DSCHC Focuses On Community Engagement Through Indigent Support Programe

By Jonathan Onwuka
 
Achieving Universal Healthcare Coverage is a desire of every government. In line with this, the Delta State Governor, Senator Dr. Ifeanyi Okowa introduced the Delta State Contributory Health Scheme and established the Delta State Contributory Health Commission with a mandate to provide access to quality and affordable healthcare for all residents in the State, in line with the National Health Insurance Act of 2014.
 
The Director General and Chief Executive Officer of the Commission, Dr. Ben Nkechika provides insight on the activities of the commission as well as their plans for the year.

“For this year, our focus is on community outreach. What this means is that we are taking the message to the rural communities at the Ward Level. What we intend to do is, every Ward in Delta State will have a liaison officer. The person’s job is to go from house to house and talk to the people about the health insurance scheme and communicate with enrollees for their challenges as well as provide feedback to the Commission because service should reach the last man.

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“There is a community engagement activity which is tied towards the Indigent Support Programme. The idea is to register every resident in every community in the state into the scheme. After registration, those who cannot afford to pay Premium for health insurance will be supported to pay from a pool of donated fund. Those that can afford to pay will be encouraged to pay full of periodic part payments. This will ensure no body is left behind in access to healthcare services under the health insurance scheme.

“Moving forward, we will ensure to reach out to all civil servants and artisans to register into the scheme, and ensure their service satisfaction. What this means is that we are taking the message to all, including rural community dwellers. We have done the urban and now moving into the rural populace. In light of this, the DSCHC has been meeting with various groups including Keke Napep/Okada Riders Association members, Market Men and Women Associations members, who will be branding and doing advocacy and sensitization for the scheme.”

Speaking on the mandate of the Commission, Dr. Nkechika said that “the Delta State Contributory Health Scheme is not a healthcare service provider but a healthcare financing system. All we do is, accumulate money and use it to finance access to healthcare for enrollees. It is the responsibility of the healthcare providers to provide quality care contained in the benefit package. Healthcare providers are the healthcare centres, the government hospitals and the private hospitals we have accredited. Their job is to see the enrollee, provide care and send us a bill. Ours is to register the enrollee, collate their data and send to the healthcare provider. When the service is provided and they send the bill, we crosscheck whether the bill is in line with the service given to the enrollee (that is the patient), and if the patient is satisfied with the care received. Every patient that goes to the hospital is expected to sign an Encounter Form that “I have accepted and I am happy with this treatment”, if the patient does not sign, we will not pay the healthcare provider.

“So you can see the distinction. In healthcare financing, it is called demand and supply, and there is always a split; so we are demanding for healthcare services on behalf of residents of Delta State; the hospitals are supplying healthcare services in line with our demand. It is necessary to have this distinction.

“In the law, there are provisions that have been made that if there is demand for healthcare services and the hospital does not provide it, there are sanctions. Similarly, if the hospitals provide healthcare services and the Commission decide not to pay the approved bills, there are consequences. In view of this, receipt of Capitation money from the Commission means acceptance to provide quality healthcare for our enrollees. That is how it works. First the commission is a healthcare financing organization; it is not a healthcare service organization. Secondly, it is mandatory for every resident in Delta State; not indigenes alone. Once you are resident in Delta, you ought to be part of the scheme.”
 
Explaining the difference between primary and secondary healthcare, the DG stated that “healthcare service starts from the primary healthcare level. When it is beyond the primary healthcare service level; you are referred to the secondary healthcare facility. It is important that where you receive primary healthcare should be near your house; so that it is easy for you to be seen and to be referred where necessary. But we know that our primary healthcare centres have challenges in terms of manpower, equipment and drugs; but we have been working with them and that’s why we have selected some that meet the basic requirements. We have also advised the primary healthcare centers that, once a patient walks in, if all you can do is to take the basic information; name, age, etc. and you see that you cannot treat, just refer. There is no point playing around with the patient. There is a referral request code that every hospital should request for referral; once a Primary Healthcare Center makes that code request, (“I have a patient, he has this problem, we cannot manage, we are requesting for referral”), referral is granted.

Continuing, he explained, “We want to advance service capacity too; which is to ensure that all primary healthcare centres in Delta State meet that minimum standard of care that will encourage an enrollee to come, and the way to do it is through community participation. Once people own a system, it will work. So the community people should be the ones going to the hospital to say “this hospital has this problem; this hospital, the nurse does not come to work” or “they lock the hospital at 2am.” Ours is to intervene and correct it.”

On the issue of compliant by enrollees, the DG stated that the commission is aware of the challenges and has put modalities in place to address them.

