BRIEF ON THE LAGOS STATE HEALTH INSURANCE SCHEME

• Background:

 The Lagos State Health Financing Policy was developed in Y2014 as tool to articulate strategies to bridge the health financial gaps and develop sustainable health financing directions, with focus on innovative exploration of alternative sources of financing.

In furtherance to the health financing policy, Lagos State Government enacted the Lagos State Health Scheme Law in May 2015 which establishes the Lagos State Health Management Agency, the Lagos State Health Scheme and the Lagos State Health Fund.

DETAILS OF LAGOS STATE HEALTH SCHEME:

The Lagos State Health Scheme addresses accessibility to quality health care services, financial protection from huge medical bills, private sector participation, equitable distribution of healthcare cost, efficiency, demand and resource pooling. The Lagos State Health Management Agency is to promote, regulate, supervise and ensure the effective administration of the Lagos State Health Scheme and the Health Fund.

Under the health insurance arrangement, funds are contributed by individuals and families and are collected into a pool called the Lagos State Health Fund (LASHEF). Risks and resources are thereby spread over the population with the healthy and rich helping to pay for the sick and poor resulting in significant risk protection from huge health expenditure.

There are 3731 registered health facilities in Lagos State made up of 460 public health facilities and 3271 private health facilities, according to the State health facility directory. Thus the purchase of health services from both private and public sector providers is to promote equity and improve physical access to qualitative healthcare services by residents.

PROGRESS MADE SO FAR:

Since the enactment of the Law, the Ministry commenced intensive preliminary technical sessions to ensure the operationalization of the Law. A Core Implementation Team (CIT) was set up comprising of relevant technical persons and stakeholders even from the private sector and donor community to draw up a blueprint to facilitate the effective roll-out of the Scheme.

The Following activities have commenced:

1. Conduct of Technical Studies required for the LSHS start-up.
   • Fiscal Space Analysis
   • Actuarial Studies
   • Impact Evaluation
   • Provider Payment Mechanism determination
   • Health Financing Governance Structure Assessment

The Fiscal space analysis, actuarial studies, provider payment mechanism determination have been concluded while the impact Evaluation is still on-going.

2. Documents Developed:

• The Lagos State Health Scheme Operational Guidelines
• Business Process Manual
• Actuarial report
• Benefit Package
• Provider payment Guideline
• Proposal on the Lagos State Health Fund(LASHEF) & Equity Fund Set-up.

3. Development of an Information and Communication Technology (ICT Platform) for the LASHMA. The Ministry is currently liaising with the Ministry of Science & Technology in order to develop a platform that will ensure strong information flow which is essential for monitoring and evaluating program implementation, ensuring compliance with established rules and regulations, preventing fraud, and making decisions about rewards and sanctions. Currently the ICT Systems Architecture is currently being developed

4. Advocacy/Social Marketing Program for the LSHS: The Ministry has been engaging with different stakeholder groups on the LSHS- Lagos State Coalition of Tradesmen and Artisans (LASCOTA), Health and Managed Care of Nigeria, Health Care Practitioners Association of Nigeria, Pharmaceutical Society of Nigeria, Associations of General Private Medical and Private Nursing Practitioners of Nigeria, Lagos State Royal Fathers, CDCs from various LGAs, the Lagos Chamber of Commerce and Industry, heads of relevant MDAs (employers of public sector labour in the State), Trade unions and cooperative heads .

5. The Lagos State Health Management Board composition is being finalized. Approval has also been given to constitute the Steering Committee

6. Positioning the Health Facility Monitoring and Accreditation for effectiveness:

• E-HEFAMAA – undergoing testing
• GIS mapping of all health facilities – has been finalized
• Outsourcing of HEFAMAA functions work in progress
• Health facility monitoring tools developed
• Development of empanelment guidelines is on-going
• HEFAMAA Handbook has been finalized