Lagos Births Social Health Insurance Scheme

Morenikeji is a beneficiary of the LSHIS

Martins Ifijeh

On the day that Mrs Morenikeji (surname withheld), a 35-year-old happily married woman found out she was pregnant, she was struck with a sudden pang of worry and fear. With news that is supposed to be the most exciting event for an expectant mother, only danger, anxiety and most of all, money, were all she could think about. The problem was that this was not the first nor second time she had fallen pregnant. Yet she still remained without a child. Complications from her previous two pregnancies, and a lack of access to quality healthcare had rendered the experience traumatic for her. Luckily for Morenikeji, her prayers were about to be answered by the Lagos State Health Scheme (LSHS).

The Lagos State Health Scheme is a state-wide health insurance scheme targeted to ensure that all residents of the state have access to quality, affordable health care services. The scheme covers treatment of common adult and childhood ailments, maternal and child services, preventive healthcare services, selected non-communicable diseases and surgeries.

In support of the LSHS, a proof of concept, supported by the PharmAccess Foundation, commenced on September 25th 2017. Country Director of PharmAccess Foundation Nigeria, Mrs Njide Ndili, explained that the proof of concept which mirrored the Lagos State Health Insurance Scheme, was implemented to demonstrate how the scheme can improve the lives of our most vulnerable population at scale, using the mobile phone and light technology.

Prior to commencement, field agents visited communities around the two selected hospitals (Igando General Hospital and Subol Hospital) to recruit eligible beneficiaries who will then be enrolled into the pilot. The Poverty Probability Index identification tool was administered to identify those eligible for the pilot programme. Morenikeji was found eligible, and was enrolled and covered by the LSHS benefit package which includes pregnancy, normal delivery, caesarean section and post-natal care at Igando General Hospital.

According to the Health Plans Program Officer, PharmAccess Foundation Nigeria, Yemisi Khalidson, the pilot was administered using the CarePay ICT platform, a mobile solution for scheme administration which serves as a digital health exchange that connects the three important stakeholders in Healthcare: payers, healthcare providers and the users or beneficiaries.

She said: “The platform can manage various types of healthcare payments and healthcare benefits from different programs, and present these payments and benefits to the beneficiaries on their mobile phone in a clear and user friendly way. For each hospital visit, the treatment data is submitted electronically by the healthcare provider and after approval by a medical claims assessor, the funds are moved digitally to the healthcare provider.”

The Commissioner for Health, Lagos State, Dr Jide Idris, stated that the CarePay platform “will guarantee ownership of all data generated and ensure that these data can be used to make informed decisions”.

He said one of the objectives was to demonstrate how digital mobile solutions can be utilized to improve decision-making and transparency, reduce transaction costs, and increase access especially for poor households.

The commissioner said in collaboration with Lagos State Ministry of Health, PharmAccess implemented the proof of concept mirroring the LSHS benefit package, provider payment mechanisms and the interaction between patients and providers.

He said the proof of concept has 153 families (659 enrolees) in two facilities (one private provider and one public provider) in Alimosho Local Government Area of Lagos State.

Idris said: “Having run for a period of twelve months, the pilot witnessed the 659 beneficiaries, whose premium was paid for by PharmAccess Nigeria, received access to free healthcare for the duration of the pilot.

“The results of this pilot show that the scheme is doable and is a step in the right direction towards achieving Universal Health Coverage (UHC) for the residents of Lagos State.”

Morenikeji is one of the many success stories from the pilot. She had a caesarean section in which she delivered a healthy bouncing baby boy (pictured right).

According to the General Manager, Lagos State Health Management Agency, Dr Peju Adenusi, the scheme is a mandatory pre-paid health plan for all residents, adding that the LSHS aims to as achieve universal coverage and provide financial protection against catastrophic health care spending. “A healthy population is a productive population,” Adenusi added.