Changing the Narrative of Maternal and Child Mortality Through Health Insurance 

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Funmi Ogundare and Ayodeji Ake, who recently joined the UNICEF media team during a  facility tour in Oyo State, examine the accessibility of affordable healthcare services through the Health Insurance Agency as a recipe to changing the narrative on maternal and child mortality

On August 18, 2016, the Oyo State Government established the Health Insurance Agency ( OYSHIA) with the mission to facilitate the reduction of out-of-pockets expenditure on health, provide financial rush protections and cost burden sharing for people of the state against the high cost of health care, through pooling and judicious utilisation of financial resources and various pre-payment plans.

 Backed by an enabling law, the effort was aimed at providing quality and affordable healthcare services in Oyo state.

However, the enlightenment among the people of the state, had been very poor, despite the effort taken by the agency to educate them.

During a two-day media dialogue on ‘Changing the Narrative on Child Mortality Through Health Insurance Scheme’, organised by OYSHIA and the United Nations Children’s Fund (UNICEF), the team visited the Oyo State Secretariat Clinic and General Hospital, Aremo,  to assess the interventions by the agency aimed at ensuring affordable healthcare services to residents especially mother and child through the insurance scheme.

Earlier, the Executive Secretary of the agency,  Dr. Olushola Akande, emphasised on the effort of the state government in achieving Universal Health Coverage ( UHC) in the state, while expressing concern over the low number of residents  on the insurance scheme which is below 10 per cent, despite the affordable price of N1,125 monthly and N13,500 per year.

He stressed the need for more advocacy on health insurance so as to ensure  improvement in the utilisation of health facilities.

“We need to begin to get our people to understand that while getting drugs in facilities is key, they must also understand that some costs have been absorbed when they enroll in insurance. The cost of consultations, other benefits, as well as seeing specialists, have been absorbed into insurance.

“Also the cost of some basic investigations has been done as part of the benefit package. If you are not administered the specific drugs, then you haven’t been given drugs. These are the important things we want people to know about health insurance that some cost has been absorbed even before they go in to see a doctor. 

The executive secretary noted that the state was pushing forward ownership ,adding that that was the essence of its community-based health insurance and doctrine model where members of the community pays a minimum of N2,500 and get enrolled into the primary healthcare centres.

” That community takes ownership of the Primary Health Centre ( PHC). They do the monitoring and quality assurance with the matron. The enrollee belongs to the community and can talk to major stakeholders in the community. With that, the providers and the staff in that PHC will need more detailed information on how to render services.”

Speaking on interventions of OYSHIA, Akande revealed that despite the low turnout for the insurance scheme the capitation gotten so far has been used to renovate 8  PHCs and two general hospitals.

He expressed  hope that  more people will  be enrolled to improve healthcare services in the state, saying, “the wonders of health insurance are obvious. We can talk about the capitation in health facilities. In the state hospital in Ogbomoso, they have public toilets constructed using capitation, they have antenatal centre constructed, pharmacy centre constructed with capitation; state hospital Saki, had a laundry, pharmacy and presently they are doing a dental centre. Various hospitals have solar power using their capitation. 

“The state hospital theatre, was also reconstructed using capitation. A lot of inventions are ongoing in hospitals in Oyo state based on capitation while 60 per cent of the premium goes back to the facilities. 

The executive secretary noted that the state hospital employed doctors, pharmacists and nurses who are being  paid from capitation, adding that it is a marriage between the government and the agency. 

“This is what agencies and agencies of government should be doing. They should be aligned to deliver on the mandate of the government and that’s what OYSHIA is actively doing and we will continue to do. I have the governor of Oyo state to thank. They are injecting one billion naira into OYSHIA. No government will inject that kind of money into an agency that is not working.”

He described  health insurance as the most viable aspect of healthcare financing that any country will want to get into, adding that to increase the ecosystem and  getting more lives insured, health insurance should be mandatory.

” What we should begin to have a conversation around now is how to enforce mandatory health insurance. We should also be discussing how we should deepen service delivery and how enrolee will begin to experience better services in various hospitals of their choice,” he stated.

Asked if the agency is planning to increase the premium due to economic hardship and inflation, he said,”there is no plan for increment. The challenge is that the insurance plan is selling for N13, 500 and I haven’t covered 10 per cent of the population. An increment to sell for N26,000 is giving me a hard rock to climb. We are not looking at increment.”

