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Expanding care through health insurance



Expanding care through health insurance

About five per cent of the Nigerian populace only has prepaid health care through health insurance, resulting in the majority paying out-of-pocket to access healthcare. BIODUN OYELEYE reports on the initiative to make care accessible to more people in Kwara State



As the world community marked the World Health Day in April, the choice of the 2018 theme, ‘Universal Health Coverage: Everyone, everywhere’, is an indication of the desire to bring healthcare to majority of the world populace, notwithstanding their financial capability. In spite of this yearning, too many people are still missing out on health coverage.

According to the World Health Organisation (WHO), at least, half of the world’s people are currently unable to obtain essential health services, mostly in developing countries. The situation is not different in Nigeria where only about five per cent of the populace has prepaid health care through social and voluntary private insurance. This has resulted in majority of Nigerians paying out-of-pocket to access healthcare.

However, based on the commitment to reverse the trend in which patients pay-out-of-pocket, the Kwara State Government in collaboration with the Government of the Netherlands implemented the Community Health Insurance Scheme (CHIS) between 2007-2016.

It was a unique programme that leveraged health insurance for healthcare delivery to the rural poor. Under the CHIS, midwifed by the Dutch Health Insurance Fund, the PharmAccess Foundation and Hygeia Health Management Organisation HMO, the average resident of the implementing communities could access basic health care with an annual premium of N200.

The Kwara StateGovernment, Dutch Health Insurance Fund and PharmAccess Foundation provided the subsidy funding for the programme while the Hygeia HMO provided the administrative framework for the participation of both public and private healthcare providers.


The programme recoded significant success, including spreading across 11 local government areas of the state and won several international recognitions, among them the Organisation for Economic Co-operation and Development (OECD) Finalist Award and “Saving Lives at Birth Award” both in 2014. By the end of 2016, some 139,714 persons from low income rural areas in the participating council areas had enrolled in the programme.

But it was not sufficient a programme to improve access to universal healthcare (UHC), hence the decision by the current Kwara State Government to expand its scope and functions. One of the shortcomings of the CHIS was its narrow focus, which targeted only the poor when there are several other residents who also deserve access to basic healthcare but are scared by the exorbitant cost of accessing such.

UHC is a health care system that provides health care and financial protection to all citizens of a particular country. For UHC to be in place, it means that all people and communities that key into it can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. This was what led to the establishment of Kwara Health Insurance Scheme (KHIS).

Speaking at the launch of the KHIS recently, Kwara State Governor, AbdulFatah Ahmed justified the scrapping of CHIS for KHIS: “The old scheme had to be replaced with a wider-spread, comprehensive, better-funded and managed scheme,” he said adding: “Consequently, I signed Kwara State Health Insurance Agency Bill into law in November 2017. The law sets up the KHIS, which makes contributory health insurance mandatory for all residents of Kwara State.”

He said further: “This law replaces the CHIS and ensures UHC for all citizens and residents of the state for a low annual premium.

Following the launch of the scheme, all citizens and residents of Kwara State are expected to enroll in the programme as required by the law establishing it. “No more will citizens and residents of Kwara State be unable to access critical treatment because they cannot afford to pay hospital fees or buy prescribed drugs,” said Ahmed.

According to the Kwara State Governor, “One of the cardinal responsibilities of governments all over the world is the provision of quality, affordable, and accessible healthcare to citizens. This is because the well-being of citizens determines, to a large extent, a country’s economic growth and development. In the light of this, my administration has since inception prioritised policies and programmes that promote the health of Kwarans.”

The new programme has caught the attention and delight of international observers, several of whom attended the launch in Ilorin, the capital of Kwara State.

Among those present were Professor Khama Rogo, Lead Health Sector Specialist and Head of the World Bank Group’s Health in Africa Initiative, Kees Storm, Supervisory Board for the Dutch Health Insurance Fund/Pharm Access Group, Aaltje deRoos, a Senior Policy Officer at the Netherlands’ Ministry of Foreign Affairs and Ms. Monique Dolfing-Vogelenzand, CEO of Pharm Access Group.

Others includ Deputy Ambassador of the Royal Kingdom of the Netherlands to Nigeria, Mr. Michel Deelen and the Executive Secretary, National Health Insurance Scheme (NHIS), Professor Yusuf Usman.

Among the dignitaries who delivered goodwill messages at the event, Professor Rogo was apparently the most excited. And the reason was simple: starting the programme, according to him, meant the restoration of the dignity of Kwarans, particularly women and children who suffer several indignities in the process of accessing healthcare.

In a highly emotional tone, he said: “Now in Kwara you can look after your health without the fear of going into poverty. It is the restoration of dignity to Kwarans because it is in this area of health provision that the rights and privileges of our women and children are trampled upon more than elsewhere. Now, no more shall mothers and children go into health facilities as beggars but as owners and employers of the facility!

“I’m thrilled I’m here; I don’t know what Kwarans do when they are happy. But in Kenya, I know what we do; we dance and run. We run so fast and so far.” The professor revealed that “Kwara is today among the top six states in quality health care in Nigeria and it was for this that the state has been allocated $4 million and out of this $2.5 million has arrived.”

In their won comments, Storm, named Kwara as the Mecca of health insurance in Nigeria. DeRoos, noted the fact that Kwara now occupies a front row seat in Africa in the area of health insurance while Dolfing-Vogelenzand also expressed delight about the strong leadership commitment that was being celebrated at the occasion.

All the dignitaries traced the success of the programme to the political commitment of both the former Kwara State Governor, Dr. Bukola Saraki and Kwara State Governor, Abdulfatah Ahmed. He said, “Your governor Ahmed) has succeeded where many African leaders failed”, Rogo told the crowd in the hall.”


The Deputy Ambassador of the Royal Kingdom of the Netherlands to Nigeria, Mr. Michel Deelen promised that the Dutch Government would strengthen its partnership with Kwara State to achieve UHC in the state while the executive secretary of the NHIS promised to partner the state to guarantee the success of the scheme.


Earlier in her welcome address, Dr. Ms Olubunmi Jetawo-Winter, the Executive Secretary of the Kwara State Health Insurance Agency which will manage the project, described it as milestone in the history of Kwara. “There are several residents in the state today that if they should fall sick, it would lead to serious poverty due to the cost of treatment,” she said, adding that her team had been engaging stakeholders to enhance the acceptance of the scheme.

Jetawo-Winter disclosed that the agency would commence registration for the Scheme in August. She said registration would hold for 90 days across the 193 wards of the state.

During the registration period, the agency would capture all baseline health information, and bio-data of all residents, which she said, would form the bedrock of standardisation of operations of the scheme.

The executive secretary of the NHIS added that the identification of the poor and special populations including people living with disabilities would also take place during the exercise.

She noted that an insurance card would be issued to every individual registered under the scheme, and that enrolment would commence once the cards have been issued. According to her, with this card, coverage averages out to a little less than N25 per day.

Continuing, Jetawo-Winter said that those registered would enjoy health benefits covered under the scheme such as maternal and child care services, emergency care services, minor surgeries, everyday ailments, chronic illnesses such as diabetes and high blood pressure (HBP), preventive health education, among other benefits.

She called on relevant stakeholders to continue to support the State government in its efforts to provide UHC to all Kwarans, just as she also thanked all the technical partners of the health insurance scheme.

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