TimeAfrica explores the fascinating backstories behind the rare success of the Delta State Contributory Health Commission (DSCHC) in providing health insurance to the poor in the formal economy and informal sector through its community-based, Delta State Contributory Health Scheme (DSCHS).
The Director General of the DSCHC is Dr. Ben Nkechika who has continued to show commitment in expanding Universal Health Coverage as part of the broader efforts of Governor Ifeanyi Authur Okowo to foster his Administration’s legacy based on rapid socio-economic development of Delta State. The Governor established the DSCHS to expand access to healthcare, as a tool to reduce the financial burden; it was also the option most compatible with the government’s core ideology of providing affordable healthcare to the entire population of Delta State.
The Secretary to the State Government, Chief Patrick Ukah in a recent interview said: “The Contributory Health Scheme in Delta State has really helped the State Government to provide Primary Healthcare to our citizenry. Before we came in, it was a bit in a sorry state and the Governor being a Medical Doctor institutionalized the scheme which he started in the Senate. And thank God we have very good and knowledgeable people in this field like Dr Ben Nkechika and Dr Akpovbeta who pioneered it. Today, children under five (U-5) and women going for deliveries have Free Healthcare.”
Again, one question that is top of mind for millions of people is: what does the future of scheme look like after Gov Okowa administration? But, impressively, many of the debates and discussions inside the DSCHC often illuminate on improving and sustaining healthcare beyond the present administration.
Consequently, Dr. Nkechika is committed and confident to ensure coverage of the entire State’s population even as he has simplified healthcare experience for patients, improved quality and enhanced enrollment to ensure access to health coverage for everyone.
Achievable are the dreams of Dr. Nkechika but not without constraints. Health financing is a very difficult situation in Nigeria right now because the Financial Institutions are not prioritizing healthcare financing, more so, because they don’t understand it. And again, because the government is financially constraint in most instances and they are not able to invest adequately to get all those primary healthcare centers working.
Moving forward, Dr. Nkechika has built and still building Public Private Partnership to surmount this challenge, reason because health experts have opined that the private sector is in a better position to accelerate transparency, best practices and innovations to enable access to quality and affordable healthcare. “85% Healthcare Providers are from the primary healthcare system which means that if you don’t have 85% of healthcare providers properly functional, healthcare delivery would be majorly sub-optimal and which is not ideal,” the Director General said.
Recently, Dr. Ben Nkechika was interviewed on the national television after hosting an all-important stakeholders conference titled: Expansion of Health Insurance Coverage in Nigeria: The Position of the Delta State Contributory Health Commission.
Excerpts of the interview, edited for clarity.
From what we understand, this is an initiative that came on board in 2018. This is 2022 and that is enough time to say if it has worked or it hasn’t worked or it is work in progress. What exactly has it been?
It has worked and it is still work in progress because it’s not a programme that has a destination. It is a programme that is supposed to evolve across the country until we’re able to achieve Universal Health coverage by the year 2030.
It would be nice to have a picture of what it was before this A2F programme. Apparently, the major issue here is finance. How have you been able to access finance in this four years that it has been on?
In 2015 when this administration came on board, we did a critical review of the Healthcare system and the Healthcare challenges across Delta State. Interestingly, phenomenon came on board. We visited all the primary healthcare centers that were functional and open. The Nurses have devised means of accessing finance to be able to run the facilities. So, we set up the Health Insurance Scheme which basically capacitated the people to be able to afford healthcare services at little or no charge. There were vulnerable people who were unable to pay, thus the government pays for them. Next, we did an analysis of the healthcare facilities available to provide the care and we realized that there were areas of the state in which healthcare services were just not there. And these are hard-to-reach areas, difficult terrains and rural communities. We tried to find out what was happening and realized that because of the terrain and environment, government workers were not willing to go there to work; private hospitals were not willing to go and set up there due to financial risk involved. But there are people living there and they are entitled to healthcare. That was what led to the A2F strategy to provide healthcare finance repayable loans to the private providers to go to those rural communities to set up and provide care and Healthcare finance repayable loan to Govt healthcare facilities that are capable of efficient healthcare resource management.
We know that out of pocket for healthcare is strenuous for everybody but in terms of outcomes, can you give us in figures in real terms for the Contributory healthcare system; what the coverage is like for Deltans and for the hard-to-reach communities, the private partnership you have had, how many of those health facilities have been upgraded, face-lifted or whatever you are doing there?
Currently, the Delta State Contributory Health Commission has 1.2 million enrollees registered into the scheme that’s basically the highest in the country and that’s because we have been very strategic in getting that done. And the critical part of our strategy is to ensure that we cover the people that don’t have access at all first into the healthcare system and gradually bring in the people that have some form of healthcare service delivery. That’s why we first concentrated on children under five (U-5), pregnant women who are very vulnerable and people that are poor and unable to afford healthcare or Health Insurance.
Currently, we have 15 facilities operating under the A@F program, we have six private providers providing care. The program has come up with a situation where Doctors are now going to the creeks to stay, work and we devised a model in which we create environment that they deserve and make sure they provide them with catering, laundry and all that. They stay there, work happily, take their time off, another Doctor comes to cover up for them. And that has provided tremendous outcomes.
You actually talked about major success factor in this programme which is a political will. This looks like a template that you want to use across the country. What are you doing in that direction to make this the norm in every part of the country apart from Delta State?
That was why the programme today was well advertised and we invited a lot of stakeholders because, first, we had to ensure the framework was workable; that the framework would determine outcomes. So, today’s event was that the Dutch Government in partnership with Pharmaccess Foundation who provided some guarantees for it now got an independent Consultant to do an impact evaluation study of the programme. Dissemination of that report was done today, providing an opportunity for stakeholders to come up with modalities and structures that could now scale it up across the country.
What are some of the deliverables going forward? What are some of the suggestions that came out of this event that you are running with?
The first thing is that there has to be the strong political will. Our Governor, Sen. Dr Ifeanyi Okowa, was very purposeful, very pragmatic and very practical. He gave us the full mandate to ensure that everybody in Delta State have access to quality healthcare service delivery irrespective of the person’s geographical location or social economic status. The next is that there must be a proper framework, a proper analysis to determine what the people need. Because most times healthcare is thrown at people without understanding what they need. The next is to have a mechanism in which the providers are encouraged and provided with incentives to provide healthcare with guarantees that their services delivered would be compensated adequately.
If you want to make this template nationwide, what were the stumbling blocks you came across?
The first and most significant is the fact that people had a lot of mistrust in government and so, you find that even when you come up with such programme they don’t believe it. But we realized that the best way out of it is develop the champions, remain open, remain resilient and you find that when people take a chance on it and they see it’s coming out well, then, they become the advocate across. So, that ability to remain resilient while ensuring a purposefully determined strategic framework that is implementable is very important for success.
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