While Delta State presently has the highest enrollees on health insurance among all states in the country, the recent roll-out of the Basic Health Care Provisions Fund in the state by the federal government has become a boost to its healthcare drive, Martins Ifijeh writes
L-R: Permanent Secretary, Federal Ministry of Health, Mr. Abdullaziz Mashi Abdullahi; Deputy Governor, Delta State, Kingsley Otuaro; Technical Director, BHCPF, Dr. Oyebanji Filani; Chairman, Oshimili North LGA, Louis Ndukwe; DG, DSCHC, Dr. Ben Nkechika; and Chairman, DSCHC Board, Dr Isaac Akpoveta during the launch of BHCPF in Delta State recently
When on April 12 last year, during the second THISDAY Healthcare Policy Dialogue in Abuja, the federal government launched the logo and beneficiary identification card for the Basic Healthcare Provisions Fund (BHCPF), not many Nigerians believed it will stand the test of time. Especially because many, otherwise beautiful programmes, have been launched previously in different sectors, but ended up not been rolled out or poorly implemented by government.
To be sure it was ready to put money where its mouth is, the 8th National Assembly took a step further and earmarked N55.17 billion in the national budget as the one per cent Consolidated Revenue Fund (CRF) for the funding of BHCPF.
That was the first time since the passage of the National Health Act in 2014, that the federal government has earmarked funds for the BHCPF.
With the Executive and the National Assembly fully on same page on the expected implementation of the programme, the new challenge was to have the buy in of states since the programme will be targeted at basic healthcare needs of Nigerians across the country through Primary Healthcare Centres (PHCs) in the various states.
The immediate past Minister of Health, Prof. Isaac Adewole had told THISDAY earlier that states were key to the implementation, especially those hungry to address basic health needs of their people.
For a seamless implementation, criteria were set, which includes having a robust healthcare financing model, release of N100 million counter-part fund by interested states, among others. With some states already having these bases, the coast was clear for its implementation, hence the birthing of the roll-out May this year in Osun State. On the last count, four states have started getting funds for its implementation.
What BHCPF Means to Nigerians
The BHCPF is an additional fund outside the healthcare allocation in the national annual budget to address basic healthcare needs of Nigerians. In the 2018 budget, it was put at N55.17 billion for primary healthcare strengthening and service delivery, which mobilises additional resources from the government of Nigeria and development partners to improve the delivery of essential basic health services to Nigerians.
According to the Technical Director, BHCPF, Dr. Oyebanji Filani, the fund will pay for a modest benefit package of health services which currently comprises prenatal, delivery, and post-natal care, as well as family planning services for all mothers in rural areas of Nigeria and also cover the cost of high- impact child health interventions.
He said it will also allow such services to be delivered by accredited private and public facilities that will be reimbursed for services delivered. “In recognition that PHCs hardly ever receive any operational costs to cover their expenses, publicly owned PHCs will be provided with operating budgets,” he said.
According to the mandate in the National Health Act, 50 per cent of the BHCPF is allocated to the National Health Insurance Scheme (NHIS) “gateway”, 45 per cent through the NPHCDA “gateway”, and five per cent is set aside to deal with emergencies under the Emergency Medical Treatment (EMT) “gateway”.
Under the NPHCDA gateway, direct cash transfers are provided to public primary health facilities, while under the NHIS gateway accredited public and private facilities are paid for delivering Basic Minimum Package of Health Services (BMPHS).
Filani said the design of the BHCPF provides an opportunity for channeling resources directly to public PHCs in the NPHCDA gateway, whilst the NHIS gateway provides an opportunity to incorporate the private sector through the accreditation of private providers in the NHIS gateway.
Launch of BHCPF in Delta State
While many states are gearing up towards having the implementation roll out of BHCPF for their residents, it was not surprising that barely two months after the national roll-out, Delta State has had its own launched last week due to its strides in basic healthcare for its residents.
Stakeholders in the health sector believed if there is any state that will meet Sustainable Development Goals on Maternal, child, and newborn issues, it would most likely be Delta due to its rural healthcare projects.
On specifics, the state has the biggest mandatory health insurance scheme in Nigeria at the moment, with its Delta State Contributory Health Scheme (DSCHS) already hitting 530,000 subscribers with a mandate to reach one million residents in no time. This is even as at least, one PHC in each ward, have been equipped and functional to deliver the basic healthcare services to residents of the state. Private facilities have also keyed into the commission’s programmes.
Speaking during the BHCPF launch last week, the Director General, DSCHC, Dr. Ben Nkechika said the state two years ago successfully kicked off its contributory scheme which has ensured Deltans receive basic healthcare services, adding that the BHCPF will be a boost to its programme.
He said integrating BHCPF into healthcare services for the state will be seamless because the state Governor, Senator Ifeanyi Okowa championed the National Health Act 2014 which birthed the BHCPF which is now been pushed for implementation across the country.
“Okowa is passionate about primary healthcare, not for only Deltans, but for all Nigerians. That is why today, we have the NHA 2014, which brought into existence the BHCPF we are having today.”
He said the state was better equipped and knowledgeable on the implementation of the BHCPF, especially since the governor was a grass root person who is bent on addressing all primary healthcare issues in the state.
Role of ICT in Providing Basic Healthcare
While many states have continued to have a turbulent start to their health insurance programmes, Nkechika said the commission has fortified all angles to ensure the programme continues to grow.
On why DSCHC is kin on the use of Information and Communication Technology (ICT) to drive the scheme, Nkechika said it will not only aid in keeping data of enrollees, but will help several primary healthcare facilities across the state, even if without doctors or nurses, to adequately investigate, diagnose and administer treatment to patients.
He said: “We realised in some primary healthcare centres there might not be doctors or nurses, but community health extension workers, who often than not are medically untrained. We therefore developed a treatment protocol such that even if it is a community health extension worker that is there, a patient can walk into the facility and get quality treatment.
“If the patient works in and complains of fever, the worker will simply type this into the drop box section of our ICT platform, where more questions about fever will be asked. Those questions will then guide the community health extension worker on the diagnosis. For instance, if it is malaria, the app will tell you the kind of investigation that should be done to confirm the diagnosis, and the worker will then tell the patient to go do the tests. If that has been done and it confirms the diagnosis, there are certain questions the app will then ask further. Based on the investigation and diagnosis, the platform will then tell the worker on what type of drugs and their dosages the patient should take, and then the cost of the drugs will automatically be recorded as well. And then all these encounters, investigations, treatment and cost will then be transmitted to us,” he added.
He believed the robust ICT platform of the commission has helped in reducing health issues in the country, adding that it is accurate and saves manpower.
On his part, the Permanent Secretary, Federal Ministry of Health, Mr Abdulaziz Mashi, assured that residents of Delta State would benefit from services worth N1 billion over the next nine months, adding that N700 million has already been released to the state for the programme.
He said: “The amount is equivalent to payment for the management of 402,000 women with normal deliveries, 1,673,000 under five-childhood illnesses or 1, 115, 000 cases of malaria.”
He also said that 268 public sector facilities would become truly functional as a result of the programme.
”Three states have flagged off. Delta is the fourth state. This programme will not negate National Health insurance Scheme and state health insurance schemes. It is going to be more of collaboration. BHCPF will ensure the underserved Nigerians have access to basic and quality healthcare at the primary healthcare level.
He added that to ensure equity in the disbursement of funds, the federal government allocated resources per state based on the incidence of poverty and on per capita basis.
“This will ensure that the basic health care provision fund helps to reduce inequality in use and access to services, particularly by the most vulnerable,’’ he said.