•How Delta adopted ICT integration to improve advocacy, enrollees, by Nkechika
Until now, despite efforts by the Federal Government through the National Health Insurance Scheme (NHIS), now the National Health Insurance Authority (NHIA), only about 10 percent of the Nigerian population of about 200 million (20 million people) have one. pre-paid or other types of health insurance.
In fact, the study, Nigeria Health Sector: Market Study Report, puts the figure for the health insurance penetration rate at 5.1 percent (10 million Nigerians.)
The study, published this month, was commissioned by the Royal Netherlands Embassy in Nigeria and coordinated by the Nigerian Office (PAF) of the PharmAccess Foundation.
The NHIS was launched in 2005 as a mechanism to achieve universal health coverage (UHC) by helping to address the health financing gap in Nigeria.
NHIA (formerly NHIS) is the regulator for health insurance activities in Nigeria and the leading social health insurance agency at the national level. The agency is the receiving channel/gateway for 50 percent of the Basic Health Care Provision Fund (BHCPF) which supports the state health insurance scheme (SHIS) at the sub-national level across the country under the provisions of the National Health Act. .
The BHCPF was established under section 11 of the National Health Act (NHA 2004) as a catalytic fund to improve access to primary health care (PHC).
To overcome the problem of weak demand and enrollment as well as other challenges, health insurance in Nigeria is now compulsory through the provisions of the NHIA, unlike the former NHIS. Also, NHIA and some experts including the World Health Organization (WHO) recommend the integration of Information Communication Technology (ICT) into social health insurance programs to increase advocacy and enrollment.
According to a recent publication, “Nigerian Health Sector: Market Study Report”, NHIA is currently working on ICT integration of processes to optimize efficiency and allow innovation to advance strategic goals.
The report notes that NHIA plans to deploy ICT infrastructure that meets established standards including data security, integration, and interoperability in 70 percent of NHIA Zones and States, SSHIA, accredited Health Care Organizations (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), has, in 2020 adopted the model. According to the latest figures from DSCHC, as of January 31, 2023, the total number of enrollees is 1,283,618. A breakdown shows that 1,101,735 people are in the Equity Health Plan; 162,648 people in Formal Health Plans; and 19,235 people in the Informal Health Plan.
Indeed, the Governor of Delta State, Dr. Ifeanyi Okowa, has made significant achievements in the field of health, especially by setting up and operating one of the most viable health Insurance programs in Nigeria with appropriate health infrastructure and human resource development.
The DSCHC statement, signed by the Director General and Chief Executive Officer (CEO), Dr. Ben Nkechika, noted: “The total number of Delta State residents covered under the scheme and the demographic and socio-economic structure of the enrollees as well as the overall percentage coverage, for the date. As of December 31, 2022, the total number of Delta State residents who have enrolled in DSCHS is 1,283,618 (about 23.5 percent of population coverage), including: Equity Health Plan (pregnant women, children under five and the elderly) – 1,101,735; Formal Health Plan (main enrollee and dependents) – 162,648; and Health Plan Informal (artisans, market women, students, etc.)- 19,235.
Nkechika said DSCHC has provided more than three million service encounters for health insurance patients from January 1, 2017 to December 31, 2022, and the total number of accredited public and private hospitals/health centers participating in the scheme is 510.
Delta State Actuarial Analysis Report provides for a Premium of N17,000/person/year.
However, considering the Baseline Assessment Survey report of low capacity and high willingness to pay health insurance premiums, the Delta State Government is now subsidizing health insurance premiums at N10,000/person/year for poor informal sector enrollees and pregnant women, children below. five and the elderly above 65 years who only pay N7,000/person or get free health insurance services.
It noted: “The premium for the Informal Health Plan is N7,000/person/year from 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 Formal Health Plan- 1.75 percent contribution from the employee’s gross salary and partners 1.75 percent contribution from the employer. The Delta State Government pays half of the premium for all government workers in Delta State, while the other half is contributed from the employee’s salary for the premium health insurance.
“Premium for Equity Health Plan 7,000/person/year is paid by the Delta State Government for all pregnant women, children under five years and elderly people above 65 years who come to DSCHC accredited health facilities for services.”
Other service delivery innovations adopted by DSCHC to increase the demand and number of enrollees include the Program “Access to Finance” (A2F), which is a Health Financing Program (HCF) Public Private Partnership (PPP) where the partnership between PharmAccess Foundation, Bank of Industry and DSCHC provide a single digit health financing facility to enable Private Health Care Providers (PHPs) to reactivate and revitalize abandoned government health facilities in remote and hard-to-reach communities to ensure no one is left behind in access to health service delivery.
There is also the “Access to Health Facility Services” Program (A2HFS) where people living in hard-to-reach river communities who do not have nearby health facilities are provided with scheduled transportation support to access the nearest accredited HCF. they require care. More than 4,500 residents in hard-to-reach river communities without access to health facilities have been provided access to the nearest accredited HCF under this program.
