Over 80 per cent of Nigerians spend a fortune to access healthcare. Nonetheless, embracing community health insurance, as typified by the Ayedun example in Ekiti State, where members of the community contribute little amount of money on a regular basis to enable them access medical care in time of need, is the way out, reports Sade Oguntola.For more than 10 years, researchers have been working with health reformers in low- and middle-income countries, focusing on governance, equity, and the effective integration of health systems. They wish to ensure that this extends universal health coverage.
It is a dream shared the world over: access to health care, delivered by competent professionals, without fear of financial ruin. But for too many, these remain just words because financing remain a crucial issue.
In Nigeria, 92.2 per cent of Nigerians live below N256 per day and cannot access medical care because drugs are purchased “out of pocket”. Sadly, fees have proven a huge barrier to the poor, whom even small costs can effectively deny access.
Despite the challenges, a growing number of interventions are being implemented to ensure universal health coverage. One of such initiative is the Ayedun Community based social health insurance programme. Premier Medicaid International, a Health Maintenance Organisation (HMO) in collaboration with Compassionate Hands International, United States of America, provides the required technical support.
Ayedun community is located in Ikole local government in the North Senatorial District of Ekiti State. It is situated midway between Abuja and Lagos. It is an agrarian community, with over 40,000 inhabitants. The community has a record of communal efforts at improving living conditions through such initiatives as the construction of school blocks, health facilities and a rice mill.
The Ayedun community based social health insurance programme involves communal contribution specifically geared towards improving the health of the populace by reducing user fees and other out-of-pocket expenses while extending equity and access to health to its 4,000 enrolees in the town and beyond.
Many Nigerians are recognising that community-based health insurance (CBHI) can increase access to healthcare services. “We are not throwing away our money by making this contribution like some people think. Due to the services we receive, many health challenges have been met. Death in old age as a result of lack of medical care, which was rampant as a result of lack of medical care, has reduced,” said Mrs Adetunmbi Awe, a 70-year old enrolee of the scheme.
Mrs Adetunmbi, whose children are all enrolled in the Ayedun community based social health insurance at the rate of N1, 200 per person, recounted a fall she had some months back, which made her unable to walk for days.
“I attest that the scheme is very good. Sometime ago, I slipped at home and had difficulty walking. It was so bad that when hot water fomentation was carried on the leg, I cried so loud that people in the next house heard me.
“I had to go in a taxi cab to seek treatment. They gave me drugs. Because the drugs were very effective, after finishing the first dose, all I did was to send my enrolee identification card to them for a refill of my prescription. By the time the second doses of medicine were used, I was perfectly well.
“Many people do not take seriously many illnesses that could lead to death. But since the inception of free access to health through the Compassionate Hands International, United States of America and our enrolment in the health insurance programme, cases of death have reduced drastically in our community.”
A big health challenge that Mr Kayode Ajayi, a 56-year-old man attested to have received help in
ameliorating was arthritis. “For me, it was the treatment given my aching knees and its effectiveness, which convinced me to enrol for the health scheme,” he declared.
Moreover, Mr Bode Ibitoye, a 76-year-old man and head of his clan, stated that the scheme bore the financial burden of his extended family when they were sick, which was a big relief.
Mr Ibitoye, also the Vice President, Ayedun Community based social health insurance programme, said “they only come back to inform me that they were ill and had gone to access treatment. It has reduced my spending on their care tremendously. This really makes me happy.”
Wondering if the scheme was only imparting the poor in the community? Mr Femi Aribisala is a retired engineer, who came back to reside in Ayedun in 2007, his home town. Even in retirement, he and the wife still had full health coverage from the establishment he worked with.
Little wonder, his concern that the Ayedun insurance programme should thrive and cater to the health needs of his relatives in the town.
“Our society is only getting to fully appreciate the scheme because change takes time. The social insurance scheme is seen as a new thing and many people do not understand its full implications. That is why a number of us are coming in to try and educate the people to understand what it is really.
“This is predominantly a farming community and like age groups will come together to work on the farm of a person at a time, this is the pooling of our resources together essentially to assist whoever is in need at a point in time to make for a better society.
“As an individual, I may not need it, but what about my uncle, nieces and so on, who do not have somewhere else to turn to when they are sick? So, in a way, we are sharing the problem of members of our community.”
