Until the day he fell from a palm tree, Mr. Paulinus, a yam farmer in Adikpo community of Benue State never had reason to spend much on health care. Although he suffered a fracture from the fall, he was confident that it would not cost much to receive treatment at the hospital. However, it soon became clear that he did not have enough funds to cover his treatment, as receiving proper care in the hospital was more expensive than he initially thought. As a last resort, he turned to traditional medicine; an option that was more pocket-friendly. Unfortunately, soon after he started using the local herbs, something went very wrong; the broken leg started to decay and eventually had to be amputated.
Mr. Paulinus’ story is not unique. He is one of many Nigerians who are suffering the consequences of life without health insurance, especially those living in rural communities. Advocating for health insurance in Nigeria cannot be over emphasised, considering the inequality in the distribution of healthcare services in every state in the country. This inequality is more evident in rural communities.
Universal health coverage and health financing
According to the World Health Organisation (WHO), Universal Health coverage (UHC) means that all people and communities have access to promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that these services are affordable and does not expose the user to financial hardship.
This definition of UHC embodies three related objectives:
- Equity in access to health services — everyone who needs services should get them, not only those who can pay for them.
- The quality of health services should be good enough to improve the health of those receiving services.
- People should be protected against financial risk, ensuring that the cost of using services does not put them at risk of financial harm.
UHC is based on the WHO constitution of 1948 declaring health a fundamental human right and on the ‘Health for All’ agenda set by the Alma Ata declaration in 1978. UHC cuts across all the health-related Sustainable Development Goals (SDGs) and brings hope of better health and protection for the world’s poorest.
Health insurance in Nigeria
Health insurance is one health financing option to achieve Universal Health Coverage in countries like Nigeria. If implemented effectively, it can improve access to health care by reducing financial barriers, ultimately improving overall health outcomes.
In Nigeria, the National Health Act empowers states to set up state health insurance schemes. This is a step in the right direction as a strong and functioning state health insurance system will improve access to health care for vulnerable people in communities and reduce out of pocket expenditure for healthcare.
Community Workers for health insurance in Nasarawa and Plateau States
Nasarawa and Plateau States are two states in Nigeria working to establish health insurance schemes. With support from Christian Aid UK Nigeria, Nigeria Health Watch partnered with the health insurance agencies of both states to conduct cross-learning sessions with leaders of community based organisations (CBOs). The goal was to create and strengthen the connection between health insurance organisations and community members.
Advocacy by community health workers has been linked to sustainable gains for health. Community health workers (CHWs) who work at these CBOs are either trusted members of or have deep understanding of the community where they serve. This close relationship helps the CHW to serve as an important link between health services and the community, to facilitate access and improve service delivery. These community health workers are frontline members of the public health workforce and they build individual and community capacity by increasing the health knowledge and self-sufficiency of patients and the community through a range of activities such as outreaches, patient and community education, informal counseling, social support, and advocacy.
The #Health4AllNaija advocacy project leveraged key roles of community health workers and equipped the select team of CBOs with tools for advocacy for health insurance. The ultimate goal was to have participants understand and carry out sustained advocacy in their various communities thus reducing out-of-pocket expenditure for health.
The event, which held on August 11, 2020, focused on helping participants become advocates for universal health coverage though health insurance to their various community members. Participants shared their own most recent out-of-pocket expenses for health and compared with costs of health plans under their state health insurance scheme. Having realized the clear benefits, the discourse delved into engaging the most influential stakeholders with health insurance advocacy, as well as understand the needs and barriers to uptake of health insurance.
Participants learned to build constant dialogue between state health insurance officials and community members in order to foster a clear understanding of the scheme’s operational challenges and determine where linkages can help ease these challenges.
At the training, participants mapped influential community stakeholders and discussed engaging them at different levels to help promote literacy for health insurance in their communities and keep state governments accountable to provide sustainable health insurance systems, as well as the role of social media as an accountability tool.
By the end of the training, participants understood what advocacy means, the basic skills for advocacy and how to use advocacy to drive community change.
Dr Fabong Jemchang, Director-General at PLASCHEMA, in an interview said the concept of universal health coverage is taking health care to people at an affordable price. He said this is not possible without a state social health insurance scheme that will serve as a vehicle for UHC.
He added that state stakeholder involvement are blocks for the successful achievement of the scheme, as groups, communities and organisations should be sensitized to change behaviors for health insurance.
Mr Kefas Diyel, one of the CBOs present, said with the experience he got from the training, he is convinced that the scheme would bring about relief on health expenditure and he is excited about taking the message of health insurance to his community to sensitize members of his community on the importance of health insurance.
The Director of Planning and Research Statistics and ICT, NASHIA, Dr. Eric Simon Isatifanus, said a major challenge is lack of trust regarding sustainability of government programs because of past experiences with similar programs. He said that to overcome this challenge, the government needs to earn back the citizen’s trust through legal frameworks and a well-designed structure for health insurance.
Do you know a State whose State Health Insurance Scheme is currently working well? Let us know! Talk to us in the comment box below or on Twitter @nighealthwatch. You can use the hashtage #Health4AllNaija when you comment.