PLAN-Health Program Supports Launch of Community-Based Health Insurance in Akwa Ibom State, Nigeria

 {Photo credit: Samuel Edet/MSH} A large crowd observes the festivities.Photo credit: Samuel Edet/MSH

There is no way we can achieve the presidential mandate of 30 percent health coverage by 2015 without tapping into Nigeria’s informal sector. Community-Based Health Insurance (CBHI) is therefore a veritable tool to ensure wider coverage, increased ownership, and an entrenched culture of health insurance among the Nigerian public. 

~ Dr. ‘Femi Thomas, National Health Insurance Scheme (NHIS) Executive Secretary/Chief Executive Officer

Less than 10 percent of Nigerians currently benefit from health insurance coverage through the mix of public and private sector platforms led by the National Health Insurance Scheme (NHIS) and State initiatives and Health Management Organizations (HMOs). People in the “informal sector” in Nigeria—small-scale business owners, farmers, traders, artisans, and others—have very limited access to coverage.

Akwa Ibom State Launches Community-Based Health Insurance Scheme

[A cultural dance troupe in an elaborate display of colors entertains guests at the launch.] {Photo credit: Samuel Edet/MSH}A cultural dance troupe in an elaborate display of colors entertains guests at the launch.Photo credit: Samuel Edet/MSH

Talking drums, acrobatic dancing, and colorful costumes heralded the official launch of the first Community-Based Health Insurance (CBHI) scheme in Akwa Ibom State, Nigeria this summer. The CBHI launch—a joint venture between the Akwa Ibom State Government, the National Health Insurance Scheme (NHIS), and the US Government, through the Program to Build Leadership and Accountability in Nigeria’s Health System (PLAN-Health) and other development partners—is expected to enhance community health system enrollment and demand for services.

The event was hosted on behalf of His Excellency the Governor of Akwa Ibom State, Dr. Godswill Akpabio, by the State Commissioner of Health, Dr. Emem Abasi Bassey, and supported by Dr. ‘Femi Thomas, National Health Insurance Scheme (NHIS) Executive Secretary/Chief Executive Officer, and MSH Country Representative, Dr. Zipporah Kpamor.

State Executive Council members, local government area (LGA) leaders, NHIS management committee representatives, traditional rulers, and about 800 community members attended the event. Even the elements were kind during the ceremony held at the Primary Health Centre, Ukana West Ward II, Essien Udim LGA, signaling the state’s commitment to achieving Universal Health Coverage (UHC). The sun shone brightly in synch with the spirit of festivity, and the thunderstorm typical of Nigeria’s mangrove swamp regions waited until the tail-end of the ceremony.

[Ukana Ward II Clan Head (3rd left) and village chiefs.] {Photo credit: Samuel Edet/MSH}Ukana Ward II Clan Head (3rd left) and village chiefs.Photo credit: Samuel Edet/MSH

Delivering the Governor’s address, Bassey called the event a symbol of the State government’s commitment to its social contract with its people:

[The CBHI launch was] driven by the strong desire to ensure that effective and affordable healthcare is accessible to every person in the state, relieving people of the financial burden associated with health-seeking activities, particularly at the point of care.

Action towards this pilot program began in 2012. Collaboration and technical assistance was provided since inception by MSH through the PLAN-Health Program which remains the key technical partner supporting the State on CBHI and bringing demonstrable experience and expertise from implementing CBHI across Africa, South America, and South-East Asia.

PLAN-Health is a five-year capacity-building intervention funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID), led by Management Sciences for Health (MSH) in Nigeria’s Federal Capital Territory, Akwa Ibom, and Gombe States.

Bassey described some of the specific interventions that facilitated the CBHI schemes’ successful take-off, including a learning-tour to existing CBHI programs in Lagos, presentations on the Kwara CBHI programs by PharmAccess made available for knowledge-sharing, and development of handbooks outlining CBHI principles and funding models.

A feasibility study undertaken to determine the scheme’s viability and establish functional parameters to guide its operations was conducted by NHIS in Essien Udim LGA in close collaboration with MSH. NHIS had requested that states identify three LGAs for support (Essien Udim being one of the three), and donated a bus to the Essien Udim scheme.

[Dr. Femi Thomas, ES, CEO, NHIS, delivering his address at the ceremony.] {Photo credit: Samuel Edet/MSH} Dr. Femi Thomas, ES, CEO, NHIS, delivering his address at the ceremony.Photo credit: Samuel Edet/MSH

Thomas said this is just the beginning:

NHIS is set to launch Community Based Health Insurance Programs in at least three Local Government Areas of each state of the Nigerian Federation before the end of the year. This is to ensure we meet the Presidential mandate of scaling up to 30 percent of Nigerians by 2015.

Thomas appealed to governors to invest more resources in developing and sustaining the culture of health insurance in their states, as opposed to relying on multiple health sector interventions which may be less sustainable in the long run.

[Dr. Zipporah Kpamor, Dr. Femi Thomas and Dr. Emem Bassey at the CBHI launch event.] {Photo credit: Samuel Edet/MSH} Dr. Zipporah Kpamor, Dr. Femi Thomas and Dr. Emem Bassey at the CBHI launch event.Photo credit: Samuel Edet/MSH
Kpamor applauded the Akwa Ibom government’s concerted efforts to position its health sector for effective, efficient, and quality service-delivery. She linked the support of the state’s health sector to MSH’s mission to “save lives and improve the health of the world’s poorest and most vulnerable people by closing the gap between knowledge and action in public health.”

Kpamor named healthcare financing as one of the key areas of technical and financial support to the State, under which the Lagos study-tour was held, as well as formation of a technical working group to coordinate implementation of the pilot CBHI program. "For community-ownership, we helped to revive the Village Development Committees across the 15 villages in Ukana West Ward II as well as Ward Development Committees,” Kpamor explained. This, along with the costing of the CBHI benefits package, feasibility studies, and the training of stakeholders, she stressed, underscore MSH's role as the only USAID implementing partner building a CBHI Program in Nigeria.

Kpamor commended NHIS and the government and people of Akwa Ibom State, for providing an enabling environment for the success of the program and expressed deep appreciation to the US government through PEPFAR and USAID for the funding provided.

The lively and inspiring CBHI launch served as a starting point for the formation of a more responsive health system in Akwa Ibom State, and an altogether unforgettable experience for the people of Essien Udim.

Ifeoluwa Alabi, MSH Nigeria communications intern, contributed to this content.

Photo credits updated, Nov. 10, 2014.