For many women, birth is a time of great joy but also great risk. The cost of a Caesarian Section (C-Section) can be staggering, ranging from N300,000 to as much as N500,000 in some hospitals. But what if you could access this life-saving procedure for just N7, 000 a year? The Delta State Contributory Health Scheme (DSCHS) has made this a reality for over 300 women every month in the state.
This health initiative does not just stop at pregnant women. Over 2.2 million children, young adults, students, artisans, civil servants, and even the elderly are benefiting from affordable healthcare under the scheme.
In this exclusive interview with Senior Reporters, Jumai Nwachukwu, Kase Greatness and Rita Oyiboka, the Director-General of the Commission, Dr. Isaac Akpoveta, shares the remarkable impact of DSCHS on the local community, the challenges they’ve faced in bringing healthcare to hard-to-reach areas, addresses concerns about the commission and the ambitious goals for the future of this game-changing health initiative. Excerpts:
Can you introduce yourself, Sir?
First of all, I wish to express my appreciation to The Pointer Newspapers for selecting me and the commission for this interview. The newspaper’s content has demonstrated notable enhancements, and I am delighted to acknowledge that the commission has received sufficient coverage through its publications.
My name is Dr. Isaac Akpoveta, the Director-General of the Delta State Contributory Health Scheme. I have previously held the position of pioneer chairman of the commission for eight years. In addition to my medical career, I have extensive experience in state and national health insurance, dating back to 2003.
I am grateful to His Excellency, the Governor of Delta State, Rt. Hon. Sheriff Oborevwori, for entrusting me with the responsibility of leading the commission once again.
For the benefit of the layman in Delta State, what is the Contributory Health Insurance Scheme, and who is the target audience?
The concept of contributory health insurance is rooted in the principle of collective funding, where individuals contribute a prepaid amount to access healthcare services when needed. In Delta State, the annual contribution of N7,000, heavily subsidized by the government, enables access to comprehensive healthcare services, including caesarian sections (C-Sections) worth N500,000 in private hospitals, at no additional cost.
While the term “free” is used, it’s important to note that the government pays a significant portion of the costs to participating facilities, making healthcare more affordable and accessible.
Health insurance eliminates out-of-pocket payments, allowing individuals to receive necessary care without additional financial burden. In emergencies, individuals can access care at registered facilities without needing to pay outside the yearly tariff, and the commission settles the bills. This safeguards lives and health, reducing the risks associated with delayed or foregone care due to financial constraints.
The Delta State Government has prioritized the healthcare needs of vulnerable populations, covering all pregnant women from pregnancy to delivery, including C-sections, and the healthcare needs of children from birth to five years. This intervention has significantly reduced maternal and child mortality rates, with over 300 C-sections performed monthly across the state, and 60-70 at the Asaba Specialist Hospital alone.
Additionally, health insurance provides economic benefits, alleviating the financial burden of healthcare costs, and reducing the danger of complications and mortality among women and children. In the past, high mortality rates among children under five were common, but with this intervention, the government has put mechanisms in place to ensure every child survives the first five years and beyond.
Delta State launched its health insurance scheme in 2016, which became operational in 2017. To date, over 2.2 million residents, approximately 35 per cent of the population, have enrolled in the program. With a total of 2.4 million enrollees when records are combined, this achievement demonstrates the success of the program in expanding access to healthcare and improving health outcomes in the state.
Apart from pregnant women and children, does the scheme also benefit other enrollees who need life-saving surgeries?
Yes. To ensure that quality healthcare is accessible to all, the Delta State Government has implemented this inclusive health insurance scheme. This program is designed for all residents of Delta State, regardless of their tribe or nationality, provided they are enrolled and have paid the affordable annual premium of N7,000.
The scheme’s benefit package is robust, covering a wide range of healthcare services, including maternal and newborn care, internal medicine, diabetes management, hypertension management, surgical procedures, lymphoma treatment, appendix removal, and basic general surgeries.
While kidney surgeries and severe orthopaedic surgeries are not covered under the basic plan, individuals can access these services by upgrading to the private plan, which has a unique payment structure and benefits.
