market Study Report”, the NHIA is currently working on promoting the ICT integration of its processes towards maximising efficiency and enabling innovation to advance its strategic goals.
The report noted that NHIA plans to deploy ICT infrastructure that meet established standards including data security, integration, and interoperability in 70 per cent of NHIA Zones and States, SSHIAs, accredited Health Maintenance Organisations (HMOs) and Providers (health facilities).
Interestingly, the Delta State Contributory Health Commission (DSCHC) through its social health insurance, the Delta State Contributory Health Scheme (DSCHS), had, in 2020 adopted the model. According to latest figures from DSCHC, as at January 31, 2023, it had total enrollees of 1,283,618. A breakdown showed that 1,101,735 persons are on Equity Health Plan; 162,648 people on Formal Health Plan; and 19,235 persons on Informal Health Plan.
Indeed, the Governor of Delta State, Dr. Ifeanyi Okowa, has made significant achievement in the area of healthcare, especially with the setting up and operation of one of the most vibrant health Insurance programme in Nigeria with corresponding healthcare infrastructure and human resource advancement.
A statement by DSCHC, signed by its Director General and Chief Executive Officer (CEO), Dr. Ben Nkechika, noted: “Total number of residents of Delta State covered under the scheme and the demographic and socioeconomic structure of the enrollees as well as overall percent coverage, to date. As at December 31, 2022, the total Number of Delta State residents that have registered under the DSCHS are 1,283,618 (about 23.5 per cent population coverage), comprising of: Equity Health Plan (pregnant women, children under five and elderly) – 1,101,735; Formal Health Plan (principal enrollees and dependents) – 162,648; and Informal Health Plan (artisans, market women, students etc.)- 19,235.”
Nkechika said DSCHC has provided over three million service encounters to health insurance patients from January 1, 2017 to December 31, 2022, and the total number of accredited public and private hospitals/health centres participating in the scheme is 510.
The Delta State Actuarial Analysis report provides for a Premium of N17,000/person/year.
However, considering the Baseline Assessment Survey report on low capacity and high willingness to pay for health insurance premium, the Delta State Government currently subsidises health insurance premium by N10,000/person/year for the poor informal sector enrollees and pregnant women, children under five and elderly above 65 years who either pay only N7,000/person or get the health insurance service free.
It noted: “Premium for the Informal Health Plan is N7,000/person/year out of the N17,000/person/year. The Delta State Government on behalf of each Informal Health Plan enrollee pays the remaining N10,000/person/year).
“Premium for the Formal Health Plan- 1.75 per cent contribution from the gross salary of the employee and a counterpart 1.75 per cent contribution from the employer. The Delta State Government pays for half of the premium for all government workers in Delta State while the remaining half is contributed from the workers salary for health insurance premium.
“Premium for Equity Health Plan of 7,000/person/year is paid by the Delta State Government for all pregnant women, children under five years and elderly above 65 years that comes to a DSCHC accredited healthcare facility for service.”
Other service delivery innovations adopted by DSCHC in increase demand and number of enrollees include the “Access to Finance” (A2F) Programme, which is a Healthcare Financing (HCF) Public Private Partnership (PPP) programme in which a partnership between the PharmAccess Foundation, Bank of Industry and the DSCHC provides single digit healthcare financing facility to enable Private Healthcare Providers (PHPs) reactivate and revitalise abandoned government healthcare facilities in remote and hard-to-reach communities to ensure no one is left behind in access to healthcare service delivery.
There is also “Access to Healthcare Facility Service” (A2HFS) Programme in which people residing in hard-to-reach riverine communities and do not have any healthcare facility close by, are provided scheduled transportation support to enable them access the nearest accredited HCF when they need care. Over 4,500 residents of hard-to-reach riverine communities with no access to healthcare facilities have been provided access to the nearest accredited HCF under this programme.
Nkechika said DSCHC has established an “Indigent Support Programme” (ISP) in which through advocacy and sensitisation, corporate organisations, philanthropist and other notable Nigerians are encouraged and recognised to make contributions to a healthcare fund which is then used to pay and support indigent residents of Delta State.
He said there is also “Identifiable Group Taxation” (IGT) Programme in which identifiable artisan groups who make daily contributions for their artisan trade taxation example Okada/Kekenapep riders, market men and women, artisan associations etc., are provided free health insurance service as an incentive.
