Theophilus Abbah
27 July 2008
interview
Mrs Fola Laoye is the Group Managing Director, Hygeia Nigeria Limited, promoters of the Hygeia Community Health Plan - a community health insurance scheme targeted at the rural poor and people in the informal sector. Since joining Hygeia, she has been responsible for the start up and growth of the HMO business and the roll-out of two ultra-modern medical facilities in Lagos. Excerpts:
The concept of "health insurance" is seen as elitist, especially in a country like ours where the literacy level is low and poverty is visible. Do you agree with this?
To consider health insurance as elitist is to consider access to healthcare services the exclusive preserve of the elite. Access to healthcare is a universal necessity. Individuals from the low socio-economic group may be constrained from accessing healthcare, using health insurance mechanisms, due to many factors, notably financial constraints. That is why in low income communities where we have introduced community health insurance schemes, backed by premium subsidies, the responses in terms of enrolment and utilisation of health care services have been phenomenal. In the first year of our operation, the Hygeia community health plan enrolled over 30,000 low income individuals in her pilot sites of Shonga - a rural community in Kwara State and among market women in Lagos State.
Interestingly, these enrolled individuals have made over 38,000 visits to the healthcare providers for various conditions such as malaria, upper respiratory tract infections, hypertension, diabetes, musculoskeletal pains, appendicitis, hernia and several other surgical conditions. Previously, these enrolled individuals would have had to pay out-of-pocket for medical care or they would have gone to alternative healthcare providers with attendant increased morbidity and mortality.
We do not see the low illiteracy rate and poverty as barriers to implementing health insurance, but rather challenges that we have surmounted using innovative means. What we have discovered is that the awareness about health insurance among Nigerians of all socio-economic groups is low. However all Nigerians readily identify with solidarity schemes such as "esusu", "ajo", "cooperatives" and other similar schemes. We have, therefore, introduced our community health insurance as a solidarity scheme and the target communities have accepted it. The premium subsidies have also definitely stimulated the communities to enrol in the scheme.
The point I am getting from the Hygeia Community Health Plan as a concept is that health care services can be subsidised. Is that correct?
Certainly, however, the Hygeia Community Health Plan scheme is a "pro-low income" population health scheme. We have deliberately targeted the individuals at the bottom of the income pyramid who are also unfortunately most likely to fall ill and to be impoverished further by disease conditions. We have the National Health Insurance Scheme which presently caters for individuals in the public sector and we also have various schemes which target the corporate and multinationals but the distinct characteristic of these schemes is that the employers pay the premiums of their employees. However, the poor or low income individuals cannot afford the required premiums. The Hygeia Community Health Plan was, therefore, set up to cater for these low income individuals who constitute the majority in our communities. After one year of operations we can rightly say that we have made a difference in the communities we are working with, and we are getting requests from other communities and State Governments to provide similar services to their communities.
So how does the subsidy come in?
Premium subsidies are financed by the Health Insurance Fund (HIF) which was promoted by the Dutch Government and several major Dutch corporate organisations, such as Shell, Unilever, Heineken and some Dutch insurance companies. The premium subsidies are provided based on the incomes of the target communities. For instance, premium subsidy for the Shonga community in Kwara State is 95% while for the Lagos market women it is 90%. The premiums were also adjusted to match the socio-economic realities of each participating community, so the Shonga enrolees pay N200 per person per year while the Lagos market women pay N800.
Enrolees select healthcare providers of their choice; the premiums we collect are then used to pay the healthcare providers on a pre-paid basis as capitation for a wide range of diseases and claims reimbursement for other defined disease conditions. So whenever the enrolled individuals fall ill during the period of enrolment they can readily visit the healthcare providers for treatment without paying a dime.
How much is the Health Insurance Fund committing to fund this pilot?
The Health Insurance Fund has committed 100 million Euros to provide health insurance for low-income populations in five African countries. Each country gets 20 million Euros. Nigeria was the first country to benefit from the fund. The scheme commenced in Nigeria in January 2007.
What is in all of these for Hygeia? Is it just about making healthcare affordable for the poor?
The Hygeia community health plan is a social enterprise which, in essence, is not in business primarily for profit, but to make a difference in the lives of the low income individuals, which constitutes 70% of our total population, by providing access to high quality healthcare services, using a donor subsidized managed care scheme. I can rightly say that we have made a huge difference in the communities we are currently operating. For instance, in Shonga, prior to the commencement of the scheme, the healthcare centre there used to receive about 10 to 16 patients per month. But with the commencement of the scheme that same health centre now receives about 1,500 visits per month and, of course, the healthcare centre has been upgraded and equipped to handle the increased patient load. Several enrolled individuals have testified to the enormous impact we have made in their lives.
You just had a one-day conference in Abuja on Community Health Insurance in Africa. What would you say was the achievement of the conference?
We set out to showcase our achievements, using a donor subsidized health insurance scheme to provide access to quality healthcare services to the public and in particular decision makers and other stakeholders in the healthcare sector and I believe we achieved that judging by the diversity and number of persons who came for the conference. We were particularly delighted that several other Health Management Organisations (HMOs) came to the conference because we believe that it would take the collective efforts of many HMOs to achieve universal coverage, using community health insurance schemes.
The high point of the conference, for me, was when the governor of Kwara State, His Excellency, Dr Bukola Saraki, said that the achievements of the Hygeia Community Health Insurance Scheme in Kwara State was not just a miracle to him but an eye-opener about how healthcare should be managed and administered in Nigeria.
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