Health insurance: Delta plots harvest of one million informal sector enrollees

3rd August 2023

From Paul Osuyi, Asaba

With a total coverage of 1.4 million enrollees into the contributory health insurance scheme, Delta State Health Commission, operators of the scheme, is not excited.

The commission said it has not done enough as it has only scratched the surface, considering that the total population of the state is estimated to be in the region of six mllion people.

Even out of the 1.4 million enrollees, no fewer than 1.2 million were plucked from the low-hanging fruit of the free maternal and under-five treatment that was in existence before the introduction of the health insurance scheme in 2017.

The 1.2 million enrollees are under the equity plan of the state government. The beneficiaries do not pay the annual premium of N7,000.00.

From the balance figure, 170,000 were also enrolled from the pool of the state’s civil service, which is the formal sector, while the informal sector accounts for just about 20,000 enrollees in the scheme.

The figure of enrollees from the informal sector, according to the acting director-general of the commission, Dr. Alfred Ebiakofa, is grossly unsatisfactory, and will not enable it to meet the overall objective of universal health coverage for all.

As such, Ebiakofa said the commission would intensify awareness campaigns with a view to enrolling over 100,000 persons by September 5, 2023, when the Governor Sheriff Oborevwori administration would be 100 days in office.

Addressing participants at a sensitisation campaign, Ebiakofa said what is used to assess the success of the scheme is the number of enrollees from the informal sector, adding that the aim was to increase the figure to over one million before the end of the year.

He told participants that over 80 percent of the reasons people go to the hospital for treatment are covered by the scheme, noting that with the payment of the N7,000 premium, the enrollee can access treatment for various ailments such as diabetes, hypertension, malaria, diarrhea and surgeries as may be needed.

“Health insurance is to help save for your projects and at the same time, a little amount is taken from you. With N7,000, if the enrollee has diabetes, he will get his drugs for one year; if he is hypertensive, he will take his drugs for one year.

“If he has both conditions, he will get his drugs for that one year. If you are not in the scheme, N7,000 may not be enough to take drugs for one month if you are diabetic or hypertensive.

“We are able to manage the situation because it is like Osusu, we collect from everybody and put in one big bag and shake it and then wait. When people say they don’t benefit, we know that it is about 15 to 20% of the population that goes to the hospital every month.

“And there are people who for three, four, five or six years, may not even take paracetamol. But the problem is you may not be sick, the person next door may carry a condition that will develop in him and be transmitted to you. So you need to guide against that,” he said.

Ebiakofa later unfolded his plans to hit the one million figure for the informal sector enrollees before the end of the year in a chat with health reporters.

He said the commission is mounting a campaign at the moment by encouraging politicians and other well meaning Deltans to key into its plan to celebrate Oborevwori’s first 100 days in office.

“Our governor will be 100 days in office by September 5. We are trying to see that on that day, we can release 100,000 people that will go to the hospital and get free treatment.

“So, we are mounting a campaign to those who are well to do to come on board with us, we are asking them to sponsor at least 100 persons in their respective communities. If 1,000 people sponsor 100 persons each, that will be 100,000,” he explained.

Another strategy, according to Ebiakofa, is to encourage low income earners key into local drift system of making daily contributions of meager amount until they are able to raise the N7,000 premium.

“There is this N100 cooperative, where the people contribute N100 daily. For some people. N7,000 is a huge amount. For instance, If you ask a woman selling plantain to give you that amount at once, you may have eaten up her capital.

“Some people contribute N100 for a day and if you are consistent for one month, we will register you by taking loan from micro finance bank to complete it while you continue paying.

“In that case, you pay for 90 days to make up the amount and there will be N2,000 extra which is used to offset the loan and pay those going round to collect the drift. That makes it easy for some people to join the scheme.

“The assessment of any successful health insurance programme is the coverage, what percentage of the population are you covering? And the better assessment is what percentage of the informal sector are you covering? In that area, we have not done well.

“But on the other side, coverage of the vulnerable, mother and child going to the hospital and getting free treatment, we are doing well. For the formal sector, we are doing well. The formal sector and organised private sector are not up to 20% of the total population,” he added.

On alleged cases of medical malpractice by healthcare providers who short change enrollees, Ebiakofa said the commission has zero tolerance for sharp practices but added that such cases were hardly reported for drastic actions to be taken.

Ebiakofa also debunked claims that enrollees were being administered substandard drugs, noting that globally, health insurance is not run on brand names, and explained that the cost of the drugs is usually reflected by the socio-economic level of where it is produced.

“Most people prefer Coartem for malaria treatment. Coartem is anthemetam and lumefantrine combination. And in the market we have about eight to ten different brands with such combination. One of them is Lumantem. Before now, it was sold for N400 when Coartem was sold for N1,500. They are the same thing, the same chemical.

“What people don’t understand is that it is not the cost of the drugs, the cost of the drugs is usually reflected by the socio-economic level of where it is produced. A drug produced in England for instance, quality for quality, will be almost five times the cost of the drugs produced in China or India.

“But it does not mean that there are no fake drugs because some people will meet manufacturers to produce certain drugs at substandard levels. We thank God for NAFDAC, such instances have reduced.

“There is this psychological thing with drugs. If you meet a good doctor, he can give you what is called placebo because of the way he talks to you.

“Some people have this psychological attachment to brand names in drug administration. The cost of drug has nothing to do with its efficacy, it is as a result of where the drug is produced,” he noted.

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