By Iyke Obi Durumba
Mallam Fatuhu Ibrahim is a small holder farmer with a fertile plot in Maiadua, Gagarawa LGA of Jigawa state which is part of the state government’s Cluster Farming Initiative. One day his 15yr old son, Khalid, felt a sharp pain in his lower abdomen while working with his father on the farm. By the following morning, he had to be rushed to the hospital where he was diagnosed with a ruptured appendicitis and required urgent surgery.
The cost of the surgery was beyond his normal means as his farm could barely feed his large family. Resorting to native herbs and traditional treatment, his son appeared to get better but sadly passed away.
It is for the prevention of unfortunate cases like Mallam Fatuhu’s son and many other similar cases that Jigawa state recently flagged off the state’s health insurance scheme whose sole objective is to provide universal health coverage for all residents. With the provision of a health insurance scheme, the prospect of achieving universal health coverage in the state has become a reality.
Jigawa is a North Western state whose Human Development Indices are not very attractive especially in the health sector. According to MNCH2, a UK govt funded programme, infant mortality stands at 83 per 1000 live-births and Maternal Mortality Ratio is 1,100 per 100,000 live births.
However, the Gov. Badaru Abubakar led administration has prioritized healthcare delivery in the state by building 83 new Primary Healthcare Centers, four new General Hospitals and two new Specialist Hospitals in the last five years. According to the Governor, paying adequate attention to the physical infrastructure is not enough as affordability of services must also be ensured to enable all Jigawa people have access to quality healthcare. The social health insurance scheme being put in place now is envisioned to provide residents of Jigawa state access to the health services they need without incurring high out-of-pocket payments.
The vision of the state Governor Badaru Abubakar to improve access to quality affordable healthcare received a big boost when the state government launched the State Contributory Health Insurance Scheme for civil servants in Dutse the state capital last week.
The scheme is planned to extend primary and secondary health coverage to people who cannot pay, such as the poor and the unemployed, who will have their contributions subsidized by government at full roll-out.
At the launching on Tuesday, Gov. Badaru Abubakar was officially enrolled and registered in the social health insurance program. The Head of Service was similarly enrolled to kick off the first step in providing accessible healthcare for the people with the enrollment of civil servants. It is estimated that over 70,000 workers (families and dependents) will benefit from health services under this phase of the scheme.
The history of health insurance in Nigeria is rooted in the National Health Insurance Scheme Act of 1999 but it was not until 2005 that the scheme became operational. By 2015, only a disappointing 3% of Nigerians had been enrolled and so, to accelerate the realization of Universal Health Coverage, the 59th Nigeria National Council on Health in 2017 approved states to establish their own health insurance schemes. Following this approval, Jigawa joins other states like neighboring Kano, Lagos, Oyo, Anambra and Akwa Ibom in creating its own health insurance scheme.
Jigawa state government established a health insurance agency called the State Contributory Health Care Management Agency via law No7 of 2019 in Dec 2019 in order to reduce health inequity and improve universal health coverage. The agency is mandated to operate both formal and informal sector health insurance.
To show seriousness and give the scheme the necessary executive support, Gov. Badaru Abubakar released the sum of N100m to the agency as start-up funds within 6months of its existence. This is in addition to providing official accommodation for the agency and the appointment of a management team of six directors and an Executive Secretary.
The agency has so far accredited 160 health facilities to start service delivery in August 2020. Already government workers have started paying monthly premiums for the last 3months in the formal sector of the scheme. Premium payment is according to salary grade and structure.
Under the scheme, there would be a contributory deduction of N4,000 from the salaries of each worker on Grade Level (GL) 14 and above. The state would deduct 3,000 from each worker on GL 10-13; N2,000 from worker on GL 7-9 and 1,000 from worker on GL 1-6.
Dr Mahmud Abdulwahab, Director Programmes, State Contributory Health Care Management Agency, had earlier provided those details in March at a one-day advocacy meeting with labour union leaders drawn from Jigawa Northeast Zone.
The director said the scheme covers a contributor with his or her five dependents to access health care services free on a visit to a health facility. These health care services include both primary and secondary health care services.
Speaking with Daybreak News, Abdulwahab expressed optimism that the scheme will extend to cover other contributors who are not civil servants. “We expect that subsequently we will start operating informal sector health insurance which will cover those people that are self employed,” he said.
“In addition the state government has already started paying to the agency the sum of 75million naira on monthly basis to serve as equity fund. This money will be used to cover for the health services of vulnerable groups that are not either formally or self employed, particularly women and children,” Abdulwahab said.
With a population of nearly 5m people who are predominantly rural-based farmers, the take off of the health insurance scheme will dovetail effectively with the energetic expansion of healthcare facilities to provide citizens like Mallam Fatuhu the opportunity to obtain decent health services when needed. Governor Badaru’s deepest desire of giving the poor and downtrodden a chance at a decent life may have found full expression in the health insurance scheme. Jigawa state has indeed taken a huge leap towards unlocking the wealth in the good health for her people.
