24 August 2012

Nigeria: Ogun Adopts Risk-Pooling As Heathcare Strategy

Maternal health is one of the main global health challenges. The reduction of the maternal mortality rate in the world by three quarters will achieve one of the objectives of the Millennium Development Goals (MDGs).

According to the World Health Organisation (WHO), up to 358, 000 women die each year in pregnancy and childbirth related cases. Most of them die because they have no access to skilled routine and emergency care. Since 1990, some countries in Asia and Northern Africa have more than halved maternal mortality.

The United Nations Secretary General's Global Strategy for Women's and Children's Health aims to prevent 33 million unwanted pregnancies between 2011 and 2015 and to save the lives of women who are at risk of dying of complications during pregnancy and childbirth, including unsafe abortion.

There has also been progress in Sub-Saharan Africa but unlike in the developed world where a woman's life time risk of dying during or following pregnancy is 1 in 4,300, the risk of maternal death is very high at 1 in 31. Increasing numbers of women are now seeking care during childbirth in health facilities and therefore it is important to ensure that the quality of care provided is optimal.

In a bid to avoid maternal mortality rate and create affordable health for the Ogun State populace, the state Governor, Senator Ibikunle Amosun, is creating awareness and providing health facilities and personnel to forestall maternal death in the state.

As one of the five cardinal points of his administration, Amosun, last week, introduced a Community-Based Health Insurance Scheme. The scheme is a community-based project where communities partner government in order to achieve its objectives. The community-based programme is controlled by the people of the communities through their Board of Trustees (community members) while the state government provides facilities and personnel.

The Ogun State Community-Based Health Insurance (CBHI) is a non-profit health care scheme which is controlled by the community and membership is voluntary. The scheme enables what is called risk-pooling which is a situation in which everyone (or most people) in a group pay a small and regular amount into a 'pool' of money while the money is used to pay the healthcare costs of the few who fall sick.

Apart from preventing mortality rate, the scheme is also aimed at preventing the usual trend with most of Nigerians, who pay directly out of their pocket, which is referred to as out-of-pocket payment. People spend a high proportion of their income on healthcare and many cannot afford the care they need or should have.

The result was said not to only increase poor health outcomes but also a poorly utilised health service which worsens the health service. However, because government cannot afford the high cost that would be needed to provide free healthcare to all, and because those who are sick also find the cost too high, the government of Amosun agreed that some form of health insurance which spreads the cost amongst many more people was the solution.

In recognition of this, Amosun in his new insurance scheme encouraged the participation in Community-Based Health Insurance Schemes across the state. According to the governor, widespread participation would enable him to keep his promise of free healthcare for pregnant mothers and children under five and affordable health care for all, and importantly, this has to be sustainable in the long term.

In this regard, enlightenment programme on the new scheme by the Ogun State Ministry of Health and the Primary Healthcare Development Board has commenced with a maiden edition at Ofada area of the state The scheme, according to the Commissioner for Health, Dr. Olaokun Soyinka, is meant for anyone interested in running or joining a CBHIS, which is aimed particularly at members of the community and other community-oriented welfare and interest groups. He noted that an important element in the success of CBHIS is that they are owned and run by communities.

The commissioner visited Ofada Community Development Centre with the aim of advocating and sensitisation of community/occupation-based leaders, as well as mobilisation on the new insurance scheme.

While speaking on what it takes to establish CBHI schemes in a community, he said the preparations include, advocacy visits and sensitisation to community/occupation-based leaders for mobilisation; identification of potential beneficiary communities/occupation-based groups and conducting rapid needs assessment; identification of existing community structures and engagement with local government and NGO bodies.

He added that election of a democratically elected Board of Trustees represents the community members in early programme planning as well as subsequent management processes other requirements include definition of benefit package based on the result of the baseline surveys and the actuarial costing of ailments while programme managers shall discuss with community members a suitable and realistic benefit package.

Soyinka, however, said the state government has started speeding up the rate at which it can get primary health care to the people, disclosing that it would bring the informal sector into the programme to enjoy the benefits of the insurance scheme which people of the state are beginning to enjoy under the administration of Amosun.

According to him, "we are in the first phase of the programme which will go round the communities.

Talk to them and get them to understand the process and for us to understand the financing. What happens is a small premium that is affordable to rural communities in order for them to access the health care services in the area of drug and services. It also covers ante-natal services and will enable us to implement the free health care service.

On getting the insurance spread across the 20 local governments in the state, Soyinka said, "it will go round the 20 local governments and we have to get it right because it is a complex programme to run, to administer and to control. We also have to help the communities to learn to run this scheme; so it is a pilot we are running in six local governments to get the process right."

He added that "initially they were sceptical, especially in those areas where the presence of government was not felt, but when you explain to them and do advocacy and outreach that we are doing today, they come out very quickly once they realise the whole project is for them and about them, they are less worried about potential disappointment by the government."

While speaking on its preventive measures, he said many people had spoken about it but definitely the government wanted to improve routine immunisation to prevent child-killer diseases, health promotions for people to understand lifestyle to avoid that would stop them from developing hypertension.

He said school health projects that the state government is undergoing was targeted at the young people so that government can catch them young and teach them early on how to live a healthy lifestyle.

The commissioner also said government was engaged in collective measures to protect its citizen's healthy lifestyle, saying that Governor Amosun's administration has programmes that would be running in the hospitals and even the primary health centres that will reach out to people with regular health education.

Providing insight into how to start the scheme, he said there would be registration of community members while contributions managers will register community members (using an established registration procedure) and collect their contribution (premiums), issuing membership cards to all registered members.

He also explained that the start-up will be supported with continuous active community mobilisation effort with commencement of access to health care services; initiation and promotion of the establishment of income-generating activities; establishment of structures for programme supervision and monitoring.

On the role of CDAs in CBHIS, he said CDAs served as a link between the scheme and the beneficiaries (community members), therefore roles of CDAs include the following: educate and mobilise the community members; ensure that the community members understand the scheme and its benefits.

Other roles according to the commissioner include: ensuring that the scheme is well accepted by the community members and the communities take ownership of the scheme; coordinate the scheme in their various communities in line with their association constitutions, which encourage support of government in the implementation of health programmes.

Speaking on behalf of the Ofada community, its Public Relation Office, Mrs. Deborah Olawepo, said it was an honour to the community to be considered as fit for the pilot programme of the community health insurance scheme in the state, saying the community comprises about 174 CDS with each of them well populated.

She said at present, good health service was very far away from the people of the community, the nearest could only be found at Sagamu area of the state, explaining that "we travel to either Abeokuta or Lagos for medical attention even in emergency situations."

"Lives have been lost during the course of such sojourns especially when there is traffic jam which always occurs on the expressway. In view of this, we would appreciate it if the two new health centres built in Ibafo and Adesan are put to use as soon as possible," she added.

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