Attahiru Aishetu, a young woman living in Bacita, Kwara State, Nigeria, had obstructed labor: a potentially deadly condition if high quality, emergency care is not available. Fortunately, Attahiru had health insurance and was referred with her card to Ogo Oluwa Hospital where she delivered a baby boy through emergency cesarean surgery. Her family members were surprised when she told them they did not have to raise money for her treatment, since her expenses were covered by her insurance. She named the baby boy, in gratitude, Hygeia, after the community insurance plan that may have saved both their lives.
Dr. Peju Adenusi, the Executive Direct of the Hygeia Community Health Plan recounted this story when we asked her recently how having insurance for the first time had an impact on people’s lives. “To her it’s such a big deal, something great,” she said, “it was a turnaround in her life to hold a live baby, and all she had to do was pay about two dollars for care throughout the year.”
Hygeia Community Health Plan (HCHP) was launched in 2007 in two Nigerian states, Kwara and Lagos, in partnership with PharmAccess and the Health Insurance Fund, a Dutch-based fund that subsidizes the premiums. The plan which is expanding to a new area of Kwara interested us so we rang Adenusi to find out more about how they designed this unique financing scheme.
How many people do you cover with HCHP?
At the end of March, we had over 75,000 people enrolled, and we hope to get an additional 25,000 with the expansion in both Kwara and Lagos. We serve women’s associations, farming communities, trade groups, or entire rural communities. A few examples of groups covered by HCHP:
- Market Women Associations, Lagos
- Lady Mechanic Initiative, Lagos
- Shonga and neighboring communities, Kwara
How did you design the product?
We normally do a study on a group we think can benefit from the scheme to determine their income level and what they are willing to pay as a co-payment for insurance. We then do market research to learn more about their health care seeking behavior: focus group discussion, questionnaires, and household surveys.
Does the product cover all illnesses for 2 dollars a year?
For N300 paid by members, it is quite a robust package. It covers a lot of communicative and non-communicative diseases: Hypertension, malaria, child health (ARI, diarrhea), pregnancy delivery, immunization, even c-sections and minor surgeries. We picked the illnesses covered by looking at the burden of disease in that area. What makes us stand out is that the package also covers AIDS medicine, supplied through Global Fund grants.
Health insurance is new for many people in Nigeria, so how do you market it?
It’s not necessarily health insurance specifically but in general the concept of insurance is rather new in Africa, it’s not really something we are used to. If you ask me how many things do I have insured in the home, I would tell you car is probably necessary, but home? The percentage of people who insure their home is very, very low. People think, there is no guarantee that I’ll be ill that year and if I’m not ill I won’t have to access care. People wonder, how do I access the funds?
The only way people become convinced is when they start accessing health care services and realizing what they are getting. They were getting the quality health care services and they tell their peers, this is real. We’ve tried it and it works. We encourage them to market the scheme to their peers. They get some commission on each person they bring into the program. Community members trust each other.
Why did you start by marketing to women working in the Lagos markets?
You need the population for the program. The Lagos Women Market Association is the single largest association in Lagos—we have had more than 40 markets participating in the scheme.
Are women and others more likely to seek health care when they are covered by HCHP?
Yes, they are. In Kwara for example the level of utilization is now really high. The health care center was almost as good as dead in Shonga—3 or 4 visits per month—and when the program started the level of utilization moved up to maybe 1000 visits in a month.
With the subsidy coming from the Dutch government’s Health Insurance Fund, is Hygeia’s plan sustainable?
Eventually, when people begin to enjoy and appreciate the benefits of self-insurance scheme—benefiting from service far above what you have paid for because of the pooling effect—the schemes will have gotten to the level where they would able to pay for health insurance scheme without it being subsidized. Co-payment is not going to be a stagnant figure we will review it as we move along and try to increase as we move along.
And actually in Kwara, the state government has passed a bill in December to provide an organizational and financial structure for health insurance for less privileged people of the state. Governor Dr. Bukola Saraki wanted to assist the low income earners in the state. The chairman of the House Committee on Health, Hon. Bisi Oloruntoba noted that the deadly diseases often affect these categories of people in society.
What else can government do to support community health insurance?
Governments can encourage cooperatives within groups to serve as financial support or backup for health insurance. If daily earners put aside certain amount of money every day, there is a lump sum that the group can use. My personal suggestion is that these groups should be linked to microfinance institutions properly.
Thanks for your time, Doctor Adenusi! Best of luck in growing this promising initiative. Click to view more photos at CHMI's Flickr stream.