LASG to promote inclusive healthcare delivery as social health insurance take root in Lagos
Over the years, healthcare service delivery has always been paid for ‘out-of-pocket’ and this to a large extent depict the delay in our healthcare service delivery and lack of investment in the health sector.
However, in the recent past the discourse on mandatory health insurance has taken the lead in quality healthcare service delivery in Nigeria. Leading this discourse in a Public Private Partnership (PPP) initiative is PharmAccess Foundation, a non-governmental organisation that provides funding and capacity building for health base SMEs.
Recently, a 35-year-old married woman Morenikeji (real name withheld), found out she was pregnant; she was struck with a sudden pang of worry and fear. Pregnancy news was supposed to be the most exciting event for an expectant mother; however, she was filled with anxiety, thinking about the cost of managing her pregnancy.
Morenikeji was filled with anxiety because it was not her first pregnancy because complications from her previous two pregnancies, and a lack of access to quality healthcare had rendered the experience traumatic for her. Luckily for Morenikeji, she was introduced to the Lagos State Health Scheme (LSHS), which reduced her burden and anxiety.
The Lagos State Health Scheme (LSHS) is a state-wide health insurance scheme targeted to ensure that all residents of the State have access to quality, affordable health care services. The scheme covers treatment of common adult and childhood ailments, maternal and child services, preventive healthcare services, selected non-communicable diseases and surgeries.
In support of the LSHS, a proof of concept, supported by the PharmAccess Foundation, commenced on 25 September 2017. According to Njide Ndili, the country director of PharmAccess Foundation Nigeria, “the proof of concept which mirrored the Lagos State Health Insurance Scheme, was implemented to demonstrate how the scheme can improve the lives of vulnerable population at scale, using mobile phones and light technology”.
Prior to commencement of the scheme, field agents visited communities around the two selected hospitals (Igando General Hospital and Subol Hospital) to recruit eligible beneficiaries who were later enrolled into the pilot programme.
The Poverty Probability Index identification tool was administered to identify those eligible for the pilot programme. Morenikeji was found eligible, and was enrolled and covered by the LSHS benefit package which includes pregnancy, normal delivery, caesarean section and post-natal care at Igando General Hospital.
The pilot was administered using the CarePay ICT platform, a mobile solution for scheme administration which serves as a digital health exchange that connects the three important stakeholders in healthcare: Payers, healthcare providers and the users or beneficiaries. The platform can manage various types of healthcare payments and healthcare benefits from different programs, and present these payments and benefits to the beneficiaries on their mobile phone in a clear and user friendly way.
For each hospital visit, the treatment data is submitted electronically by the healthcare provider and after approval by a medical claims assessor, the funds are moved digitally to the healthcare provider.
Jide Idris, the commissioner for Health in Lagos State, stated recently that the CarePay platform “will guarantee ownership of all data generated and ensure that these data can be used to make informed decisions”. According to Idris, one of the objectives was to demonstrate how digital mobile solutions can be utilized to improve decision-making and transparency, reduce transaction costs, and increase access especially for poor households.
In collaboration with Lagos State Ministry of Health, PharmAccess implemented the proof of concept mirroring the LSHS benefit package, provider payment mechanisms and the interaction between patients and providers. The proof of concept has 153 families (659 enrolees) in two facilities (one private provider and one public provider) in Alimosho Local Government Area of Lagos State.
Having run for a period of twelve months, the pilot witnessed the 659 beneficiaries whose premium was paid for by PharmAccess Nigeria gaining access to free health care for the duration of the pilot.
“The results of this pilot show that the Scheme is doable and is a step in the right direction towards achieving Universal Health Coverage for the residents of Lagos State,” said Idris stating that Morenikeji that had a caesarean section in which she delivered a healthy boy, is one of the many success stories from the pilot test.
According to Peju Adenusi, the general manager of Lagos State Health Management Agency, the scheme is a mandatory pre-paid health plan for all residents. The LSHS aims to achieve universal coverage and provide financial protection against catastrophic health care spending. “A healthy population is a productive population,” said Adenusi.
SEYI JOHN SALAU