Private intervention helping Nasarawa residents reduce out-of-pocket spending

Ensuring equal access to quality health services without financial hardship is  critical to achieving Universal Health Coverage (UHC). However, Nigeria, Africa’s most populous country, still has a lot to do to achieve UHC. Over 71 per cent of Nigerians pay for healthcare out of pocket, according to the National Health Accounts, leading to financial hardship for some.

To expand health coverage, state governments across the country started their State Health Insurance Schemes. Their plan was to cover more citizens to reduce out-of-pocket expenditure on health.

Nasarawa State, in north-central Nigeria, started its health insurance advocacy from the informal sector. These include the aged, vulnerable, persons with disabilities and generally people who don’t have any formal employment in the public or private sector. As of December 2022, the state had about 100,000 enrollees under the Nasarawa State Health Insurance Agency (NASHIA).

Collaborating with the private sector

A major component of strengthening health systems to achieve UHC is through public–private partnerships (PPPs). It enables governments to collaborate with the private sector in pooling resources and accessing technical skills to improve the health of the population.

An example of the PPP in achieving UHC in Nasarawa is the fund provided by Christian Aid (CA) to pay premiums for 400 persons across five wards in the Lafia Local Government Area of the state. To implement the project, CA worked with a local organisation called Development Government International Foundation (DGIF), which focuses on the aged, vulnerable and PWDs. Using five approaches, DGIF worked with community leaders and other informal groups to identify the vulnerable people in the community.

Identifying the vulnerable groups

DGIF and NASHIA identified stakeholders by working on three broad themes. The first is capacity building for the community mobilisers on the promotion of health insurance in the community. The second is advocacy and resource mobilization for the enrolment of the poor and vulnerable while the third is the sensitisation of beneficiaries of the Christian Aid adoption and other existing health insurance subsidization programmes e.g BHCPF, on the right health-seeking behaviour and the appropriate use of the health insurance benefits. The third also included modalities involved in getting access to healthcare and advocacy to influential personalities on resource mobilization for the enrolment of the poor and vulnerable people in the community.

In reaction to the financial burden lifted from many people in Lafia, Martha Samuel, one of the beneficiaries of the programme, thanked Christian Aid for their support during her pregnancy till delivery.

“The health insurance card has helped me very well because when I was pregnant and it was time for me to deliver. I only paid very small money and I used to collect medicine every week,” she said.

Hussaina Atiku, another beneficiary of the programme, narrated how she has battled with a long history of asthma, and how the programme helped finance her medical bills.

“I am one of the beneficiaries of this programme. Under this project and with the help of NGN12,000 health insurance, I have been well taken care of, and I still have more services to utilize before the insurance expires. I even went there twice, and they gave me oxygen without paying anything.”

Sekinat Sanusi, the programme officer for DGIF, identified that there was minimal access to the political class to secure their buy-in for the adoption model. She said this was due to heightened political engagements in preparation for the 2023 general elections.

In addition, the project sought to engage existing organized community contributory platforms such as Village Savings and Loan Association (VSLA) and cooperative societies towards ensuring these platforms are used to collect premiums. However, there was difficulty in identifying these platforms in the communities where the project was implemented, she said.

To ensure the sustainability of the project, community ownership was put into context in every activity. All community-based activities were championed and coordinated by the Community Resource Persons (CRPs). They were well-informed about the duration of the project from inception and the importance of sustaining the interventions was over-emphasized. Supply-side issues will continuously be addressed at the monthly Ward Development Committee meetings, she said. Also, a good relationship and communication line was formed between the NASHIA team and the community focal person.

Furthermore, the WhatsApp group for the CRPs will remain functional beyond the project duration so that the DGI Foundation and NASHIA teams can receive feedback from the CRPs and guide them accordingly.

It is expected that the provisions in the Vulnerable Group Fund in the recently assented National Health Insurance Authority Act will be a window of opportunity towards ensuring the sustainability of the subsidisation of health insurance for the vulnerable populations in target communities.

This story was produced in partnership with Nigeria Health Watch through the Solution Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.