The Hygeia Community Health Plan (HCHP) commenced operations in January 2007. Working with the Dutch Health Insurance Fund and PharmAccess Foundation the HCHP provides equitable access to affordable and quality healthcare services to individuals in selected low-income communities in Lagos & Kwara states of Nigeria. In my experience a vital success factor in the successful implementation of community health insurance schemes is building and sustaining a thriving relationship with the community.
Implementing successful community health insurance schemes requires creating and sustaining partnerships with several parties such as government (executive, administrative and legislative), health care providers and communities. Of utmost importance is the partnership with the communities and institutions of the community such as the leadership (traditional, religious and civil), age groups, gender groups, trade groups etc. Achieving this partnership requires that we enter the community appropriately, listen to the people, understand their culture/way of life, understand what their healthcare needs are, understand their health seeking behaviour and determine what specific improvements they would like to see in improving access to health care delivery. It is also critical to determine the ability and willingness of the community members to pay enrolment fees. We do not take it for granted that providing access to health care through health insurance will provide a value premium for the community members above other orthodox and unorthodox health care alternatives sufficient enough to attract the community members to subscribe overwhelmingly to the community health insurance scheme in the first instance and to re-enrol after the expiration of their first insurance cover.
It is pertinent to involve the community in programme design, management and monitoring and evaluation. Working with these communities, we identify which health centres they patronize, what treatments should be included in the benefit package of the scheme and how and when to mobilize and enrol them into the scheme. All these findings are taken into consideration in scheme design, scheme marketing and communications. We are only able to implement specific interventions including preventive health care components of the community health insurance scheme when we have understood the way of life of the people. In the communities we work in we have organized the formation of community health associations that spearhead advocacy, community mobilization and enrolment for the community health insurance schemes. Boards of trustees also exist to oversee scheme activities and provide guidance to the community health associations. It is inappropriate to impose a one-size-fits-all take-it-or-leave-it model on all communities, developing the proper model and implementation approach requires flexibility and openness to ideas emanating from the communities. This can only be achieved through a healthy relationship underlined by mutual respect and trust. Our successful enrolment of 124,000 people over 40 months in Kwara &Lagos State has been predicated on the thriving relationships we have built with low income market women in Kwara and farmers in Kwara State