The quest for universal health coverage appears to have gained momentum in Delta State within three years, OKUNGBOWA AIWERIE writes.
When on February 24, 2014, the landmark National Health Bill was passed on the floor of the red chambers at the NASS, incumbent Delta Governor, Dr Ifeanyi Okowa, then a serving senator, and chairman, senate committee on Health , was instrumental to the passage of that piece of legislation.
For Okowa, the quest for universal health coverage came full circle when early in his tenure as governor, on February 4, 2016, signed the Delta State Contributory Health Scheme into Law.
The scheme, a state supported health insurance program, was established to improve both physical and financial access for all residents of Delta State to quality and affordable healthcare services.
The insurance scheme operates three healthcare plans. They include the Formal Health Plan – which covers workers in the Public Service and the Organized Private Sector. The Equity Health Plan – which cover vulnerable people as described in the DSCHC Law and The Informal Health plan – covers all residents not captured in the aforementioned plans.
According to Delta Information Commissioner Charles Aniagwu, the scheme has enrolled 702,413 participants comprising Formal Health Plan-168,516, Informal Health Plan-11,187 and Equity Health Plan- 522,710.
He said premium contribution for enrolees on the formal plan is a percentage of salary for those working in organisations with a payroll system to cover the principal participant,spouse, and four biological children below 18 years.
While premium contribution for the Informal plan is N7000 per year to cover only an individual. Family registration attracts a discount.Those in trade unions will be enrolled under the identifiable taxation programme.
Also premium contribution on the Equity plan comprising pregnant women, children under 5 years, widows, aged and physically challenged will be paid from a pool comprising federal and state grants and contributions from philanthropists and international donors.
With over 350 accredited hospitals within 3 years of existence, social health insurance scheme appears to have gained traction in Delta State.
Its growth, notwithstanding, the scheme still grapples with sundry administrative issues and poor perception of the schemes’ benefits by enrolees.
For example, the directive to health providers by the scheme to use only generic drugs for treatment comes with a problem. Many enrolees misconstrue the drugs cheap, and of a less quality.
Many enrolees complain of illegal deductions of spouses on the scheme and failure to refund such deductions.
While enrolment figures for the formal plan, which houses public servants and organised private sector, is high, low enrolment figures have continued to plague the informal health plan.
Another vexed issue is alleged sale of drugs and payment for diagnostic tests covered in the schemes’ prescribed drug formulary and drug tariffs by patients at accredited hospitals.
Health providers have also been criticised for poor service delivery, some enrolees cite poor interpersonal skills on the part of care givers as a major disincentive.
For Mr Tony Efe, 57, a civil servant working at the Delta State Government House Library in Asaba admits that his family of six have benefitted from the health services provided by the scheme, but wants the scheme to pay his backlog of deductions since 2017.
Mr Efe, whose wife is also a civil servant, said following a series of complains, the insurance scheme stopped making deductions from his salary, but laments that his backlog has not been paid since 2017.
Efe said it was imperative to get his backlog paid because he was retiring soon.
His words: “The social insurance scheme is not a bad idea. I have recently benefitted when sometime last month I was admitted at St Luke’s Hospital in Asaba after my blood pressure rose uncontrollably. I only had to get to the hospital to get treatment. But I am unhappy that my backlog deductions since 2017 has not been paid. I am retiring soon what will be my fate? So I want my money paid so I do not lose it.”
Another civil servant, who pleaded anonymity, said the N2000 monthly deductions was not commensurate with the quality of treatment provided by accredited health provider.
According to her,” I was sick recently and went to the hospital. I was shocked to be given malaria drugs and sent away. I cannot understand how N2000 will be deducted from my salary monthly when I don’t fall sick regularly. I feel that my monthly payments is too much.”
While for Mrs Faith Okebunor, a junior worker on grade level 07 while narrating her experience accused the medical doctors at Okwe General Hospital, Oshimili South of intimidating patients.
According to her an argument broke out over allegations of illegal payment. She said no body defended her when the doctor on duty was rude to her and insisted she pays for drugs she was entitled to receive free.
Mrs Okebunor, whose retired husband regularly visits Okwe General Hospital under the scheme, noted that the idea of walking into a hospital without money in one’s pocket was good, adding that in many occasions her family has benefitted from the services of the insurance scheme.
To further deepen the schemes’ reach, Okowa, on November 2017 , approved the Access to Finance Framework initiative: a public/private partnership aimed at tackling the lack of quality health services at the primary healthcare level in the State.
The initiative supports the outsourcing of defunct healthcare facilities to the private sector to revitalise and provide services to the participants of the health insurance scheme, especially in rural areas.
In addition, through a matching fund arrangement between the Bank of Industry and the state government, the private sector haS access to loans with concessionary interest rates to renovate these facilities.