“What we did was that, we had two premium packages of N8,000 and N13,500, so we left the N8,000 package for group enrollment for the adoption model, while the individual package for N13,500. We are not thinking of increasing rather, we want to push and get more numbers to enroll in the scheme. The more number we get, the better. 

He appealed to mothers to get enrolled and enjoy the benefits of the basic healthcare services and also take their children under the age of five to the hospital for care.

He also appealed to all stakeholders to donate to vulnerable groups, saying that the state is enrolling 100,000 vulnerable groups and we still need more people to enrol. Your money makes no meaning if the poor and vulnerable do not taste your riches. 

At the Oyo State Secretariat Clinic, renovated by OYSHIA,  the Chief Nursing Officer, Mrs. Olayemi Adaramoye, told journalists that  some of the civil servants enrolled on the insurance scheme,  do have misconceptions and reservations about the lack of drugs, adding that despite these, they believe  that the scheme is very important.

According to her, “some of them do not like insurance, some have said it because they don’t have access to drugs, but here they have access to the doctor and every health personnel,   and we attend to them immediately. People come around to the clinic because they love to get treatment and  they know that when they are sick they don’t pay. 

“Some also say they don’t fall sick and so no need to be enrolled. We have had cases when some will say they don’t give them enough attention where they are enrolled. Here in the clinic, I can say that on a scale of 100 the turnup for insurance is 99. The civil servants and non-civil servants come to the clinic to get treatment. Although, we have restricted it to the civil servants alone so we don’t get our facility overwhelmed,” she said.

She stressed the need for an increase in advocacy on health insurance through all communication platforms including social media to explain the benefits of the scheme. 

“Public sensitisation is also needed to capture the informal sector. Not everyone has access to the internet, but taking the advocacy to the market women and men is also very important. Insurance is good and saves lives. Being on insurance guarantees access to equality healthcare,” she stated.

At the General Hospital, Aremo where OYSHIA has major interventions such as renovation of the existing buildings and construction of a new diagnostic centre, women undergoing antenatal session commended the Oyo State government and OYSHIA for introducing health insurance, especially for mother and child care.

Addressing journalists, the Apex Nurse,  Mrs. Felicia Olapeju Oladejo disclosed  that the number of enrollees into the scheme have been growing every day as  people including mothers who come for immunisation, have been sensitised on the importance of the insurance scheme. “when they come for immunisation, we explain the meaning of OYSHIA to them , and tell them how much they are going to pay and that it will last them for a year.

Asked how it has impacted maternal and child health, she stated, ” it is fantastic. People are coming because of its low cost . For instance, if they want to do surgery for OYSHIA patients, the money will be reduced unlike non patients who pay N150,000. They like and appreciate it .

The  Director Planning , Research and Statistics, OYSHIA, Mr. Joseph Oyewale stated that the list of enrolles  are updated on a monthly basis and sent to every hospital, adding that every patient must come in with their ID cards which will be used by the health workers to attend to enrolees. 

“This effort is replicated in every hospital . All the enrollees that want to pick this place will come here. We also allow people who are staff to see a doctor and they can attend to as many patients as possible.”

 Asked how the facilities help in curbing deaths of children and women, he stated, “when we first started in May 2021, we held a programme for women and we did pap smear and free cervical screening;  and we even went ahead to ensure that those that needed advance treatment were arranged with University College Hospital (UCH).

He said so far OYSHIA has renovated 10 health facilities in Aremo, Oyo, Bashorun, Ojoo, Ajibode, Orayan  and Staff Clinic, Secretariat, among others.

He stated that the equipment at the  clinic before renovation were obsolete, adding that the agency  considered the upgrade because most of the women and children live nearby. 

A civil servant and an enrollee, Ms. Oreoluwa Adetona described the scheme as wonderful saying that she and her mother had been on it for the past three years when they were treated for malaria, dental care, and  arthritis. She said one of the challenges encountered was that they were told that the scheme only covers limited health challenges and that the  hospitals need to enlighten  enrollees what their insurance covers so that they will not be cheated on their rights.

The Director Marketing and Quality Assurance for OYSHIA, Mr. Steven Dauda , expressed delight that the agency is renovating in order to touch many lives, saying  that a lot has been done in creating awareness through radio programmes and jingles.

“However a lot of the problem is their purchasing power to take up health insurance to pay the N13,500. If you are coming through a group or association, you can pay a monthly installmen

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