Improving Maternal Care Through Health Insurance

Nursing and pregnant women waiting to receive care at  Agbongbon Primary Health Centre, Ibadan Oyo State, recently.

Efforts to reduce out-of-pocket payments for healthcare, a huge burden on households and individuals remain a mirage in view of the poverty level of Nigerians which is put at 70 per cent. However, health insurance provides financial protection for pregnant women, spreading risks and pooling funds which would make maternal healthcare affordable and accessible, writes CHIOMA UMEHA.

Every day, Nigeria loses about 145 women of childbearing age, making her the second largest contributor to the maternal mortality rate in the world, according to United Nations Children’s Fund (UNICEF). When this statistic was released in 2017, it generated different responses from different people even as many disputed the figure.
Though pregnancy and child birth supposed to be safe and normal, so many women and their new born die due to pregnancy and child birth related reasons, those who survive end up with complications. Here lies the need to increase access of antenatal care for pregnant women.
Antenatal care, also known as prenatal care, is a type of preventive healthcare. The goal is to provide regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy and to promote healthy lifestyles that benefit both mother and child.
Despite that antenatal care increases the chances of the survival of mothers and babies, the cost of accessing the ‘life-saving’ procedure makes it unaffordable to many poor families in the country. While some pregnant women resort to accessing care from unskilled attendants, some deliberately request family members to take the delivery evade payment of antenatal care from skilled attendants in health facilities.
Research has also shown that why many poor women and their families shun antenatal care is due to out-of-pocket payment, a barrier to accessing healthcare globally.
To tackle the issue of out-of-pocket payment and remove the  barrier it poses to many poor pregnant women from accessing antenatal care, the Oyo State Government recently initiated what it tagged, the Oyo State Health Insurance Agency (OYSHIA). This may be just a measure from the south west; it
OYSHIA intervention is in line with the global strategy to achieve Universal Health Coverage (UHC).
The UHC means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services do not expose the user to financial hardship.
At least half of the world’s population still do not have full coverage of essential health services and based on this, all United Nations (UN) member states have agreed to try to achieve UHC by 2030, as part of the Sustainable Development Goals (SDGs).
It was on this basis that the National Health Insurance Scheme (NHIS) established under Act 35 of 1999, was established by the Federal Government to provide easy access to healthcare for all Nigerians at an affordable cost through various prepayment systems. However, 14 years after, less than five per cent of Nigerians are covered by NHIS.
OYSHIA, established 18 months ago is improving health service utilisation and providing financial protection against huge medical bills, according to Dr. Olusola Akande, its Executive Secretary.
He explained that the scheme in Oyo State would protect citizens of Oyo State from financial hazard, spreads the risk among every enrolee, pool the resources and consequently make it available to enrolees that become ill and need treatment.
The good news about OYSHIA is that the services have been made compulsory for all citizens of Oyo State. Akande, said the scheme was targeting 450,000 residents of the state with two per cent of its consolidated fund from the state internal revenue.
In less than two years, the scheme is reported to have made remarkable achievements, which includes over 80,000 enrolees from 33 local government areas (LGAs), 350 vaginal deliveries and 78 caesarian sessions, over 10,000 children under five years and pregnant women covered, creating employment opportunities for residents, upgrading three fully accredited PHCs and seven others at various stages of completion, as well as institutionalisation of engagement platforms for various stakeholders.
The need to use the services from OYSHIA to bridge the gap created by the out-of-pocket payment by pregnant women cannot be over-emphasised in view of the state’s infant mortality rate.
Dr. Adebola O. Hassan, UNICEF’s Health Specialist, said Oyo State is the third largest contributor of new born mortality rate in the whole of the south west.
Explaining why new born in the state were dying, she said although, there was a total of 33 LGAs and 351 wards in the state, overwhelming majority of the nurses and midwives were in urban LGAs and there was no single doctor in three LGAs: Egbeda, Ona Ara, Ogo Oluwa.
Also, she lamented that many citizens demonstrated poor health seeking behaviour, facility utilisation rate for children under five years across all LGAs, adding that only 10 LGAs have more than one per cent utilisation rate.
With the introduction of OYSHIA, Hassan said access to healthcare would be made convenient for citizens because of the method of payment. Apart from making the services mandatory for citizens, accessing health care is also perceived as the human right of people in Oyo State.
Akande further said 100,000 civil servants had been captured, but regretted that despite the success so far, there were still challenges such as negative beliefs, attitudes and customs of people on insurance policies, adverse selection and attitude of health-workers.
Other challenges are enrollees, subsidy and cross-subsidy for the vulnerable groups and the poor, limited resources for advocacy, inadequate and untrained manpower logistics and publicity and enlightenment.
He disclosed that even farmers and others who cannot afford to pay the N8, 000 were encouraged to pay with their farm produce to the agency in lieu of cash. “Many people who would have loved to enrol in our health insurance programme, but lack the financial capacity to pay the premium voluntarily agreed to give us yams and palm oil and other farm produce in lieu of cash to be paid for the premium,” he said.
“In the agency, we have set up a marketing section that is helping us to sell the yams and palm oil and other farm produce and when we sell them, we help the owners to keep the money until it is enough to pay the premium and enrol them.”
Akande said the goal of health insurance was to provide quality healthcare services for the people of the state without experiencing catastrophic health expenditure. Regretting that many people were still not aware of the activities of OYSHIA, he encouraged the media to support the initiative and boost enrolees by creating awareness on the importance of health insurance.