Lagos Health Insurance Scheme Will Be Accessible, Affordable To Residents – Adenusi

 Chioma Umeha

Dr. Peju Adenusi is the General Manager of Lagos State Health Management Agency (LASHMA).Recently, she  spoke to select journalists on the operation of the newly launched Lagos State Health Scheme  and the role of individuals and families in making it successful. CHIOMA UMEHA was at the briefing

On the unique features of the Lagos State Health Insurance Scheme

I will start by giving an overview of the scheme. The Lagos State Health Insurance Scheme (LSHS) came about through a law that was enacted in 2015 and that law makes health insurance mandatory for every resident of the state. Its main objective is to provide quality healthcare services, which is accessible, affordable to the residents of Lagos state and in so doing, reduce, if not eliminate the financial catastrophe that arises from huge medical bills.

Three entities were derived from the law. We have the LSHS which is the programme, we have the Lagos State Health Management Agency, (LASHMA), which is the agency that has been established to supervise and coordinate the health scheme activities in Lagos state. The third entity derived from the law is what we call the Lagos State Health Fund. The Lagos State health fund serves as a basket of funds with various sources.

Insurance generally is a relatively new concept to us in Africa and Nigeria is not an exception. Insurance is just a culture that we are not used to and health insurance is not an exception. When you tell people to come and pay money for a health event that can take place in the future, the quickest thing that comes to mind is that there is a sickness/illness. So, why do I want to pay for sickness in advance? Am I praying for illness? With our religious background, the first reaction would be: “God forbid! I reject it. It is not my portion.” So, it becomes very hard to convince people.

The irony in it is that it is a practice that is common among us, but we don’t know that that is what we have been doing. For instance, if someone in a group runs into trouble related to health and that person can’t afford it alone, that person would rally round and people would begin to contribute money for her. So, the concept is there with us.

Health insurance is just putting that practice that is already with us in a structured manner. It is a communion thing. It is a form of solidarity. So, we come together, we pull our funds together, we pull our risks together and we pay for one another. When I say health insurance, we are just putting it in the right structure.

From what I have said, you know that those that are worst hit are the vulnerable, the poor people in our society, and so, in coming up with what is it that can be of benefit to everyone regardless of their social status, their financial background and that is where the issue of equity comes in, the state government came up with health insurance scheme.

LSHS and Universal Health Coverage (UHC)

Just as it is on the global movement, we are talking about Universal Health Coverage, (UHC). That means everyone should have access to health, regardless of their background and one of the ways of achieving this is through health insurance. If it is implemented the way it should be implemented, there will always be funds which are the financial in the pool to take care of health issues.

However, it is also important to note that there is no health insurance programme that covers all health conditions and for us also to be able to demystify the issue of insurance that it is only for the sick, pregnancy is not a sickness, and that is why I like using the word health condition. Going to the hospital to give birth is not a bad thing. That is something that is exciting and we all look forward to and we can also say that this is something that is planned, but there are other health conditions that come and are not planned for. Sickness does not write to anyone to say I am coming, so, prepare for me. When it comes, there has to be a way to cover the cost that may arise from such a condition.

Should Lagos residents trust the scheme?

When the National Health Insurance Scheme (NHIS) came, I am sure people have trust and that is why people enrolled into the scheme. But let us keep that aside. The healthcare delivery system may not be at the level that we want it to be. I talked about the UHC and I also talked about the main pillars which are accessible, equitable, quality and financial protection. I believe that the Lagos state government has thought this through and has taken this as part of the health sector reform strategies. I also did mention to you that one of the things that will be happening within the scheme is the quality improvement programme that is engaging the providers on a continuous basis to make sure that what is being provided is what is promised to the people.

Services provided under the LSHS

So looking at all these, the Lagos State Government decided to come up with the LSHS and looked at what are the common ailments that make people come to the hospital and can actually cause a financial burden to the people. Health insurance is always developed to address the needs of the people, at least the basic needs. So, if we look around us, we would find out that the common illness are malaria, common childhood diseases that are preventable through immunisation, diarrhoea and the long communicable diseases like hypertension, diabetes, and all these services can be rendered at the Primary Healthcare (PHC) level, which is what the benefit package seeks to address.

However, we also know that there are some conditions that go beyond the PHC level and these are the things that we considered before developing the benefits package. It is a starting point. You start small, and then you can build on that package. It is a dynamic package. However, we have to take a step at a time and that is why what is being pushed forward now is just one single health benefit package plan that cuts across and like I did mention earlier, these are conditions that we have seen that regardless of who you are, your social status, your background, where you live, whether urban or rural, these conditions can happen to anyone.

Relationship with the Lagos state chapter of NMA regarding the scheme

The unit of participation concerning the scheme is at the facilities and not membership, it is not as an association. So you come as a facility. LASHMA  is dealing with all facilities as a facility. I have not encountered any challenges. There was an advert toward the end of 2017, asking facilities to indicate interest to come on the scheme. I told you that they have to express interest, it is not automatic, so you have to say, I want to be part of the scheme and as many that have said that and have been assessed by HEFAMAA  and have scaled through the HEFAMAA process and have also scaled through the procurement process of Lagos state, are on board. Those who are yet to join have come to make enquires, we hear from them almost on a daily basis that they want to be part of the scheme and they are well informed on what to do to come on board.