Lagos Leaders Share Success Factors for a Viable Community-based Health Insurance Scheme

Dr. Jide Idris, Lagos State Commissioner for Health (middle), Dr. Barry Smith, MSH Nigeria Country Director (right), and Permanent Secretary, Lagos State Ministry of Health during an interactive session with participants at the ministry headquarters. {Photo credit: MSH.}Photo credit: MSH.

Many Nigerians are recognizing that community-based health insurance (CBHI) can increase access to healthcare services. Since 2008, Nigeria’s Lagos State Ministry of Health has been piloting CBHI schemes in Ikosi-Isheri and Ibeju-Lekki local government areas. Enrollment in the CBHI has grown, with more than 16,000 enrollees in Ikosi-Isheri alone. Out-of-pocket healthcare spending by low-income earners has been reduced. According to Lagos State Commissioner for Health Dr. Jide Idris, the pilot communities are responding positively, despite challenges in implementation.

In September 2012, fifteen participants from two Nigerian states, Akwa Ibom and Gombe, toured the two pilot local government areas to learn from their successes, sponsored by the PEPFAR- and USAID-funded Program to Build Leadership and Accountability in Nigerias Health System (PLAN-Health) project, led by Management Sciences for Health (MSH). The participants met with officials of the Lagos State Ministry of Health, CBHI scheme service providers, and Boards of Trustees from the two areas and visited three communities already implementing CBHI schemes: Iberekodo, Awoyaya and Olowora.

The leaders of the pilot areas in Lagos shared five key success factors for CBHI schemes: strong commitment from all levels, an active board of trustees, quality services, community involvement, and a plan for sustainability.

The first factor is strong commitment at all levels. “What is important is that the government, especially the State Ministry of Health, the local government areas, and the Boards of Trustees must be committed. If you get these three levels of commitment, the rest is very easy,” said Dr. Wale Atoyebi, Board of Trustees Chair in Ibeju-Lekki.

Second, the Boards of Trustees must be strong and active. “It is the Board of Trustees that really holds the scheme. If you want to have a successful scheme, the Board of Trustees must be strong,” said Mr Kunle Solesi, Board of Trustees Chair in Ikosi-Isheri.

Third, the scheme must provide quality services. “Quality of services is a key issue, it is a selling point,” said Dr. Tosin Ijimakinwa, Health Financing Officer, Lagos State Ministry of Health. “A doctor must be around 24 hours and all services must be available,” added Dr. Femi Ogunbekun, Technical Adviser to the Board of Trustees in Ikosi-Isheri.

Fourth, the community must be adequately mobilized and involved. Dr. Ijimakinwa said, “Community participation is very important, because if you can get the community members involved they will not let the scheme die.”

“You have to do a lot of education on the importance and benefits of the scheme,” added Mr Solesi.

Lastly, you must have a sustainability plan. “Sustainability is a major issue; people are very reluctant to provide that money upfront,” said Dr Idris.

“It is a very good scheme but you must consider sustainability before you start,” said Mrs. Grace Akinbayo, Matron at Olowora PHC.

The participants were impressed with the tour and are certain that CBHI can help finance health services and minimize health challenges in their states. Yerima Danzaria Kumo, a participant from Gombe State said, “It is possible. It is an impressive program that can improve the health indices if implemented in the states.” Participants used information gathered from the tour to develop a two-year strategic implementation plan for applying CBHI in Akwa Ibom and Gombe states.