With agreements signed between the partners at a ceremony in Asaba for the 26 defunct health facilities, Board chairman, Dr Isaac Akpoveta said: “With this agreement, the private sector will take over the running of the centres, equip them to standard and ensure that they are operational 24 hours for our people who have enrolled in the contributory health insurance scheme.”
Akpoveta said the partnership ensures round the clock quality health care services across Delta for its Contributory Health Scheme, adding that it provides continuous services during industrial disputes while providing health service options for residents.
Akpoveta added: “The initiative is a pseudo private/public arrangement with funds from Delta government, Bank of Industry and PharmAccess, a Dutch NGO , also providing funds that is warehoused in BoI. We advertised for doctors willing to manage such hospitals built by NDDC, DESOPADEC and philanthropists in rural areas that had become moribund.”
He said healthcare providers shortlisted on the scheme could access N40 million loans at concessionary rates, stressing that only those willing to manage hospitals in rural areas qualify. His words: “Following an advertisement, shortlisted doctors, were allowed to do a needs assessment of the hospitals and make a list of equipment needed which PharmAccess certifies before a loan is given through BoI for basic care.”
He insisted the scheme is being sustainably administered and highlighted some of its revenue sources to include .5% of the state’s annual budget, 3.5% contributions from government and enrollees and investment of funds in liquid assets amongst others.
His words:” The State is funding the whole insurance scheme. Civil servants contribute 1.75% while government provides another 1.75% as counterpart funds making 3.5% of total remuneration which is given to us. The law of the commission mandates government to set aside .5% state revenue for health insurance. So as soon as the budget is determined, that amount is set aside.
According to him, “The system if properly administered is sustainable.90% of premium paid is for primary care while 70% is for secondary care and between 10-20% for tertiary care. Also 10% is allocated for administration; a certain percentage is set aside from administration’s fund monthly for buffer funds. We also our funds in semi liquid assets”.
He said fifteen hospitals are currently running such partnerships in Delta State, stressing that 11 more hospitals will ready soon but warned that only doctors that meet the commission’s stringent standard will get on the programme.
Responding to accusations of lapses in the scheme, Akpoveta enjoined enrolees to be conversant with the benefit package a booklet that contains the rights of a patient.
His words: “It is untrue that care given at accredited hospitals is not commensurate with deductions. You must be conversant with the provisions of the benefit package. It contains what we offer the enrolee for paying us some money. We provide primary, secondary and tertiary care. For primary care which includes malaria, typhoid, wounds, headache. If a patient walks into accredited hospitals in the state with the above ailments, he will be checked and treated. The scheme has paid “capitation” money in advance to the healthcare provider for such ailments. But if they find you have pain in your lower right abdomen and they suspect appendicitis, that is secondary care. The caregiver gets in touch with the scheme for approval. An approval is sent to them and the required surgery is done. For that type of care we pay “par diem” because not everyone will require surgery at the same time.
“If you take the basic social health scheme, there is a limit. There are ailments not covered by the plan. That is the reason we issued a booklet called benefit package to spell out your rights. It contains along with the drugs tariffs all diagnostic tests a patient is entitled to. If the drug you require is not in the drug formulary and tariffs, it can be sold to the patient. We have not proclaimed that all drugs and ailments can be provided by the scheme.”
On the issue of the use of generic drugs in accredited hospitals, he said the decision to use generic drugs was informed by the need to reduce cost of health bill, adding that the scheme pays only for the active ingredients in drugs.
According to him, “You can have a drug Azithromycin. It is a generic name, but that same drug produced by a big pharmaceuticals will typically be branded and be more expensive. Both are efficacious in the treatment of the particular disease but one is more expensive. This scheme is for the very indigent people. So it makes sound economic sense to insist on the use of generic drugs by caregivers.”
He lamented that 11,187 enrolment figures recorded on the informal health plan was poor, attributed it to socio- cultural attitudes of the people.
He said: “The informal plan can only grow gradually. This sector is very reluctant partly due to cultural attitudes. We are hopeful that it will grow. Rwanda is 98% insured, but it took them twenty years. We are just three years active. We have the reserve funds and political will to run the scheme.”
Although, the scheme has yet to activate the plan for physically challenged persons and the elderly, plans are currently being fine-tuned to accommodate these groups of Deltans.
Okowa assured that the contributory health insurance scheme will upscale to include other groups of Deltans.
Okowa said: “Consideration is also being given to some of the widows and as things improve we will scale it up to include the elderly and the physically challenged.
“That programme has done so well both in the state and nationally that we had become a model for some states.
“Other states are now coming to us as a state to know how we are running our contributory health insurance programme. “Delta has become the focal point of the study of the health insurance programme.”
