Nigeria: Providing UHC during a Pandemic,The Delta Model

1 October 2020

If there is one event that has altered government programmes around the world, it is the COVID-19 pandemic. From its depletion of economies, to the devastation it has caused on education, health systems, human capital development and the global Sustainable Development Goals (SDG), the best of countries have had their fair share of the consequences it carries along.

For Nigeria, not only that it is gradually sliding the country into recession, it has slowed down several government programmes and policies, especially on healthcare delivery where many people have had hitches accessing services other than that provided for the management of the COVID-19 pandemic.

Many have even lost their lives because healthcare resources have shrinked since the pandemic started.

But if there is one state that did not let the pandemic alter its healthcare service delivery to its residents, it is Delta State. It had built an information technology platform for the delivery of basic health coverage many months before the pandemic started, making it seamless to provide services to the almost one million persons registered under the Delta State Contributory Health Commission (DSCHC) even during the total lockdown instituted in the heat of the outbreak.

The sharing of this model was part of the highlights at the 40th annual general meeting of the National Association of Resident Doctors (NARD) held in Delta State last week, tagged: 'Accelerating Progress towards Universal Health Coverage in Nigeria: Opportunities and Challenges in the Era of a Pandemic: The Delta State Perspective."

The key note speaker and the Director General, DSCHC, Dr. Ben Nkechika told the audience that the state knew beforehand that healthcare was a vital part of living, hence its decision to ensure it is provided irrespective of the national situation occasioned by COVID-19.

He said: "During the COVID-19 pandemic shutdown, the DSCHC was able to continue full operations leveraging on its integrated ICT platform. Enrollees of the scheme continued to have access to health services. We provided logistics support to facilities, doctors and nurses to enable them be at their work places.

An online healthcare support service was provided to enrollees through dedicated phone lines and those that needed physical medical support were provided transportation as much as possible. The electronic clinic software system comprising e-medical records, e-treatment protocol, e-referral process, e-billing system, and e-payment portal were all active during the period, including the commission's 24 call centres.

"Following the high COVID-19 infection rate amongst doctors, nurses and other healthcare providers, especially with the death of one of our notable medical consultants from the COVID-19, the state embarked on an Infectious Disease Prevention and Control Advocacy and Sensitisation campaign at all accredited healthcare facilities.

"High quality facemask most suitable for frontline healthcare providers and infrared thermometers for early patient triage were handed over to each of the facility. The commission also used the opportunity to review the status of quality service delivery from accredited healthcare facility with guidance for a "patient centered" healthcare service delivery to enrollees of the scheme."

He said the state was providing UHC to residents, and that the pandemic has reawakened consciousness on the need for a vibrant, viable, purposeful and resilient healthcare system designed to deliver quality services to all residents of the country at best cost, all year round. He added that UHC has been identified globally as the mechanism to achieving quality "Health for All" in which no one is left behind.

According to him, a well-designed, structured and strategically implemented health insurance programme was the special purpose vehicles that will enable the country achieve UHC, adding that this was what Delta State was using.

He mentioned that the state was able to provide health coverage outside COVID-19 management because the Governor, Senator Ifeanyi Okowa understood the best working models for the sector; an understanding, which he said, also saw him champion the National Health Act (NHA) at the 7th National Assembly.

He said: "The NHA has today become the fulcrum for an efficient and effective healthcare service system in Nigeria. The Basic Healthcare Provision Fund (BHCPF), a component of the NHA has also become a significant catalyst for achieving UHC in Nigeria especially in a post pandemic era.

"The BHCPF is the healthcare financing program under the NHA with a mandate to provide quality healthcare service to all Nigerians especially the poor and vulnerable in the society.

Nkechika mentioned that the Delta State health scheme was now operational in 405 accredited healthcare facilities spread across 268 primary healthcare centers, 66 secondary healthcare facilities, 65 private healthcare facilities, Federal Medical Center (FMC), three Abuja healthcare facilities and two Lagos healthcare facilities).

He said: "At close of business yesterday, DSCHC has in its database, 788,740 enrollees comprising 171,123 (principal and dependents) members of the formal sector groups whose premium are paid based on deduction from the worker salary from payroll and employers counterpart contribution on behalf of the worker as stipulated in the DSCHC operational guideline, 11,456 members of the informal sector groups whose premium are paid based on N7,000 per enrollee per year as stipulated in the DSCHC operational guideline and 606,161 (225,717 pregnant women and 380,444 children under five years) members of the Equity Health Plan Group whose premium are paid for by the Delta State government. Current effort is to continue to enhance the informal sector enrollee population especially in rural communities leveraging on the BHCPF programme."

On his part, the Special Guest of Honour, Governor Okowa said the NARD AGM offered the country the opportunity to review ongoing national efforts to combat the COVID-19 epidemic as well as assess readiness to respond appropriately to future public health emergencies.

He said Nigeria has the capacity to turn the crisis into an opportunity to bolster health infrastructure, expand capacity and upgrade manpower in the health sector in such a way that the country's healthcare system will be better poised to deal with future outbreaks.

He said: "There are two major takeaways for me from the COVID-19 pandemic as it relates to Nigeria. The first is the necessity of having in places a national policy document on responding and managing unforeseen public health crisis. The absence of such a framework as well as the novel nature of COVID-19 posed a major drawback in articulating a coordinated response at the initial stage of the pandemic in the country.

"Testing was a huge problem because of the shortage of human resources, testing kits, laboratories, and case definition for testing that prioritises symptomatic cases and their contacts. The country only attained a daily testing capacity of 2,500 samples late in July, which is a far cry from what it should be for a country our size. Testing was not only extremely low; it took days before the results could be known.

"Confronted with a fast spreading disease like COVID-19, the delay meant the virus could spread unchecked as it hindered early contact tracing. Here in Delta, samples had to be taken to the Irrua Specialist Teaching Hospital in Edo State, which served the entire South-south geo-political region.

The wait was excruciating and exerted immense physical and mental toll on critical health personnel who had to be making frequent trips to Irrua in Edo State.

"Subsequently, we were able to enter an arrangement with Irrua Specialist Teaching Hospital in partnership with Pan African Network for Disease Outbreak Research and Rapid Response (PANDORA) to establish a molecular mobile laboratory in Delta. Since then we have conducted over 9,000 tests while confirmed cases are 1,799 as of Friday, September 18. More importantly, as result of the improved testing and transmission of results, we have been able to achieve 99 per cent contact tracing. "

He mentioned that his second takeaway was for post COVID-19, there should be a compelling need to adopt and implement viable and sustainable healthcare financing programme for all states in the country.

He said each state was primarily responsible for the financing and implementation of their health system, adding that a health financing programme focused on up-scaling primary healthcare services, enhancement of human-resource-for-health capacity, deployment of a technology enhanced healthcare services delivery process and improved access to measurable quality healthcare services outcome for all, was an imperative.

He stressed that the country must start to consciously measure outcomes as part of healthcare delivery process since that was the surest way to revamp a floundering healthcare system.

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