LAGOS STATE HEALTH INSURANCE SCHEME
Lagos State Government in its bid to ensure that its residents have access to quality health care services irrespective of gender economic status or location, without suffering financial catastrophe, commenced a number of activities.
1. 1. The Lagos State Community-Based Health Insurance Scheme
In 2007, the Community Based Health Insurance Scheme (CBHIS) was proposed as an integral part of the broader State Health Insurance Framework which would provide social health protection coverage for the poor, informal sector population as well as underserved communities. Under this arrangement, the scheme is to be scaled up to every local government in the State in order to create the stimulus for demand for health insurance all across the State.
The Scheme is targeted predominantly at the informal sector workers, and offers a package of prepaid healthcare services for enrolled members of the community. The projected outcome of the intervention is the conversion of the current prevalent out-of-pocket payments for healthcare into prepayments which is more progressive and equitable.
The pilot Community-Based Health Insurance Scheme; the Ikosi-Isheri Community Based Health Insurance Scheme was launched by the Lagos State Government at the Olowora Primary Health Centre on July 23rd, 2008. The scheme is presently in its sixth year of operations and has enrolled 19,991 people since inception.
The Ibeju-Lekki Community Based Health Insurance Scheme was launchedon the 2nd March, 2011 in two facilities; Awoyaya and Iberekodo Health Centres. The scheme is presently in its 5thyear of operation and has enrolled 10,162 members since commencement.
On the 15th of January, 2013, the State launched the Ajeromi Ifelodun Community Based Health Insurance Scheme at Tolu Health Centre. The scheme is currently in the 2nd year of operation and has enrolled up to 9388 lives since inception.
The scheme’s concept represents a collaboration between the State Government, the Local Government and the Private Provider with the latter providing an element of Public-Private-Partnership. The Ministry of Health being the initiator of the scheme subsidizes the capitation being paid to the provider, perform oversight functions and provides technical support.
The Local Government provides the Primary Healthcare Centre for the scheme, provides maintenance services for the facility and security, ensures the availability of an ambulance for emergency services as well as assist in monitoring to ensure no interference or disruption of the services rendered by the provider.
The Private Health Care Provider staffs and manages the health facility, provides drugs and consumables, offers prepaid primary health care services to the registered enrollees, provides and maintains documentation to assist in monitoring and evaluation of the scheme and is charged with the responsibility of adherence to given quality of care – personnel, drugs etc
1.3.1. Benefit Package and Premium
The benefit package offers enrollees and their dependants primary healthcare services at the Community Based Health Insurance Scheme Health Centres with basic outpatient care, treatment of common ailments, provision of prescribed essential medicines, immunization, maternity care, normal delivery, health education, short-stay admissions.
The enrollees, to ensure access to the services at the facility, prepay a premium of N1200.00 per family of six persons per month or N600.00 per person per month.
1.3.2. Healthcare Provider (PPP model)
Services are available on a 24-hour basis at the CBHIS Healthcare Centres which is being managed by contracted private health care practitioners whose responsibility it is to staff and stock the facility with drugs and medical consumables. Members requiring services outside the scope of the benefit package are referred to the nearest State owned secondary care facility –where these are entitled to a 25% discount on care received by those who fall outside the coverage of the State’s Free Health Scheme. In addition, ambulance services for emergencies are available by the health centre’s LGA/LCDA ambulance services or via the Lagos State Ambulance Service.
1.3.3. Scheme Administration
The scheme is managed by Board of Trustees, members of whom are selected principally from the community with a representative from the LGA/LCDA (Medical Officer of Health). They delegate their authority to the administrative staff either deployed by the LCDA/LGA or employed by them, and these in turn, manage the daily activities of the Mutual Health Association office. These officers perform the critical functions of Registration, Premium Collection, ID Card Issuance, Care Authorization, Scheme Reporting, Provider Management and Scheme Marketing.
1.3.4. Morbidity Profile of Members
Morbidity profile of the enrolled population shows that the common diseases encountered at the clinic include Malaria, Respiratory Tract Infection, Diarrhoeal Diseases, Hypertension and Diabetes Mellitus.
1.4. Assessment of Ikosi Isheri CBHIS
A Rapid Assessment of one of the schemes, the Ikosi-Isheri CBHIS, was conducted for the State by Partnership For Transforming Health Systems II (PATHS 2) in December, 2012. This was to enable the State examine uptake and challenges of the Scheme.
1. 2. Identification of the Indigent
For the Government to provide for the indigent in the society in an objective manner, the Ministry of Health embarked on the training on the use of Poverty Wealth Ranking tool for the determination of the less privileged and indigent in the State in June and July 2012. This was to help in identifying those to whom Government subsidy should be targeted for health care services. The use of this method of identification of the indigent is limited in Lagos State because it is most suitable for small villages and communities where persons in the community can classify households according to their socioeconomic status.
Thus, the State in collaboration with PATHS2 developed a Poverty Assessment Tool which was piloted iin Ikosi-Isheri and Ibeju-Lekki in October, 2013 to ascertain if the tool were ideal for Lagos State and if there was a need for modification. The result of the pilot showed that there was a need for the modification of the some aspect of the tool which was subsequently carried out.
1. 3. The Lagos State Health Management Agency Law
The law on “The establishment of the Lagos State Health Management Agency, To Institute The Lagos State Health Scheme For All Residents Of Lagos State And For Connected Purposes” was signed into law by the former Governor of Lagos State, His Excellency Mr Babatunde Raji Fashola on the 25th of May, 2019. Prior to this the bill was processed thus:
• 1st Stakeholders forum held at the House of Assembly – April 9th, 2014
• 2nd Stakeholders forum held at the House of Assembly – November 7th, 2014
• 2nd Reading at the House of Assembly – November 10th, 2014
• Public Hearing – January 9th, 2015
• 3rd Reading – May 6th, 2015
• Governor’s Assent – May 25th, 2015
The Law is to ensure that all citizens of the State have access to quality healthcare services without catastrophic financial outcomes.
1. 4. Health Financing Policy
The Honourable Commissioner for Health, Dr Jide Idris constituted the Health Financing Technical Working Group (HFTWG) on the 19th of February, 2015. The HFTWG has amongst its responsibility, the facilitation of the development and implementation of the State’s Health Financing Policy.
The Lagos State Health Financing Policy is premised on the guiding principles of equity, risk sharing and solidarity. It represents the collective will of the Government and citizens of Lagos State to achieve Universal Health Coverage. It was developed using a participatory approach led by the 17-member health financing technical working group. It involved a series of commissioned studies on health financing practices, collation of evidence and best practices from the African region and beyond, technical discussions and extensive policy consultations.
The draft Health Financing Policy was circulated to relevant stakeholders on the 2nd of June, 2015 for their review and comments in preparation for the validation of the document.