The introduction of State Health Insurance Schemes to complement the National Health Insurance Scheme, NHIS, and extend coverage to residents, especially the vulnerable groups.
However, these state-level schemes vary in scope, coverage, and implementation effectiveness, impacting overall progress towards universal health coverage (UHC) but some Nigerians, particularly women and children under the scheme are reaping the benefits of health insurance and living above out-of-pocket payments. Chioma Obinna who was in Oyo State last week writes.
Two years after Mrs Adeleke Christiana Olabisi, a staff of the Oyo State Youth Development, knew about the state health insurance through the Oyo State Health Insurance Agency, OYSHIA, she has been using it for her medical care needs.
After struggling with chronic knee pain and expensive treatments at the University College Hospital, she found relief through the state health insurance scheme.
According to Christiana, her first treatment was for a chronic knee problem which was later diagnosed to be arthritis. She was treated and when the pain persisted she was sent for further diagnosis which was done free of charge.
For her, it was a big relief after paying seven times at the University College Hospital’s physiotherapy unit.
“It was free. I didn’t pay a kobo. After that, I was given the results. I brought back the results and I was placed on drugs. Since then I’ve been okay. I had difficulties walking before but now I’m better. I appreciate the OSHA scheme.
“I registered under the scheme and every month a little money is deducted from my salary. It is about N666, 00. Initially, I was going to UCH and paid about seven times there before I came down here. It has been nice here. I appreciate the state government for the scheme,” Christiana stated.
Now, Christiana can walk comfortably again and is grateful for the affordable healthcare provided by OYSHIA.
Again, Mrs Bola, 40 years old, mother of twins, at the Aremo Primary Healthcare, Bodija, Ibadan, Oyo State.
Since Bola started attending antenatal care at the PHC, after her first month of pregnancy, she had never missed her appointment. According to Bola, not because she was constantly ill or to know the state of her baby but because treatment is free and she was being attended to by skilled professionals.
“I was excited about the scheme. I was surprised it was free. The PHC staff are good and the facility is good and neat. I have no reason to skip my antenatal days. I cannot say because I have no money for routine drugs,” Bola said amid smiles.
“Drugs are never out of stock like in some places. That is why I am excited to attend my antenatal and waiting for the day I will give birth.”
As if, Bola calculated her decision, she gave birth through cesarean section, CS. “If not for this scheme, how would I have been able to pay for my treatment,” she asked amid tears.
“My husband is a Keke mechanic, how much does he make in a day? How much is my salary as a civil servant? We have other children to take care of. For me, this is the best for poor people. Paying gradually through health insurance allowed me to access the same healthcare available for the rich. I am grateful to OYSHIA,” she added.
Christiana, Bola, and Fatimah are shining examples of how OYSHIA is making a difference.
Like, Bola, Mary Joseph’s experience with OYSHIA demonstrates the value of health insurance. It has helped her and others avoid financial burdens by covering out-of-pocket medical expenses.
“There are cases that are beyond someone’s control. You will even need a lot of money to be able to cure them. But as an enrollee, it will reduce the cost.
“For example, two months ago, I was having an issue with my tongue when I went to the hospital to use a pacemaker. I went with my card and they asked me to do some scans. Ordinarily, if I am not a beneficiary of health insurance, that scan outside the health scheme would have cost me N7,000. The question is, do I have such money? I did the scan free of charge.
“I have somebody that gave birth through cesarean section. She paid less than N22,200 for CS. But if you are not under the scheme, you will be spending more than N100,000 but she paid less than N22,200 for the CS.”
Another enrolee, Mrs Lawal Fatimah told Vanguard, how she has been relieved of the constant payment of hospital bills, said: “I encourage people to come and register because I was on my way to drop my child in school when I had a crisis. But someone brought me here and I was treated. I could not drive my car when the stomach problem started. I did not even have money with me then.”
According to data from the Nigeria 2021 Multiple Indicator Cluster Survey, the percentage of the population covered by health insurance has been steadily increasing over the years.
However, significant gaps still exist, with a substantial portion of the population, especially the vulnerable, remaining uninsured.
Nigeria faces a critical roadblock in achieving the UN’s Sustainable Development Goal (SDG) of universal health coverage by 2030. Despite mandatory health insurance, enrollment remains alarmingly low with only 5 percent coverage at the national level. This has created a significant financial barrier, forcing many Nigerians to pay out-of-pocket for essential healthcare services. This burden disproportionately impacts low-income Nigerians, leading to preventable deaths for those who could be saved with timely medical care.
Changing health indices of Oyo State
But Executive Director, Oyo State Health Insurance Agency, OYSHIA, Dr. Olushola Akande said the state is changing the narrative of maternal, and child health and the general health of citizens as well as driving UHC in the state in line with the SDG target of UHC, including financial risk protection, access to quality essential healthcare services among others.
According to Akande, established in 2016 while the enrollment began in 2017, its total enrollment to date is 190,968. While the formal sector has enrolled 104,533, the informal sector has 86,435 enrollees, hence, the agency is targeting 500, 000 vulnerable enrollees this year.
“I won’t say that it has succeeded, but we are succeeding. We have about 3 to 4 percent of the population enrolled and when you consider the beliefs and attitudes of people on insurance, that’s a great gain. So, we are on course.”
Again, through the scheme, he said the state is gradually changing the picture of the UHC. We have various facilities on capitation and they are using it to change the landscape of various hospitals.
“We have a woman who delivered a baby that was not so good. The skin of the abdomen was not well covered. Today, the baby is alive in intensive care. Very soon, they are going to do some grafting and close-ups. As of the last count, the hospital has put together a bill of over N1.5 million for the care of that baby. Ordinarily, you know, the family would have abandoned the mother.
They would have abandoned the baby. You know, so this is how health insurance is changing, the health indices of Oyo State.
He said with the increasingly high cost of drugs and medical supplies in Nigeria, it was risky for anybody not to have health insurance coverage, likening to somebody playing with death. “It is very risky if you don’t have health insurance.
Cost reduction
“It takes only N13,500 to be covered for a whole year. If you went into a hospital, a good hospital today, a visit to the doctor, you won’t spend less than 13,500. Even for a farmer, we say, bring your farm produce, you turn it into money. And then you get into Oyo State Health Insurance,” he said.
I just gave an example now. You have a woman who delivered a baby that is a bit abnormal. They understand. He’s done surgery.
He said the scheme has saved many lives and costs for families and has provided patients with skilled health workers, particularly for mothers who would have visited Traditional Birth Attendants, TBAs, due to their inability to afford the cost of medical treatment in hospitals.
“One of the health indices in Nigeria today is how many deliveries that was attended to by trained birth attendants. Health insurance is improving, health insurance is pushing, people to go to a facility where they’re able to have doctors attend to them, you have nurses attend to them, you have pharmacists attend to them.
“The data mapping on one of our hospitals, General Hospital Aremo, we found out that utilization after renovation is as high as 300 percent,” he added.
