Rock Amegor, director general, Edo State Health Insurance Commission, in this interview with Churchill Okoro, speaks on the ongoing enrolment of residents into the health insurance scheme, and how the commission is addressing the burden of out-of-pocket health expenditures.
What prompted the state’s health insurance scheme?
The Edo State Health Insurance Commission provides a health benefit package for residents of Edo State through the state’s health insurance scheme. We realised that out-of-pocket spending was almost getting to 85-90 per cent, and was pushing more people into poverty.
So, in light of this and keeping unemployment ratio at the back of our mind, we came up with the health insurance scheme to close some of the social gaps which can reduce criminalities in the society and improve livelihood of our people.
We thought of ways to get over the challenges of healthcare expenses, and the only way is for everybody to contribute their little quota into a pot that will strengthen the health system and reduce catastrophe in the society.
At the moment, no person has started receiving care from the health insurance scheme because we are still in the preliminary phase. For now, it is a pilot study. We have started with three Local Government Areas, and we will extend to the other 15 LGAs. So, what we are doing is that we are enrolling people into the scheme and allocating them to various health care facilities where they will start receiving care in about 60days. We have a moratorium of 60days from enrolment before the time they start seeking care. The period is to allocate people to a facility and then advice against adverse selection if there is any, and come to a middle ground to know what services to offer, especially those with chronic diseases. We will also use the period to give them health education and also let the beneficiaries know what we are doing in the scheme. What we are doing in our health space is that we allocate facilities to people based on the proximity to their houses or workplaces.
Many countries have been successful with health insurance because there is political will. What we need to do on our end is to maintain our integrity and make sure we continue to improve our processes so that this health insurance will become far-reaching and widespread such that other society will see Edo state as a beacon of light, bringing healthcare to the residents of Edo State. We want everybody to contribute something minimal and insignificant to their pockets, and in turn bring out big outcome to the society.
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When did the scheme commence?
The health insurance scheme was assented by the Edo State House of Assembly in March 2019, and I was appointed the Director General in August 2019. We immediately started sensitisation because we knew that there was a knowledge gap as regards health insurance. And so we started going to schools, religious organizations, village heads among others, to enlighten them on the relevance and benefits of the scheme.
Basically, when we started, we did a learning tour; we went to about six states in the country, we also travelled to some African countries, including Rwanda and Kenya. Today, Kenya has the best insurance in Africa with about 88 per cent coverage, and so we brought the knowledge to our people here. In doing that, we stratified the society into five groups. If you look at the stratification based on our health benefits package, you can tell that it is all-inclusive, which means that everybody in the society irrespective of your gender, age, level of income or even geographical location will be able to benefit from the health insurance scheme that the federal and state government have put together.
Can you give a detailed description of what the scheme entails?
It is mandatory that everybody belong to the health insurance scheme, the law states that you are either in the National Health Insurance Scheme or the Edo State health Insurance Scheme. So, those who have private health insurance scheme will have to come to us to strike a balance on what services we can offer them.
The beneficiaries are those poor people, formal sector, informal sector and students. For the formal sector, it covers civil servants and those being paid by the government, while the informal sector covers entrepreneurs, market women, owners of private facilities, artisans and hoteliers. We also have those in the private organised sectors such as banks and airline industries. And we also have a plan for the students, which is going to commence at the beginning of the new student year. For the students, the premium is charged into their school fees. We will go to their doorsteps and teach them how to use data to purchase health services such that there will be improved outcome and reduced financial expenditures.
We have been sensitising market women in Egor, Ikpoba-Okha and Oredo Local Government Areas. What we do with those sectors that are largely informal is that we formalise it as a formal sector. For example, we form bike riders into an association because it is easier to reach out to them, and they in turn talk to their members.
We started with the civil service where premiums are directly collected from their salaries in an integrated payment system, the deductions comes directly from the source, 1.75 percent of civil servants’ salaries, and there is a co-contribution or subsidisation from the government of another 1.75 percent. Both percentages amount to about 3.5 percent of their gross salaries.
We know that in a population, not everyone fall sick, and there is a study that says you do not get more than 30 per cent utilisation at a time. So, what we are doing is like risk pulling, we collect money from 10 people, and hope not more than three persons will be sick at the same time. So that when those three people fall sick in order not to push them into poverty or criminality by looking for money to pay for their health needs, these monies that everybody have dropped will be able to take care of those who are sick at a particular time.
What are the different plans of the insurance scheme?
We have five plans that cover every person in the society. These plans are Basic HealthCare Provision Fund (BHCPF), informal, formal, student and enhance plan.
The first plan, BHCPF is for those who don’t have money and can’t pay for the premium. They are the ones that the federal and state governments have put resources to pay for them. It is a federal and state government initiative, we get 1per cent consolidated revenue from the federal government, and is spread across the 36 states in the country. We have a parastatal called the National Social Safety-Nets Coordinating Office (NASSCO) which is in tandem with the Social Investment Program. What they do is that they go round the country and collect data from those who are poor, those with minimum living expenses, and persons with disabilities. These funds put together by the FG and state government will be used through NASSCO to deliver health to these people. In Edo State, the fund is limited, we were allocated N300million in our state, and so if you calculate that, it implies we can give healthcare to 25,000 people in a year in our state.
Presently, we have enrolled about 2,600 people in the BHCPF. We have 40 teams registering from LGA to LGA, making sure that the people we collected from NASSCO is validated with their names, and give them a card for one year before we start providing healthcare based on what government has provided.
The second plan is the informal plan, which has the highest number of people in the society such as farmers, artisans, market women, owners of private facilities among others.
The third plan is the formal sector plan, which involves civil servant, while the fourth plan is the student plan for those in tertiary institutions. The last plan is the enhance plan; it has higher benefits than other plans. For example, if you belong to the enhance plan, you will be entitled to home visits, nurses can come to your home to check your blood pressure and perform other medical checkups. We usually recommend enhance plan for residents with aged families or parents living alone.
So, what we intend to do is that in this pilot study we want to use one quarter of the year to check and see what we can achieve in the formal sector plan.
Today, we have started with two health plans, the formal health plan and the Basic HealthCare Provision Fund (BHCPF). And so in few weeks time, we will able to start the informal sector plan. Hopefully, by the end of the year, we would have cascaded training to all the LGAs, all sector plans would have taken full effect and we will be able to meet our target of registering about 400,000 lives in our first year of inception.
We have a growth plan, we want to cover 1million residents in Edo by 2024, and before the end of 2021, we will cover about 400,000 residents.
What are your challenges so far?
When we started, we had a problem of attaching health insurance to religion because some religious sect believe health insurance is a sin, and they begin to question why people are paying for what hasn’t happened to them. We tried our best to convince them that the knowledge of insurance was given to everyone by God to bring healthcare to people’s doorsteps.
The thing with health insurance is that it is better to make it all-inclusive. Community health insurance have failed in the world because when you disseminate information about insurance to a particular community and they don’t utilise the knowledge or get registered, before it gets to the next community, that knowledge has dissipated. So, what we are saying is that as much as we do training, it must be practiced. In that line, health insurance should capture most of the state at once but we are also not blinded with the fact that there is logistics problem and manpower deficit in our system. So, what we are doing now is to start with metropolis such as Egor, Ikpoba-Okha, Oredo LGAs, where they are easy to reach areas.