“We are aware of this problem, we have been sending out bulk messages in the last two months in partnership with the State Orientation Bureau. The problem is that if an enrollee goes to a hospital and does not receive proper care, and does not inform us, it makes it impossible for us to act, because we act based on feedback.”

“For example, there was an enrollee who went to a HCF to receive treatment and he was told to buy the recommended medicine outside. He told them to sign and they did and he went outside, bought the drugs and subsequently wrote us a letter explaining all that transpired and that he paid Two thousand five hundred Naira for the drug outside.
 
“Two thousand five hundred naira is small money, but for the significance of that action, we invited him to congratulate him for doing that and he will get a refund of the money.
We invited the HCF to come and explain why they sent that patient away to go and buy drugs; a service covered under the Scheme.”

“We also don’t want the burden to be on the enrollee that is why we are expanding our feedback mechanism. We have had meetings with all stakeholders in the scheme (the primary healthcare centres, Hospital Management Board, the Commissioner for Health and others) on how to resolve the problems we have identified. We usually do spot check by calling patients as a way of follow-up.”
 
On the issue of sustainability of the widows welfare scheme, the DG assured that those captured in the scheme that still have their ID cards will receive treatment because government has already paid their premium.
 
“Governance is continuous, so long as they are in the scheme and they are holding the ID card, they are obliged to receive treatment. Government pays their premium every year. The widows’ programme is to support widows that are poor. The fact that you have been granted access to this programme, government has classified you as poor. So what government is doing is payment into the Equity Fund plan to support their care. The only challenge we had then was that, most of these women are rural dwellers; so they live in rural communities and the only facility available to them is the primary healthcare centres in these communities, and the primary healthcare centres are the ones that have the challenge. That is why it is looking like those widows were not getting service. But we have decided to revitalize these primary healthcare centres. We are bringing private sector to run the ones that have been abandoned completely under the Access to Finance Programme and we have already done fifteen. The key point is that; there is a statutory provision in the law that, anyone classified as poor will benefit from the Equity Fund Programme.

“There is also a component of our law called the Equity Health Plan: it covers pregnant women, children below five years, the elderly above sixty-five, physically and mentally challenged, and any other person considered to be poor in Delta State.”

On challenges facing the scheme, Dr Nkechika noted that, “when you focus on your challenges you will not make progress but you need to look at what you have achieved and how to do better.

“We actually don’t look at our challenges because if one focuses on them, you will not make progress. What we focus on is the progress we have made and how to improve on them and achieve more results.

“Currently, we have the highest number of enrollees in the whole country. In terms of enrollment we have exceeded our one million target. But there is a problem; the bulk of our enrollees are pregnant women and children. The people in the informal sector: Okada riders, market women, plumbers, other artisans and self-employed people are a large part of the population and are not in the health insurance program, so we need to bring them into the scheme so that they too can go to the hospital and receive quality care.

“Also through our ICT system we are now able to monitor the quality of service given to our enrollees and that the bill sent to us is in line with the quality of service given.

“In terms of payment, we pay hospitals their capitation fee every month so there is no excuse as to why they can refuse to provide healthcare services.

Explaining further he disclosed that, “currently we have developed a software that if an enrollee walks into a hospital, their finger print will be scanned, and if is not the enrollee, it will not open access to care. The finger print data is linked to National Identity Management Commission, so it cannot forged. All of these is to ensure that our enrollees get the best of care they deserve.”
 
Conclusively, the DG explained that the Delta State Contributory health Commission is a healthcare financing organization, set up by the State government to implement a mandatory contributory health insurance scheme for all residents of Delta State.

“I will like to clarify the reason we chose that name, ‘Delta State Contributory Health Scheme’. Every enrollee is expected to contribute a token for the year because the government has discounted the amount you are supposed to pay. The government has taken most of the cost that is why enrollees pay a token of N7.000.00 (seven thousand naira) for a whole year and anytime they fall sick they will get care once the service is within the benefit package. We cannot cover every illness but at least the most basic illnesses and diseases are covered.”
 
“Health insurance is for the both rich and the poor. It is also meant to support the poor who cannot afford to pay which is why it is called a social health insurance scheme. There is a private health insurance scheme for people who are rich and can pay more for more healthcare services. We offer you ‘Access to Healthcare services’ irrespective of your Geographical Location or Socioeconomic Status, that is our mandate. No matter where you live, no matter your socioeconomic status, you should be part of the scheme. You are either able to pay health insurance Premium or we find money to support you to pay health insurance Premium through the Indigent Support Program, and that is why the scheme is mandatory for every resident in the State.”