Nkechika who is also a Harvard-trained health economist, said the daily trade contribution paid by each member of the identifiable group becomes a part of his or her health insurance premium and thus they will not have to pay any further money to receive health Insurance service under the DSCHS.
He said the “Birth Registration and Certification” programme in partnership with the Nigeria Population Commission (NPC), United Nations Children Emergency Fund (UNICEF) and the DSCHC in which all children below five years and pregnant women in Delta State are provided free health insurance when they register for the DSCHS and obtain an NPC Birth Certificate.
He said the bodies, would, from next week, ensure children born in the state’s healthcare facilities (HCFs) benefit from free Medicare under the DSCHS Equity Health Plan/ Basic Health Care Provision Fund (BHCPF) programme and receive NPC-approved birth certificates.
In the first phase of the programme, over 134 residents of inaccessible communities were ferried to access healthcare services at Oporoza Pololubo, Ode Itsekiri, Awanba, Ogbudugbudu, Ogbinbiri and Sandfill healthcare facilities.
DSCHC said the activities has been phased and would go round all in deference to the “Access to Healthcare Services” initiative across the oil-rich state.
It noted: “The expected outcome is to ensure every newborn in Delta State that will benefit from the DSCHS programme receives a certified NPC berth certificate. The DSCHC registration platform ensures that all required registration field complies with NPC standards.
“The process is to update and validate registration records of all children, who have received service under the DSCHC and issue them a certified NPC birth and DSCHS service certificates.
“Second, to mandate all DSCHC field agents attached to all DSCHC accredited HCFs to ensure registration of all newborns with the DSCHC NPC compliant registration portal and issue them a certified NPC birth certificate and a DSCHS ID card under the Equity Health Plan/BHCPF programme.
“The NPC and DSCHC will have a system for data integration that ensures data safety.
“The NPC, UNICEF and DSCHC shall each nominate two people to form a six-people team that will be responsible for Monitoring and Evaluation (M&E) and report to their supervisors.”
Nkechika the DSCHS has created innovative models of public private partnership and healthcare financing inventions.
He said there is healthcare financing partnership with the Bank of Industry for Small and Medium Enterprise (SME) Healthcare Financing to revitalise defunct Primary Healthcare (PHC) service facilities in Delta State under the Access to Finance Programme – an innovative healthcare-financing framework in partnership with PharmAccess Foundation and Bank of Industry.
Nkechika said DSCHC has partnership with Servier Pharmaceuticals for access to quality and affordable hypertension and diabetes management drugs procured at discounted prices and provided to enrollees of the Scheme when they need such medication free as part of coverage under the DSCHS.
He said there have been landmark improvements of the ranking of the State in healthcare coverage, health service delivery, and health sector performance, attributable to the contributory health scheme through ICT.
The health economist said all DSCHC accredited Primary and Secondary Healthcare Facilities are fully ICT enabled and compliant for its entire service delivery processes from electronic medical records to electronic clinical service process, electronic claims management processing, electronic provider payment process and electronic analytics and reporting.
He said the DSCHC administration operates through an electronic Enterprise Resource Planning (ERP) software with dedicated Server system under an ICT architecture infrastructure and that all DSCHC accredited HCFs are solar powered for it service operations.
Nkechika said the DSCHC service operations has been listed and designated as compliant with the National Data Protection Regulations (NDPR) requirement of the National Information Technology Development Agency (NITDA) and has successfully passed its yearly NDPR audits.
He said the DSCHS benefit package has been recognised as a standardised health insurance benefit package and adopted as the national minimum benefit health package in Nigeria under the BHCPF.
The Nkechika said the DSCHC has won international and national awards/recognition won from inception to date, including: an award for being the State with the Most People covered under a State Health Insurance Scheme with focus on the poor and vulnerable population (2018) presented by the World Bank/SOML Programme; an award of the Outstanding State Government Healthcare Programme of the Year 2017 presented by the Nigerian Healthcare Excellence Award; recognition and a Presentation at one the Side Meetings of the 2022 World Health Assembly in Geneva Switzerland; and an award for Outstanding Service Delivery by the Government of the Netherlands.
“Senator Dr. Ifeanyi Okowa has shown great capacity with profound experience in the healthcare service delivery processes and will expand this capacity and experience across the country as a Vice President,” Nkechika said.