Notably, the basic health insurance plan covers up to 80 per cent of the average healthcare needs, making it a valuable investment for individuals and families.
What about the hospitals in the rural areas, and people who live in low-income communities, where they don’t have access to standard health facilities, how does the commission attend to their needs?
A key mandate of our commission is to ensure universal healthcare coverage for all Deltans, regardless of their location or socioeconomic status. To achieve this, we’ve successfully extended healthcare services to the most rural and hard-to-reach areas of the state.
We recognized that several organizations, such as Chevron and Shell, had built healthcare facilities in these areas that had fallen into disrepair. So, we launched the Access to Finance Program in partnership with the Bank of Industry, World Health Organization, and Credit Fund, pooling over N500 million to support the revitalization of these facilities.
Through this initiative, we invited healthcare professionals from around the world to participate in a Public-Private Partnership (PPP) with us. We took them to these rural facilities, and they identified the ones they could manage. We then provided loans of up to N14 million to equip and activate these facilities.
I’m delighted to report that, over the past four to five years, we’ve successfully established 18 functional hospitals in remote areas, and the loans have been fully repaid. This demonstrates the program’s success.
Our commission has the authority to regulate, implement, and supervise healthcare services. We don’t need to build new hospitals; instead, we activate existing ones built by philanthropists and organizations, leveraging PPPs to ensure their effective operation.
Besides hard-to-reach communities, how does the scheme benefit and incorporate the high population in higher institutions?
When I assumed the role of Director-General, I conducted a thorough review of the Higher Institution Health Insurance System. I discovered that the National Health Insurance Scheme’s Tertiary Institution Social Health Insurance Program, launched in 2014, had unfortunately failed to gain traction. No state had successfully implemented it. I analyzed the reasons behind its failure and identified opportunities to improve the system.
By adjusting the framework and engaging with stakeholders, we successfully sold the package to institutions. To date, we have on-boarded Dennis Osadebay University, Asaba, with over 4,000 students, the University of Delta (UNIDEL), Agbor, with over 8,000 students, and soon, the Delta State University (DELSU), Abraka, with over 30,000 students.
Our higher institution package includes capitation payments, where we pay a monthly sum of over N4 million for 10,000 students after they pay their premium to us. This enables them to upgrade and run standard health facilities. If students are referred to other facilities, we cover the costs. Even when they’re on holiday outside Delta State, they can receive treatment at any health insurance hospital, and we’ll foot the bill. This is what we call portability.
I presented this innovative approach at our quarterly meeting of Director-Generals of all health insurance agencies in the federation, and it received widespread acceptance. We’re now working to establish portability across all agencies in the federation, ensuring that students registered in Delta State can access treatment, including surgeries and sickle cell medication, anywhere in the country. The student union has enthusiastically embraced this initiative, recognizing the immense benefits of subsidized healthcare for young students entering university.
How is the commission addressing situations where healthcare facilities claim certain treatments and essential medications are not covered by insurance?
It’s essential for enrollees to understand their rights and privileges when it comes to their health insurance. If you’ve purchased a policy from our scheme, take the time to read and understand what you’re covered for. This way, if you’re incorrectly told that a medical service isn’t covered, you can confidently dispute it. We’ve made it easy by displaying the benefit packages in hospitals, so you can verify the information firsthand.
I recall a story shared by an Indian lecturer, who noted that Nigerians often purchase electronics without reading the manual, only to seek guidance when something goes wrong. We want to empower our enrollees with knowledge, so we’re reviving our leaflets and providing a copy to each enrollee. This way, you’ll be well-informed about your rights and can advocate for yourself when seeking medical attention.
It’s important to note that we pay hospitals in advance to treat our enrollees, whether they receive care or not. This can sometimes lead hospitals to try to minimize the use of these funds. However, if you’re aware of your rights, you won’t be taken advantage of. Recently, a Special Assistant to the governor experienced this firsthand when they were told that their insurance didn’t cover a medical test. After investigating, we found that the scheme does indeed cover tests. We encourage the media to partner with us in exposing any attempts to sabotage our efforts and ensure that our enrollees receive the care they deserve.
