BusinessDay 23 Mar 2018

20 BUSINESS DAY C002D5556
Friday 23 March 2018
Quality, affordable healthcare are
objectives of Lagos state – Jide
The Lagos State Health Scheme Bill w signed into law in May, 2015 is a compulsory health insurance bill established by the enabling law of the state
to ensure all residents of the state have access to affordable and quality healthcare. JIDE IDRIS, commissioner for health tells BusinessDay’s ANTHONIA
OBOKOH that through this scheme, people living in Lagos can be protected from financial distress resulting from huge medical bills. Excerpts:
What is Lagos health insurance
scheme all about?
Lagos health insurance
is a healthcare
financing scheme for
the state; it is a way of
mobilising fund for
the sector, look at the sources
of funds and how you channel
the funds to do what you want
to do. The sector is very huge
and resource demanding. The
law created a fund that is the
insurance fund; it is just a pool
of fund to which contributions
are made. Every residence of
Lagos is expected to contribute
something into this fund by law.
The state government will contribute
its own bit into the fund
in terms of equity fund, local
government too will contribute,
philanthropist who wants to
support or anyone who is willing
can contribute. And if things
go right at the National level, we
also stand to benefit from some
contributions based on their
law the National Health Act.
How is Lagos state planning
to achieve this feat?
We are achieving this feat by
creating a pool of funds which
will be managed by the agency
and the fund is used to pay for
services provided by accredited
providers and because people
are contributing, they have a
choice of who their provider
will be. They can choose from
any of the facilities either from
the public or private. If you are
not happy with any provider,
you have liberty to make complains
to the agency and if your
complaint is genuine and well
investigated, you are free to
change your provider. For those
people who are poor and cannot
genuinely afford the cost of
care, the state government will
take care of it. That is why under
the law, 1% of the consolidated
revenue will go into that fund
every year to take care of the
poor and the vulnerable. But
we need to determine who is
poor because once people feel
the money is there, everybody
becomes poor.
Why the slow pace of implementation?
We are not starting the scheme
100 per cent complete because
we cannot do that in one vessel;
people need to understand the
scheme and be explained to.
But it is going to be a gradual
process, as people see it progress,
more people will enroll. So
that is where we are.
But the key thing again is
that, when we were doing the
actuarial studies, one of the
major challenges is that we do
not have data in this environment.
It is not the problem of
Lagos state; it is the problem
of the country. We thought of
sourcing data from the national
level, so that we do not have
delay, but we realized they do
not have and that was part of
time wastage for us. So we have
to start from the scratch. So
when we are starting, it was not
perfect because of the dearth
of data. But we took a decision
that we must warehouse our
data, hold our data that is why
we are deploying a robust ICT
system which is going to link the
enrollees, the providers and the
Health Maintenance Organisation
(HMOs) we are going to
use. The information will collect
which include demographic, financial
and medical history will
be analysed to plan, so it is very
essential we get the ICT platform
right. So what we are also doing
is that we are talking to different
stakeholders but it is a continuous
thing and we are also engaging
the media through media
briefs. The HMOs we are using,
contrary to what is happening
at the national level, has been
well with us because they have
the institution and the structure
although they needs to be monitored
and controlled, We have
shortlisted about 7 to start with
after the advertisement and they
will be part of the enrollment
process because we are going
to assign them to different local
government.
Is the scheme mandatory for
all Lagos residents?
Unlike the federal level, it is
mandatory and compulsory
for every resident of Lagos state
by law, everybody must contribute.
For those on the NHIS
scheme, we cannot force them
to stop, it will create unnecessary
problem, and our focus is
on those who do not have at all.
In Lagos state, for civil servant,
the government takes care of
75% contribution for the staff
while the staff takes care of the
remaining 25%.
How is Lagos state government
going to address the
issue of easy and quality
access to care for enrollees
on the scheme?
If you look at the totality whether
in primary care, secondary care,
tertiary care owned by the government,
I do not think they
are up to four hundred. And
in these state, if you look at all
the private practitioner they are
over four thousand. So, our focus
is to effectively bring the two
together so that the people will
benefit, that is the issue of access.
You also know that people
have been complaining that if
you go to the general hospitals,
it is always over crowded, long
queue waiting and at the end of
the day some people feel they
are not properly treated or issue
of quackery, which is part of the
fundamental problem within
the system. What we are trying to
do with this scheme is to reorder
that system to address all those
key problems.
How much are the different
health plans for enrollee under
the scheme?
After all the actuarial studies,
government settles to 40,000 for
a family of 6 annually which is
for the basic plan, anybody who
needs extra will pay for extra. If
70 per cent of the population is
covered under this basic care
plan, sickness will go down.
The idea is to maintain wellness
of the people not merely to
treat them; it is a total reorientation.
We want to have these
schemes so that people do not
fall ill, giving them health education,
specific protection, children
who require immunization
are easily provided, quality care
for pregnant women so they can
be monitored, delivery via normal
or caesarean section. These
are the little things that can be
handled at the primary healthcare
level. Lagos state wants to
deal with the basic plan first
and then primary health care is
the picking point, we have two
other plans. Private sector plan
and formal sector plan. There are
other people in the private sector
who already have one plan or
the other, but if you look at the
totality they are less than 5 per
cent of the population covered.
Are there plans for people
especially those in the informal
sector to pay in installments?
Yes we are flexible, we have
plans but not in pieces, there
are provisions for people to pay
quarterly and monthly but we
need to make sure they have
means of paying to avoid cheating
on others, so there is an open
window you have once you
enroll to start paying to forestall
cheating, because if we break it
down, it is 500 naira per person
but you can only access care with
providers in Lagos.