Changing Neo-natal Narrative Through Health Insurance

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Alarmingly, Nigeria ranks third after Pakistan and India amongst the 10 countries with the highest number of new born deaths.

Nigeria’s Neo-natal Mortality Rate, (NMR) contributes nine percent (almost 1 million) to the global number of new born deaths annually (these are children who die within the first 28 days or 4 weeks of life).

In the South Western region of Nigeria, Oyo State is the third contributor of Neo-natal Mortality Rate in absolute numbers while ranking by panta 3, it holds 54th position.

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Health experts say, the first 28 days of life of a neo-nate is when changes are very rapid, hence adequate attention and care is needed for survival.

One may ask, why do these new-borns die? Some of the reasons are; non-affordable healthcare services, unequal distribution of nurses and mid wives to Primary Health Care Centre, (PHCs) in Local Government Areas, high patronage to Traditional Birth Attendant, (TBA) as well as poor health seeking behavior of the people.

However, these barriers to health care remains an important predictor of child survival, reduction in maternal mortality, improved life expectancy of the people and general improvement in health indices.

While other countries and governments are striven to improve access to adequate health care through the elimination of barriers to access, Nigeria still records less than five percent in its National Health Insurance Scheme, (NHIS) 14 years after its establishment.

For these reason, Oyo State government has taken the giant stride to check out-of pocket expenses by bringing affordable, accessible, quality healthcare to its citizens and chart a way towards achieving Universal Health Coverage, (UHC).

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The health insurance scheme is however executed through Oyo State Health Insurance Agency,(OYSHIA), a scheme that covers or shares the expenses associated with healthcare of individuals or families.

The 18 months old health insurance scheme is improving health service utilization and providing financial protection against huge medical bills.

A media field trip to Agbongbon Primary Health Care Centre, facilitated by United Nations Children’s Fund (UNICEF) and OYSHIA, some beneficiaries like, Olufemi Badamasi, a school teacher, a resident in Oyo said, ” i have prayed for a stress-free access to healthcare even before i got married. Like a dream come true, i luckily enrolled into the scheme a few months after i got married.

“I never believed that with just N8, 000 per annum, my wife could have a successful Cesarean Section without paying through my nose. I registered about two months after I got married and the initial payment was made two months after.

“Luckily, my wife got pregnant and gave birth and, since then, I have been paying less to nothing. It may not be 100 per cent success but I am happy with the programme.”

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Also, another excited beneficiary, a six months old pregnant mother, Bukola Adeniji who spoke to our correspondent, said, “I paid only N2, 400 the first time I came and, since then, I have not paid any other money. I am happy with the scheme.

“You see many women in our community don’t have money but since the government introduced free delivery, many of us have been coming. You can see that many people are here now.

“I joined the scheme in March last year. This programme is very good because they take care of us. They give pregnant women all the attention they need. After you deliver, you will be given a bed free of charge.”

For Rashidat Abdullazeez who had her first child in a traditional home popularly known as Traditional Birth Attendant, (TBA) expressed great joy as she is registered in the scheme and receiving all medical attention.

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Abdullazeez said, “I am four months pregnant. This is my second pregnancy and I make sure I don’t miss my antenatal visit and also take my routine drugs because that will ensure my child’s survival.”

This health scheme will in a great measure reduce the high number of Neo-natal mortality in Oyo State if well accessed by its citizenry.

To create accessibility in the OYSHIA scheme, civil servant enrollees are expected, from level 1 to 12, to pay the Standard Plan of N8, 000 as premium per annum inclusive of N200 registration /service fee while, from level 13 and above, will be on the Standard Plus Plan of N13,500 premium per annum.

Talking about the increase in the number of patients, Assistant Record Attendant, Health Records at Agbongbon PHC, Mrs. Adekola Atinuke, said that, the centre takes 40 deliveries in a month and can be more sometimes.

She said, in the past, we used to have 20 to 22 deliveries a month, but last month alone, we had 36 deliveries.

According to Atinuke, “Last year, 2018, we had 905 pregnant women in our record. But in the first five weeks of this year alone, we have over 108 on the list already.

“Although some women are still going to TBAs but since the introduction of Oyo State health insurance scheme, there has been continued increase in antenatal uptake here and the number of other patients at the health centre. More women are now delivering here since they know they will not pay. Sometimes, money can keep them away.”

The doctor in charge at Agbongbon PHC, Fasan Desimola, said she has 600 enrollees under her care out of which government caters for 400 while the remaining 200 are private enrollees.

Dr Desimola said that, “it has not been easy getting people out to come and enjoy this programme but the programme has given more people the opportunity to access care.

“I also have a lot of pregnant women and children under age five who registered free and they are being catered for by the State government. The only payment they make is 2,400 for ante natal registration (1500 for registration, 900 for lab test) while the government caters for all other bills but for those in the scheme, they don’t pay anything.

” I also have many elderly ones here. It is easier for them to access care here because their children can pay from wherever they are.

“I have a lot of hypertensive and diabetic patients. I have never had any reason to complain. There is nothing more disturbing than when you manage a patient that cannot afford the cost of treatment, as a doctor you cannot be happy. For that, I am very grateful for the opportunity to serve under the scheme. My patients are happy and I am happy.”

Also speaking during the visit, the Executive Secretary OYSHIA, Dr Olusola Akande, said the scheme is targeting to capture 450,000 residents of the State with two percent of its consolidated fund from the State Internal Revenue.

According to him, under two years, the scheme has made remarkable achievements which include over 80,000 enrollees from 33 LGAs, 350 vaginal deliveries and 78 Caesarian Sessions, over 10,000 children under five years and pregnant women covered, creating employment opportunities for residents, fully upgraded three OYSHIA accredited PHCs and seven others at various stages of completion, as well as institutionalization of engagement platforms for various stakeholders.

He stated that 100,000 civil servants had been captured, however, Akande regretted that despite the success so far, there are still challenges such as beliefs, attitudes and customs of people on insurance policies, adverse selection, attitude of health-workers and enrollees, subsidy and cross-subsidy for the vulnerable groups and the poor, limited resources for advocacy, publicity and enlightenment, and inadequate and untrained manpower logistics.

Speaking further, he disclosed that even farmers and others who cannot afford to pay the N8, 000 are encouraged to pay with their farm produce to the agency in lieu of cash.

According to Dr Akande, “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.

“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.”

The Executive Secretary, OYSHIA said the goal of health insurance was to provide quality healthcare services for the people of the state without experiencing catastrophic health expenditure.

However, he expressed worry that many people are still not aware of the activities of OYSHIA and sought the support of the media to propagate the importance of health insurance to the people so that more people would enrol.

He said, “OYSHIA has been rated very high in terms of performance. We will not relent in making sure that the people of the State enjoy quality healthcare without expending their entire savings on medical bills.”

Stating the importance of regular health check-up, Akande said, it has become imperative for people to visit their doctors as occasion demands with the aim of determining their health status as health insurance remains protection against financial hazards, spreading of risks as well as pooling of risk to ensure that people remain healthy with a little financial commitment.

Photo Caption: Some beneficiaries, pregnant women of the OYO State Health Insurance Scheme receiving services at Agbongbon Primary Health Care Centre, Ibadan, Oyo State.

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