How is the commission handling these discrepancies?
While we advise patients to know their rights and demand for it, we appeal to hospitals to follow the operational guidelines and tariff of the scheme sincerely. The law of the commission is only 25 pages and is on our website, www.dschc.org.ng. There are punishments and fines for going against these guidelines and repeated offences can be further punished.
What criteria do the medical facilities enrolled under the scheme have to meet?
Our operational guidelines explicitly outline the criteria for medical facilities to qualify as primary healthcare providers under our scheme, categorized into levels 1, 2, and 3. Additionally, general hospitals must meet our comprehensive requirements to provide surgeries and fulfill the healthcare needs covered by our scheme. We have successfully accredited 520 health facilities, designating them as trusted providers and assigning them a corresponding level. Private hospitals that join our network must also adhere to these standards, undergoing regular reaccreditation every two years to ensure consistency in quality care. If a facility’s performance deteriorates, we provide a two-month window for improvement. If they fail to meet our standards, we take prompt action and remove them from our network, ensuring that our enrollees receive only the best care.
What is the commission doing to monitor the services provided by the hospitals under the scheme?
We boast the largest network of agents in the country, with 350 agents stationed in hospitals and on the streets, monitoring and reporting daily. Every government hospital has our agents on site, ensuring we’re always informed. However, we need patients to play an active role in reporting any issues they encounter.
Our enrollees enjoy the flexibility to choose their preferred hospital within a five-kilometre radius, and they can even change their choice, if needed. I sign off on hospital changes daily.
One issue we’re addressing is patients requesting specific brands or large quantities of drugs, thinking it will lead to better treatment. But our doctors are trained to prescribe the right medication for effective care. Rest assured, our drug revolving fund in Delta State ensures that only genuine drugs enter our hospitals. We prioritize generic drugs for their efficacy and cost-effectiveness, rather than branded ones. Our focus is on delivering top-notch care, not promoting specific brands.
What legacies do you aim to be remembered for when your tenure as Director-General ends?
It has been a great experience serving Deltans. I have been involved in National health insurance since 2003. When the National Health Insurance was introduced in Abuja in 2005 by Obasanjo, I was there and we have since been implementing it both in practice and theoretically. I am glad that the state recognised my efforts and called me to write the bill that became law for the scheme.
The immediate past governor of the state, Sen. Dr Ifeanyi Okowa appointed me chairman of the commission then. We started from a vision that seemed too big and the government has invested so much to make it a reality; number one in the country. The recipe for the scheme’s success in the state is that they brought in two technocrats in health insurance, myself and, the former Director-General of the commission, Dr Ben Nkechika, experts in health insurance and trained in both Harvard and Oxford University in the same to lead the scheme at inception.
Secondly, Sen. Okowa approved that the board should not be a political one. Meanwhile, the Nigeria Labour Congress (NLC), Trade Union Congress (TUC), Civil Society Organisations (CSOs), Nigeria Employers’ Consultative Association (NECA), Ministry of Economic Planning, Ministry of Health and Head of Service are stakeholders in the scheme.
I am happy that Deltans are responding to the scheme. My passion is about the vulnerable people and the health insurance is a vessel to advance their health services with state fund. Therefore, I adopted this program, the Indigent Enrollee Adoption Initiative. I task well-meaning Deltans, philanthropists and organisations to pay for insurance to those who need it but cannot afford it. A lot of them have responded positively. One recently donated N10m to buy insurance for 1500 persons. My legacy goal is to register at least eight million indigent people into the health insurance scheme.
We also have the Artisan Enrollee Inducement Initiative in the pipeline to make artisans see the value of health insurance. Through this, we have made money available for soft loans to artisans of N7000 to repay N100 daily for 90 days. Within one month of payment, you start receiving treatment and within 90 days, you have paid off. By the next year, if they are satisfied with the service, they will be willing to pay at once. With these, I am sure I would have left a lasting and positive legacy.