Nkechika said that DSCHC has established an “Indigent Support Program” (ISP) through advocacy and sensitization, corporate organizations, philanthropists and other prominent Nigerians are encouraged and recognized to donate to the health fund which is then used to pay and support the poor. from Delta State.
He said that there is also an “Identifiable Group Taxation” (IGT) Program where an identifiable group of artists who contribute daily to the artisan trade tax, for example, Okada/Kekenapep riders, market men and women, artisan associations, etc. In addition, free health insurance services are provided. as an incentive.
Nkechika who is also a Harvard-trained health economist, said that the daily trade contribution paid by each identifiable group member forms part of the health insurance premium and therefore they do not have to pay any more money to receive health Insurance services. according to DSHS.
He said the “Birth Registration and Certification” program in partnership with the Nigerian Population Commission (NPC), the United Nations Children’s Emergency Fund (UNICEF) and DSCHC where all children under five and pregnant women in Delta State are provided with insurance free healthcare. when registering for DSCHS and obtaining the NPC Birth Certificate.
He said that the agency will, from next week, ensure that children born in public health facilities (HCFs) benefit from free Medicare under the DSCHS Equity Health Plan / Basic Health Care Provision Fund (BHCPF) program and receive an approved birth certificate NPC.
In the first phase of the programme, more than 134 residents of inaccessible communities were transported to access health services in Oporoza Pololubo, Ode Itsekiri, Awanba, Ogbudugbudu, Ogbinbiri and Sandfill health facilities.
The DSCHC said that the activity has been phased and will be carried out in compliance with the “Access to Health Services” initiative in the oil-rich country.
It was noted: “The desired result is to ensure that every baby in Delta State who will benefit from the DSCHS program receives a certified NPC birth certificate. The DSCHC registration platform ensures that all the required registration fields comply with the NPC standards.
“This process is to update and validate the registration records of all children, who have received services at DSCHC and issue NPC birth certificates and DSCHS service certificates.
“Secondly, to order all DSCHC field agents present in all DSCHC accredited HCFs to ensure the registration of all new babies with the registration portal corresponding to DSCHC NPC and to issue certified NPC birth certificates and DSCHS ID cards under the Equity Health Plan/BHCPF program.
“NPC and DSCHC will have a data integration system that ensures data security.
“NPC, UNICEF and DSCHC should each nominate two people to form a six-person team that will be responsible for Monitoring and Evaluation (M&E) and reporting to their supervisors.”
Nkechika DSCHS has created an innovative model of public private partnership and the discovery of health financing.
He said there is a health financing partnership with the Bank of Industry for Small and Medium Enterprise (SME) Healthcare Financing to revive the dying Primary Healthcare (PHC) service facilities in Delta State under the Access to Finance Program – an innovative health financing framework with partnership. with PharmAccess Foundation and Bank of Industry.
Nkechika said that DSCHC has a partnership with Servier Pharmaceuticals to access quality and affordable hypertension and diabetes drugs which are sold at discounted prices and provided to the participants of the Scheme when they need the drugs free of charge as part of coverage at DSCHS.
He said that there has been an improvement in the country’s ranking in health coverage, health service delivery, and health sector performance, due to contribution health schemes through ICT.
The health economist said that all DSCHC-accredited Primary and Secondary Health Facilities are ICT enabled and compliant for all service delivery processes from electronic medical records to electronic clinical service processes, electronic claims management processes, electronic provider payment processes and electronic analytics and reports.
He said that the DSCHC administration operates electronic Enterprise Resource Planning (ERP) software with a dedicated Server system in the ICT architecture infrastructure and all DSCHC accredited HCFs are solar powered for the operation of the service.
Nkechika said DSCHC service operations have been registered and designated as compliant with the National Data Protection Regulation (NDPR) requirements of the National Information Technology Development Agency (NITDA) and have successfully passed the NDPR audit every year.
He said the DSCHS benefit package has been recognized as the standard health insurance benefit package and adopted as the national minimum benefit health package in Nigeria under the BHCPF.
Nkechika said DSCHC has won international and national awards/recognitions won since its inception to date, including: the award as the State with the most coverage under the National Health Insurance Scheme with a focus on the poor and vulnerable population (2018). by the World Bank/SOML Program; the Outstanding State Government Health Program of the Year 2017 award presented by the Nigerian Healthcare Excellence Awards; recognition and Presentation at one of the Side Meetings of the World Health Assembly 2022 in Geneva Switzerland; and an award for Outstanding Service Delivery by the Dutch Government.
“Senator Dr. Ifeanyi Okowa has demonstrated great capacity with deep experience in the health service delivery process and will expand this capacity and experience across the country as Vice President,” Nkechika said.