Implementer Perspectives: Know Your Community

_CHMI asked Fola Laoye, Chief Executive Officer of Hygeia Nigeria Limited, to share key lessons from the implementation of [Hygeia’s]( programs. Through its Implementer Perspectives series, CHMI will continue to bring to light the experiences of those working on the ground to improve health markets for the poor._

_**We can only implement successful community health insurance schemes when we understand the way of life of the people.**_ -- Fola Laoye

My organization, Hygeia Community Health Plan, was founded in 2007 to provide affordable and high quality health services to the poor of Lagos and Kwara states in Nigeria. Our enrolment of 124,000 people over three years in prevention-focused health insurance schemes has been predicated on thriving relationships we have built with community groups like farmers and women’s market associations.

Indeed, a vital success factor in the successful implementation of community health insurance schemes is building and sustaining a thriving relationship with the community.

**Cultivating successful partnerships to get community support**

Implementing successful community health insurance schemes requires creating and sustaining partnerships with several parties such as government, providers and communities. Community leaders are extremely important to involve, including heads of traditional, religious and civil groups, age groups, gender groups, and trade groups.

**Determining health beliefs and catering to community needs**

We listen to these people to understand their way of life and health needs. We seek to understand their health seeking behaviour, and they tell us how they would like to access health care. We must also understand what fees community members are willing to pay to enroll in health programs. We do not take it for granted that providing access to health care through insurance will be more attractive than formal or informal alternatives available in the community.

**Community participation in design**

Hygeia involves the community in programme design, management and monitoring and evaluation. We identify which health centres community members patronize and what treatments they seek. All these findings are taken into consideration in designing, marketing and communicating about the program. To ensure a focused, localized approach, Hygeia set up community-based trustee boards to provide guidance to community health associations now leading advocacy, community mobilization and enrolment for community health insurance schemes.

Even with a model effective in certain settings, it is inappropriate to impose a one-size-fits-all model on all communities. Developing an appropriate 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.