Mr Aribisala recounted the case of Mr Femi Alade, an enrolee of the social health insurance scheme, who was involved in a motorcycle accident and sustained serious injuries. He needed surgery and through the support of the scheme, he was able to pay his N219, 000 medical bills.
“Ordinarily, by the set up of an insurance scheme, there are limits to one’s insurance cover. But in the case of Mr Alade, he had 100 per cent cover and also had support form Sir Dr Kayode Obembe to upset his medical bills.
“Today, he is back on his feet because he has support. If there are things that cannot be done to help as a social health insurance body, we ask individuals who can assist to do so. This is a small community where everybody knows one another.
Mr Aribisala, recounting that the free medical mission by Compassionate Hands International, which was introduced to the community by Dr Obembe, was the prelude to this community-based social health insurance programme, stated that “the introduction of the health insurance scheme was to get more people involved in making health available by their token contribution of N1, 200 per year.”
“People pay N100 a month. Some people pay in instalments while others pay yearly based on their convenience. They are used to the cooperative system. They know that whatever they pay will be available to help an enrolee of the scheme with health needs.
“Every enrolee has a card, on which his or her picture is pasted. The card cannot be exchanged or used by another member of the family that is not on the scheme. The scheme also gives coverage to pregnant women and covers child delivery.”
But how does the scheme operate? According to Chief Oladepo Adelusi, the Chairman, Board of Trustees of the programme, the scheme, which commenced operation in year 2011, involves the enrolee seeking health care from the government health facilities in the town and receiving care without any payment at that facility.
He stated that once the person is identified as an enrolee of the scheme, his or her ailment is diagnosed and free treatment is offered under the scheme.
“If you are sick, you go to meet the nurse who links you up with the medical doctor and you are treated without making any payment so long as the enrolee is up to date in payment. Where the bill is on the high side, it is sent to the board for approval. Where the case is an emergency, a phone call is made to the board to give direction.”
Dr Emmanuel Akintoye is an NYSC medical doctor attached to the comprehensive health care centre in Ayedun. The medical doctor, who described work at the community as both challenging and interesting, said that prevalent diseases attended to in the community were malaria, hypertension, diabetes and upper respiratory diseases.
Dr Akintoye, noting that lots of ignorance and misconception on issues bordering on health still thrived in this community, stated that often times, adherence to medication on chronic diseases such as hypertension and diabetes was a problem.
“Many people take their drugs and once they feel better, they assume everything is okay and so stop its intake. They only come back to the hospital when the symptoms come back,” said Dr Akintoye.
But are all ailments handled at this level? Dr Akintoye: “When a patient comes, his or her health problem is diagnosed and if it is something beyond what we can handle based on what is available at our disposal, such is referred to the State specialist hospital at Ado-Ekiti.”
Conversely, Mrs Ireti Celina Aluko, a chief nursing officer at the Ayedun comprehensive health care centre stated: “Access to timely and quality health care services in the town has made Ayedun a referral point for other neighbouring communities. Sick people are told to come to Ayedun to access free care on Thursday and this has helped to sell the health insurance scheme to them to enrol.”
Mrs Aluko, who noted that patronage of that comprehensive health care centre had improved tremendously, said “we see about 40 to 45 patients per day now and most of them are enrolees on the health insurance scheme.”
Meanwhile, Oba Jacob Fatunase Ala, Alaaye of Oke Ayedun-Ekiti, in an appraisal of the scheme in which he and his households are also members said “it is something that looks far ahead in the interest of the health of the society. It ensures people live longer and healthier.”
According to him, “now, instead of an ailment keeping a man down and leading to death afterwards, there is early attention. Such will be cared for. He will live longer and everything will be better. There is no doubt about that.”
“I am not just paying into the scheme; aside home care that I receive, my use of the scheme is also to encourage other people to join. People do not join a scheme like this, particularly one where you do not reap the immediate benefits of what is sown.”
Oba Ala praised the community for being in the forefront of community interventions to improve their wellbeing, stressing: “Our unity has always made us to be in the forefront of progress in Ikole Local Government. Based on our population, we would not have been able to make any name, but for our unity of purpose.
Tribune
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