Lessons from Nigeria - Health Insurance Fund

Lessons from Nigeria
Fola Laoye
CEO Hygeia Nigeria Limited
BACKGROUND ON NIGERIA
Most populous country in Africa and 8th most
populous country in the world; population of
over 140 million
The health care system in Nigeria is ranked
197 out of 201 countries
Listed among the "N11" economies by
Goldman Sachs, but also noted that the
country’s low Life Expectancy will hamper its
growth potential if not immediately addressed
Nigeria
The healthcare sector is under-developed
because of resource constraints, with total per
capita expenditure of about $22 with 75%
being Out-of-pocket
Government expenditure currently about 6% of
total Government Expenditure & less than 3%
of GDP
Private Sector currently delivers almost 50% of
all care in the Country
KEY HEALTHCARE INDICATORS
Source: WHO Statistical Information System 2003
MMR
(per 100,000)
U5MR
Life
(per 1,000)
Expectancy
53
48
58
41
45
52
Benin
Cameroun
Ghana
Niger
Nigeria
Togo
850
730
540
1,600
800
570
154
166
95
262
198
140
MDG 2015 Target:
75
30
HEALTHCARE FINANCING REGULATORY ISSUES (I)
Necessary to seek alternative sources of financing and
access to health care, shifting to demand-based and
output driven schemes
Led to growth of Risk Pools, starting with formal sector
(public and private workers), directed by regulatory body
(National Health Insurance Scheme) and administered by
Private Sector HMOs
Resulted in significantly increased access to modern
healthcare services
3 million people presently covered nationwide
Adding about $1 per capita to the nation’s healthcare
expenditure
HEALTHCARE FINANCING REGULATORY ISSUES (II)
Approx. 70% of Nigeria’s population outside formal sector, i.e.
most of informal sector and rural communities cannot afford to
pay for health insurance
Their inability to take part in risk pooling & solidarity schemes
endangers them as they remain unable to access healthcare
readily
Additional $18 per capita required to provide necessary
subsidies to bring this 70% into the risk pool, with an
appropriate benefit package to address the health related
MDGs and access to Emergency & Trauma Care
Resulting “unlocked” demand will necessitate a significant
investment in country’s healthcare delivery system, both public
and private, across primary, secondary & tertiary care
5
APPROACH
Collective healthcare
financing system including:
• Pre-payment
• Risk pooling
f in
an
ci
•Introduce a financing
system and subsidise
membership to stimulate
demand
ng
Subsidy
injection
f in
an
cin
g
DEMAND:
Healthcare membership
Medical care usage
•Healthcare revenues are
guaranteed, meaning
investments can be
made in healthcare
quality
SUPPLY:
Quality healthcare
•Higher quality of services
further fuels demand
delivery
ABOUT HYGEIA
OUR VISION
To be the 1st Choice for Healthcare Solutions of
International Standards
in Nigeria
INTEGRATED HEALTHCARE DELIVERY
SCHEME OVERVIEW
CURRENT BENEFICIARIES
Commenced end of Jan 2007 with:
Lagos:
i.
Lady Mechanic Initiative
ii.
Market Women Associations:
currently enrolling in 41 markets
Kwara:
i.
Shonga Community Kwara
ENROLMENT TARGET VS REALIZED
LAGOS
KWARA
TOTAL
CURRENT TARGET
24,000
45,000
69,000
CURRENT REALIZED
15,027
29,966
44,993
63%
67%
65%
PERCENTAGE
ENROLMENT STRATEGIES
OVERVIEW OF HCHP ENROLMENT STRATEGY
• To achieve an enrollee base of 75% of defined target
population of 115,000 by end of Year 5
• To ensure growth and sustainability (renewals) for the scheme
• Marketing activities include Media Campaign using of T.V,
Radio and print media
• Community Engagement through sensitization and awareness
of target groups, Provider involvement, Give-aways, Market
Storm
KEES STORM AT THE MARKET STORM!
