Delta Health Insurance as Model for Nigeria

While it is taking ‘forever’ for the Nigerian government and most of the states, including its richest – Lagos, Kano and Rivers – to produce seamless health insurance schemes for their people, there appears to be a glimmer of hope in Delta with its consistent increase in universal health coverage to residents. Martins Ifijeh writes

16 years after the Nigerian government launched its flagship universal health programme, the National Health Insurance Scheme (NHIS), the country is still grappling with selling the idea to its 215 million citizens, resulting in the abysmally low number of persons it has so far enrolled into health coverage.

For clarity, the number of its enrollees have been on the decline since 10 years ago when it reached its peak of 5.6 million Nigerians. Some stakeholders believed as at today, not up to two million Nigerians are currently enrolled into the scheme across the nation; a figure that suggests that only about one percent of the entire population are under the federal government’s health insurance coverage.

As a form of salvage, some states have at different times, established their own health insurance programmes. Although most states have not established any, majority of those who have launched theirs, are unfortunately battling with workable models that would ensure their residents benefit from health coverage under an insurance arrangement.

A study published in The Lancet, a medical journal, noted that more than 90 per cent of the Nigerian population do not have health insurance; meaning they pay out of pocket for their healthcare irrespective of whether they can afford it or not. The World Health Organisation (WHO) had said all countries should have Universal Health Coverage (UHC) by 2030.

According to reports, only a little over 10 million Nigerians are benefitting from health insurance either through NHIS, state governments or private organisations. However, within this figure, not less than 1,019,461 are under the Delta State Contributory Health Scheme (DSCHC) alone, while the remaining nine million are scattered across NHIS, states and private organisations. Of the over one million beneficiaries from Delta, 832,964 persons are Equity Health enrollees, 172,418 are Formal Health Plan enrollees, while 14,079 are Informal Health Plan enrollees. It is believed that beyond the enrollments, the state has moved past planning and consolidation phase of health insurance, and now on continuity phase of health insurance provision.

It is in ensuring that the Delta model is sustained, copied and implemented across the country that the DSCHC and the United Nations Children’s Fund (UNICEF), in a policy dialogue session held in Delta State recently, came up with a draft that highlights financial and programmatic steps towards extending reforms in health insurance arrangements at the sub-national level and its multiplier effects on wellbeing of Nigerians.

Speaking during the policy dialogue, the Director General, DSCHC, Dr. Ben Nkechika believes the state has made progress in health insurance because it developed a strategy that was bringing better outcomes, adding that political will from Governor Ifeanyi Okowa played.

He said DSCHC strategically engaged with all sectors, including formal, Informal, among others.

“For instance, we engaged labour at the conceptualisation stage of the scheme. Several meetings were held with their leaders and at one such meeting; we got to know of their interest and ensured it was accommodated in our planning processes. Thus, labour got involved in our planning and made valuable input and when we were ready to start, resistance was low. The only resistance we got was their fear for quality of healthcare service delivery from government hospitals, which we overcame by enlisting their choice private hospitals into the scheme and enhancement of government hospital service delivery capacity. In view of that, UNICEF has taken interest in the achievements of the commission, done a research review on it, and most of our service delivery processes are comparable to safe delivery processes of other notable countries that have achieved universal health coverage. So, with that mindset, we know what has happened in Rwanda, Malaysia, the Philippines and other countries that have achieved universal health coverage,” he said.

Nkechika, who is a Harvard University trained health financing expert, said the state was continuously engaging the informal sector groups through their trade unions, cooperative societies, town unions, and premium payment incentives. Adding that “lack of trust in service delivery from the local healthcare facilities and the assumed narrative that paying upfront for healthcare equates to wanting healthcare challenges, has been found to be among the reasons for informal sector unwillingness to pay for health insurance. We are tackling this by the day.

Nkechika said one of the strategy was that the programme was not only mandatory, but that it came with incentives and sanctions for non-compliance as well. “We also ensure we earmark public funds to pay premium for those unable to pay and a commensurate revitalisation of quality primary healthcare service across the board.”

He noted the workable systems and processes were what prompted the UNICEF to collaborate with it, adding that other nations, including Rwanda have at some point visited the state to share knowledge.

“UNICEF has seen that Delta State is on a good pathway and a good trajectory towards achieving universal health coverage by the year 2030. So, with that we came up with a position paper. UNICEF felt that before they take on the position paper as a model for expanding versatile universal health coverage in Nigeria that it was good they bring in expert policy makers, private sector, service providers under one roof to review, critique and analyse it,” he added.

The 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, noting that Primary Health Care (PHC) was the most accessible healthcare in Delta State.

Emu called for a strong private sector partnership, noting that 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 Chukwu, who was present virtually, said it was time states, as well as the federal government look at health insurance that can be sold to the people.