A model for affordable healthcare

it is fitting that Senate President Bukola Saraki should blaze the trail in the introduction of a health insurance scheme to Nigeria. Concerned about the health challenges of Kwarans, especially those in the informal sector, and their lack of access to quality and affordable healthcare, Saraki’s first programme shortly after he was sworn in as the Governor of Kwara State was the introduction of the Kwara Health Insurance Scheme. The scheme, introduced over a decade ago, has continued to benefit thousands of Kwarans.Senate President, Saraki recently canvassed the introduction of a similar scheme for those in the informal sector across the country.

While receiving the World Health Organization (WHO) Regional Director for Africa, Dr. Matshidiso Rebecca Moeti, who was accompanied by the Minister of Health, Professor Isaac Adewole, Minister of State for Health, Dr. Osagie Ehanire, and other top management staff of the Federal Ministry of Health, Saraki said that one of the strategies to achieve Universal Health coverage was to provide a health insurance scheme to the informal sector of the country. “The Universal Health Coverage is something that is dear to my heart. I remember when I was Governor of Kwara state, I introduced informal health insurance scheme to those who are unemployed in rural areas as I have always believed that the formal sector can take care of itself.”

What he did not tell his audience was that when he became the governor of Kwara State, he inherited a healthcare system that was worst than hospitals being mere consultancy centres. People died in thousands because they could not afford the cost of medical care which made them to resort to herbs, which caused more damage. Working with local and international partners like the Dutch Government, The Health Insurance Fund, Hygeia Community Health, PharmAccess Foundation and others, he started the pilot project in one of the 16 local governments in the state. With the payment of N200, then in 2003, every individual was entitled to medical treatment for the rest of a financial year. Beneficiaries enjoyed free consultation, drugs, medical investigation, blood transfusion, ultra sound and minor surgeries such as CS, appendectomy, circumcision, evacuations and others. It also covered maternal and child care, chronic diseases, hypertension and diabetes, minor surgeries such as caesarean section, hernia, circumcision, appendectomy, evacuation surgeries including Caesarian sections as well as the treatment of lifestyle and some non-communicable diseases and all other primary healthcare activities were all covered under the scheme.

The scheme worked through community leaders. There was a Board of Trustees for each community, usually headed by the traditional ruler. They mobilised the community for participation and managed the scheme for optimum performance. In Edu local government, where the pilot project took off, the scheme enjoyed tremendous patronage. The General Hospital in Tsonga that previously hardly saw 10 patients in a day had over 5000 patients in the first month. Nearly everyone in the town, from the traditional ruler to the peasant farmer, registered for the scheme. Buoyed by the success of the pilot scheme, Saraki expanded to other local governments in the state before he handed over to the current governor, Abdulfatah Ahmed, in 2011. The scheme had covered 10 out of the 16 local government areas with 400 communities.

Within the same period, over 3,000 births and more than 600 caesarean sections were carried out.  The scheme was limited to rural areas because Saraki was concerned about how to subsidise healthcare and make it affordable for those living on below one dollar per day. With Legacies Continue as his campaign slogan, Ahmed built on the legacy in the health sector and by 2015, almost all the nooks and crannies of the state had been covered. Like every good work, the success recorded by Kwara State government with the Community Health Insurance Scheme has not gone unnoticed. The scheme was one of the global top-ten finalists for the Development Assistance Committee (DAC) Prize organised by the Organization for Economic Cooperation and Development (OECD).  At the awards ceremony held in Paris, France on the 7th of October, 2014, the OECD praised the sustainability of the program and commended the significant approaches that the Kwara state government has been utilising to overcome the barriers that often lead to market failure in such endeavours.

The scheme had earlier received commendation from the UN and Bill Gates Foundation for its creative approach to pro-poor health care. Saraki’s feat has also led to Kwara being described as the home of Community Health Insurance Scheme due to its pivotal role in spreading healthcare delivery to the grass roots. As a student doctor who did his internship and youth service in rural Kwara, I had firsthand experience of Kwara Health Scheme and its enormous benefits to the poor. Where I work now, up North, I have lost many patients due to their inability to pay for drugs. Many don’t even bother to come to the hospital. A national application of the scheme will help millions in the informal sector. Beyond calling on governors of other states and the federal government to embrace the scheme, Saraki must take it upon himself to start a national campaign, appealing to leaders to embrace the scheme. Though without executive power, he should use his influence as the Number Three man in the country to work out a system that will enable the federal, state and local governments to create a functional funding window to support Health Insurance Scheme for those in the informal sector nationwide.

• Fatigun is a former chairman of Ekiti Local Government, Kwara State.