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.
