Lagos and its Stagnant Health Insurance Scheme

Sanwo-Olu and Adenusi

In a highly celebrated ceremony last December, the Lagos State government launched what was supposed to be the biggest mandatory health insurance scheme in the country -The Lagos Health Insurance Scheme. However, 10 months later, the process appears to have towed the line of the National Health Insurance Scheme which refused to grow since the past 13 years of its existence. Martins Ifijeh writes

Sanwo-Olu and Adenusi

When on December 18 last year the Lagos State government launched what was supposed to be the biggest mandatory health insurance scheme in Nigeria – the Lagos Health Insurance Scheme – because of its plans to enroll 2.5 million Lagosians in 2019, and over 10 million residents within years of commencement, healthcare stakeholders and lovers of Universal Health Coverage (UHC) saw it as a welcome development that would not only disrupt the healthcare space of the entire country, but bring Nigeria closer to achieving health for all. They ticked it in their bucket list as one of the things that have been kickstarted to better the country’s health sector.

Healthcare stakeholders and development partners at the launch even had a stronger belief in the scheme when the then Lagos State Governor, Akinwunmi Ambode and the present Governor, Babajide Sanwo-Olu, walking side by side at the launch, both pledged to ensure the scheme succeeds, with Lagos residents, especially poor ones, no longer having to pay out of pocket for their healthcare
For lovers of the UHC, their hopes are gradually being dashed. 10 months after the hugely celebrated launch that brought Lagos to a standstill, with the venue almost turning to a campaign hub of some sort, nothing has been heard of the scheme. Not even residents of the state whom the government had said at the launch would be visited in their homes for registration, are aware there is anything called health insurance scheme for Lagosians.

The residents, most of whom, have continued to grapple with health expenses from their pockets, with those unable to pay for healthcare now living at the mercy of their immune systems or waiting for any outcome that may result from the ill health.

At the launch, the then Commissioner for Health, Lagos State, Dr. Jide Idris said systems were put in place to ensure healthcare providers target residents even in their homes to ensure everyone was registered into the scheme.

He also emphasised that civil servants in the state would be automatically registered into the scheme and that government would pay 75 per cent of their contributions, while those in the informal sector, which constitutes a huge chunk of the population, were being talked to through their various unions to be part of the scheme, assuring that a huge number of them have embraced the idea and were ready to be registered immediately after the launch.

He also outlined beautiful blueprints which he said would ensure members of families no longer die from preventable diseases since they could walk into designated health facilities and have their children or themselves attended to even without monies in their pockets.
He said in an exclusive interview with THISDAY in December that, “the scheme has about three plans – basic, private and then general. We are starting with the basic plan which involves care at the primary healthcare level. Treatment of commonly seen conditions like malaria, typhoid, measles, including immunisation, counseling for non-communicable diseases like cancers, among others will be covered.

“We are also focusing on maternal and child care because that is part of where you have high mortality rates. Some key diseases like Human Immuno Virus (HIV) and tuberculosis, which are common with the poor, will be financed by some organisations that have signified interest. A huge chunk of the scheme is directed at the poor. That is why the law establishing it says a minimum of one per cent of the consolidated revenue fund of the state will go into a pool which is an equity fund basically to address people who cannot afford to pay. That is to guarantee a financial protection for them.

“In preparation for this launch, we did a poverty assessment of some areas like Makoko as a pilot. We have a designed tool to know those who are poor. Their own contributions will be paid from that equity fund. Again, insurance is more like subsidisation such that the rich covers the poor. It is going to be a new dawn for Lagos residents.”
But 10 months after the launch, Lagos residents are still patiently waiting for that new dawn which seems to either be walking at a slow pace or even at a pause.

One then wonders whether the state hopes to go the way of the National Health Insurance Scheme (NHIS), which refused to grow itself since the past 13 years, when it was first launched.

Till date, NHIS has only enrolled four per cent of Nigerians, while its counterpart agency in Ghana, which started the same year with Nigeria, has enrolled over 45 per cent of its citizens.

With the Lagos State government still on about 100,000 enrollees, according to the General Manager, Lagos State Health Management Agency (LASHMA), Dr. Peju Adenusi at the four-day flag off training for LSHIS Wellness Ambassadors in Lagos recently, it shows the state is so far at 0.5 per cent with a population of 22 million. It also shows that for its 2019 target of 2.5 million residents, it has only enrolled four per cent of the entire population.

Members of the public are still patiently waiting for the ambassadors which the state government said would move from house to house to enroll residents.

With the civil servants regarded as an easy catch for the government to enroll into the scheme considering the laws guiding it, it still baffles why the total enrollees of the state still rests on 100,000, especially considering that Lagos State workers are more than that figure.

How many Lagos residents in the informal sector are enrolled in the scheme? How many poor have been approached or enrolled in the scheme? Has Governor Sanwo-Olu decided to jettison the otherwise beautiful programme or healthcare is just not one of his priority? Or could we just regard the celebrated December launch as one of the ‘Ekos for Show’ such that it was designed only to tell the world that Lagos has started its health insurance scheme, whereas in reality, the scheme is only on paper.