Dr. Ben Nkechika is the Director General, Delta State Contributory Health Commission. In this interview with Martins Ifijeh, he said with a governor who understands the operational manual of the Basic Health Care Provisions Fund, it would totally complement the state’s health insurance scheme. Excerpts:
Is there a disparity between BHCPF and health insurance scheme?
The BHCPF program as enumerated in the operations manual, if applied as a healthcare financing mechanism as prescribed in the National Health Act, will complement the state’s healthcare financing programmes. It will provide the needed extra funding, capacity development and technical expertise to reach more Nigerians especially in the rural communities through the Primary Healthcare facilities.
It should start with the baseline assessment of the current status of PHCs in at least one PHC per ward across the country, followed by capacity enhancement in terms of operations and service delivery and then funding through the primary healthcare gateway to upgrade the PHC to be ready to provide care under the BHCPF benefit package for all Nigerians especially in rural communities that will be paid for through the NHIS gateway. The BHCPF program should be an offshoot of the NHA to compliment the implementation of the PHC gateway and the health insurance gateway across all the states.
Delta is the fourth state where BHCPF is being flagged off. How did this happen?
A flag off of the BHCPF programme has been done in three states, Osun, Abia and Niger. We felt that Delta State, which already had a structure on ground to implement it, should have been a part of the phase, which was why we pushed for us to be the next state for the flag off and implementation of the program. It was explained to us that Delta State could not be in the first set and later when there was plan for more states we were eventually included. What we felt was to actually showcase the Delta State Governor’s passion for better healthcare financing, which he championed in the National Assembly to ensure the passage of the NHA and the NHIS, and also that to showcase the political will to implement the BHCPF programme. It should start from the state that has that political willingness and capacity. This is what we have achieved today.
Some states are yet to key into the BHCPF programme as they are skeptical. What is your take on it?
With proper information, states will key into the scheme. I give you an instance where some states have the assumption that the BHCPF is either a parallel health programme to the NHIS or a programme designed to shut down the NHIS. Another instance, is that recall every state was told to provide a counterpart funding of N100 million but because of lack of understanding and clear information, some states thought the N100 million is for the PHCs only, while some believe it is for the ministry of health. So, where there is confusion, implementation is stalled. My suggestion is for a forum where there is proper and clear information flow that will remove the wrong assumptions. In Delta state, we have studied the BHCPF operational manual and we pushed for it to come to Delta State because we understand the collaborative benefit the program will bring.
With the BHCPF, are we looking at a free health programme in Delta State?
First of all, we do not believe there should be statements like free healthcare programme. It does not encourage sustainability. Instead what we believe is that you set up a healthcare programme that has a financial sustainability plan. Those that cannot afford to pay, you set up a system to pay for them; you don’t call it free anymore. Those that can pay will pay and those that cannot pay somebody pays for them through a social support system. So it is that ability to keep paying for those who cannot pay that is the sustainability plan. Let me give you an example of what we do in Delta state. There is a free maternal and child healthcare programme that was running successfully which, we inherited. So, what we did was instead of continuing to call it a free maternal and child health care programme, we transitioned it to become the Equity Health Plan in the DSCHS and the government pays the premium for these categories of people routinely.
Is BHCPF a threat to health insurance programme?
With the right information, BHCPF is no threat to health insurance programme operated by states and the federal government. There are integration possibilities for both programmes. We have a governor who understands the operational manual of the BHCPF, and he knows exactly how to inculcate this into our programme. You can recall he was key into bringing the NHA into reality, out of which we have the BHCPF.
The difference between the BHCPF and the DSCHS is the benefit package. For example, let’s say the DSCHS benefit package has 10 items and the BHCPF benefit package has three items, it means that one to three in the total benefit package is covered free from the federal and four to ten is covered by the state.
So, what we are saying is that this kind of integration will provide covers for at least 70 per cent of the cases you see in the hospital. So, if you make the first three free for people, those not willing to pay the premium because the package from BHCPF is free will now see the benefit and the premium could be reduced from the initial state amount or the benefit package of the state could be increased to cover more services.
What we are suggesting for Delta State is this, once you register for the BHCPF programme, you are automatically registered for the DSCHS programme. The only reason we can do that is because we have an existing health insurance programme. So, anybody that comes to a facility to receive free healthcare under the BHCPF program, is automatically registered into the state health insurance programme and encouraged to top up to benefit from the extras in the state scheme.