{MAGAZINE} Health: Domesticating Health Insurance In Osun

Restore Healthy Living is one of the six-point integral action plan of the administration of Governor Rauf Aregbesola in the State of Osun, and in line with this, the state government has made arrangements to domesticate the Health Insurance Scheme with a view to making healthcare system readily available for all. FRANCIS EZEDIUNO writes on the efforts made so far by the state government in this regard.

Nobody saves money for health issues, but when it does come knocking, scarce resources are made available to get the best treatment one can afford. However, in a case where money is not available and the best health care is absent, what does one do?

The question of health should be of utmost concern to every human being, because the human body is like a machine which needs adequate maintenance. If left without regular maintenance, there is tendency for the supporting mechanism to start showing signs of wearing off, so also, is the human body. There is need for constant medical check up because as the body ages, there is the need for total revamp in terms of medications to boost healthiness and vitality.

African governments have been known to have the populace-welfare agenda and therefore people have on several occasions enjoyed free education and health policy, but emphasis being more on health. Subsequent governments therefore, because of some financial constraints took steps to restrict the free medical treatments for mother and child; particularly pregnant women and breastfeeding mothers and children under the age of 0-5 years.

This policy had worked for some times until recently when reality dawn on governments at various levels such that it has made free health care services and provision became nearly impossible.

What now is the way out? True to fact, government’s aim is to provide free basic medical services for its citizens.

Wisely, the federal government provided a soft landing by way of enacting a health insurance policy. Free health is not the norm again and health insurance is the way out.

Initially, the free health scheme had worked successfully for previous administration in the state of Osun, a major reason why the present administration deemed it necessary to make it a part of its six-point integral action plan of ‘Restoring Healthy Living’.

Originally, the implementation of the free healthcare system in Osun went smoothly, as various health based programmes were rolled out one after the other, in accordance with the stated aim and objectives of government plans. The major beneficiaries of the free health programme in the state were the aged, children under the age of 5, women and the vulnerable.

Unfortunately, due to no fault of government, the free health programme became undesirable which necessitated the steps being taken by the state government towards localising the National Health Insurance Scheme (NHIS).

The NHIS was established by the administration of Chief Olusegun Obasanjo in 2004 and it has enjoyed some level of successes, but the lack of enlightenment amongst the citizenry has kept the programme at the far corner from the people it’s meant to cater for.

Already, the NHIS has been viewed as an elitist programme due to inadequate enlightenment on the part of government but surely, the way out of the myriad health challenges besetting the nation is to domesticate the national health insurance policy, bring it to the state level, so that even the poor of the poorest could afford health at a relatively low cost.

The aim of domesticating the health insurance policy in the state is to act as an alternative to the free health programme embarked upon by the state government which for the economic situation ravaging the country, could not be sustained.

There is also a political will to it as a popular saying goes; “where there is a will, there is a way”.

The Rauf Aregbesola administration wants to leave behind a lasting legacy that would be a reference point for future administration in the state, the Southwest geopolitical region and indeed the whole of Nigeria.

The health insurance policy works in this way; the rich will pay and the poor will also pay; medical attention would be based on the principle of equity, where at a certain pocket-friendly amount, sound healthcare will be made available to all and sundry either in a public or private health facility. Accessing health care either at the primary, secondary and tertiary levels would be made affordable.

Taking a look at the society, illiteracy and ignorance have been an hitching factor and when health challenges come knocking, the poor and vulnerable prefer to resort to either self medication, local health initiatives and by the time the health status worsens, it would have been too late to render any adequate medical intervention. By then, death will be inevitable.

Many Nigerians may see the idea of contributing a certain amount of money for health insurance as a waste of money due to the fact that some may stay for months without having any health issues.

Alas, when it finally comes knocking and a comparative analysis is made, the actual amount paid for the health insurance scheme would be little compared to the total cost of securing good medical intervention.

The services may be attributed to the poor, but what of the rich who may think that in the event of such, they would simply seek medical care from the medically advanced countries with good health care track records.

What is National Health Insurance? According to UNICEF: “it is a government managed insurance plan, seeking to enrol the entire population into some financial and risk pooling insurance mechanism or set of mechanisms with the aim of removing the financial barriers to attaining Universal Health Care (UHC)”.

A visit to medical institutions in the state will reveal a parlous state of affairs.

How can one fathom a situation where in a public health facility, the rich have money and they cannot access health care, except they visit a private facility; and the poor who do not have the financial wherewithal hence patronising these public health facilities but do not have money to get essential drugs they need. Added to this is also that they do not have the money to procure expensive treatments from private facilities and they end up dying a needless death.

These and other problems are why the health insurance scheme needs to be implemented nationwide and domesticated in the State of Osun.

The number of needless deaths amongst the state’s poor and vulnerable population is increasing and it is not because some of them are ignorant of the need for adequate medical care, but it is due in part to the fact that “the spirit is willing but the flesh is weak”, meaning the financial resources is lacking to get drugs and health care and when death comes, they ignorantly accept it as the will of God.

The earlier the health insurance policy is domesticated the better.

In the recent past, the state government has strengthened other organs of the Ministry of Health by constituting the State of Osun Hospital Management Board, creating the State of Osun Primary Health Care Development Board and with the recent move by the state government to bring UHC nearer home. The creation of the Osun State Health Insurance Scheme (OSHIS) and its mother agency became inevitable with the appointment of a competent hand as the Executive Secretary in the person of Dr. Niyi Oginni who has been saddled with the responsibility of running the affairs of the new agency.

With the track records of the new Executive Secretary, one would hope and pray that the crises befalling the NHIS would not be the case of OSHIS.

The government of the day has not hidden its desire to send a Bill to domesticate the health insurance scheme in the state.

Already, the agency to supervise the scheme had been created and staffed, hence, what is next is the Bill which would be sent from the Executive to the legislature.

Last week, a consultative forum was held in Osogbo where experts from the NHIS, state Ministries of Health, Finance, Justice and other partner agencies brainstormed for two-days before arriving at a draft Bill which had been forwarded to the State Executive Council for approval.

As the Executive Bill is yet to be sent to the Osun State House of Assembly, a media enlightenment session was held recently where journalists were educated and sensitised on the advantages and the need to embrace the health insurance scheme whether at the national level or when the state starts its implementation.

Dr Ogini while speaking at an awareness programme stressed that public health services should be considered part of the social safety net which is the responsibility of government to provide for all people.

“Governor Rauf Aregbesola wants free health care services for his people but at the same time he realises that it cannot be totally free, he knows that it cannot be hundred per cent possible, hence the creation of the Osun Health Insurance Scheme becoming a necessity.

“It is the desire of the Governor to deliver quality health services to the people of the state on a basis of equity, I want to assure the people of the state that through the O’HIS, the death of children under five will be greatly reduced in Osun.

“The scheme would be operated on equity where those who do not have money can have access to quality health services and we want it to succeed so that Osun will be an example to emulate”, Ogini stressed.

Another question which will be left to answer will be whether the scheme should be made optional or compulsory.

The writers opinion on this is that it should be made compulsory because it is a part of the core component of this administration’s policy thrust.