UTILIZATION
No of Encounters
UTILIZATION–POST SCHEME COMMENCEMENT
50000
40000
30000
20000
10000
0
Total Utilization
Female
47174
Male
26476
• The enrollees appreciate and are utilizing the scheme
• Over 73,000 encounters since start of scheme
SIGNIFICANT UTILIZATION PATTERNS
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
Malaria
Maternity
Hypertension
URTI
Enteric fever
Malaria continues to be the most prevalent diagnosis
Diabetes
FOCUS ON PREVENTIVE CARE
Malaria outreach exercises including health education,
environmental sanitation, distribution of insecticide
treated nets (ITN)
HIV voluntary counseling and testing
Hypertension and diabetes screening programmes
Free routine check up including Visual screening and
Breast examination
Focus on Maternal Mortality by encouraging pregnant
women to attend at least 4 sessions of Ante-Natal care
DISTRIBUTION OF ITNS
Malaria Outreach Programmes in
Kwara Communities and Lagos Markets
HIV/AIDS OUTREACH PROGRAMMES
PROVIDER SYSTEMS
PROVIDER TRAINING PROGRAMMES
• Training programmes held quarterly in 2007 & 2008
• Trainers selected from PharmAccess, Lagoon hospitals, UITH,
LUTH and LASUTH
• Year 1 (2007) focused on Scheme Management, Maternal care,
HIV/AIDS care, Infant and Child care & Malaria in infants
• Year 2 (2008) focused on Malaria, Hypertension, Diabetes and
Quality Management
• 2009 programmes to target health related MDGs including:
– Malaria
– Obstetric emergencies
PROVIDER TRAINING PROGRAMMES
Training on current trends and basic clinical management with
emphasis on using clinical protocols and preventive care
EQUIPMENT & INFRASTRUCTURE UPGRADE
Equipment Upgrade:
• Providers have been supplied essential clinical equipment
under the Year 1 upgrade plans with 3 year target for
achieving Quality Improvement Criteria
Infrastructure Upgrade:
• All scheduled works have been completed but further
upgrades planned in Year 2
These upgrades have complemented other HCHP quality
improvement initiatives resulting in
improved provider services and patient care
TESTIMONIALS
PMTCT AND MATERNAL CARE TESTIMONIALS
HIV negative baby born to
HIV positive parents
Mother and baby “Hygeia” doing
well after obstructed labour
during child birth
TOWARDS SCALE UP
CONFERENCE ON COMMUNITY HEALTH
INSURANCE IN AFRICA ORGANISED BY HYGEIA
• Held May 8th 2008 in Abuja
• Opened by HE Kwara
Governor Bukola Saraki
• Other Speakers: HE Mr.
Arie Van der Wiel, the
Dutch Ambassador to
Nigeria and Prof. E.A
Elebute, Chairman Hygeia
• Field trip to pilot
community in Shonga,
Kwara State for 30
participants
LOCAL & INTERNATIONAL ADVOCACY (1)
Presentation to Nigerian Governors’ Forum Retreat in
October 2007; seven additional states have expressed
keen interest
Presentation made to DG of WHO, Dr Margaret Chan on
visit to Nigeria in February 2008
Dr Chan supportive of “Shonga model” as exemplary
primary health care delivery system in Africa
LOCAL & INTERNATIONAL ADVOCACY (2)
OECD Countries have recognized need for
innovative financing models to be used to address
Global Health issues
HIF/Hygeia model presented and well received at
the OECD Innovative Financing in Healthcare
meeting on October 7, 2008 in Paris
Global Investors & Investment Banks now building
up core competence in social investments,
especially in the Global Health sector (eg. Goldman
Sachs & FMO with HIF & IFHA)
LESSONS LEARNED
•
Unlocking the Demand Side: Setting Premium levels to cover
Appropriate Care & Financing the Subsidy Gap
•
Investing in the Provider Network & articulating the expected ROI
•
Quality Monitoring
•
Education & Awareness (New Enrolment & Renewals)
•
Community-owned Administrative Systems
•
Use of Technology
•
Advocacy with Key Stakeholders
•
Managing the Risk Pool
•
Product Development
FOUR PILLAR APPROACH TO SCALE -UP
FINANCING
THE
SUBSIDY
PROVIDER
SYSTEMS
MANAGED
CARE
PLATFORM
QUALITY
SYSTEMS
EDUCATION
AND
AWARENESS
COMMUNITY
ADMINISTRATION
33
THANK YOU
Q&A