Equitable Health Access Initiative (EHAI) has years of progressive experience implementing several health intervention programs, which has made the organization adept at tapping into the rich capacity of communities to own and drive issues that relate to their health and wellbeing. As an NHIS accredited Technical Facilitator / Program Manager / Third Party Agent on Community Based Social Health Insurance Schemes (CBSHIP) in Nigeria, we were able to set up some CBSHIP schemes. We set up the Moferere Oja Mutual Health Association, a CBSHIP initiative in Moferere Oja Community in Ondo West Local Government Area of Ondo State between 2015 and 2018, with almost 1,000 enrollees. We also set up CBSHIP for parishioners of the Ondo Diocese of the Catholic Church in 2018 with over 1,000 enrollees. These two schemes have been successfully transitioned into the Ondo State Social Health Insurance Scheme administered by the Ondo State Health Management Agency. By virtue of this experience, EHAI recognizes that an appropriate model of Health Insurance for the informal sector is essential in order to break the vicious cycle of poverty and poor access to healthcare in Nigeria.
Based on our years of experience in engaging communities for health insurance, we developed the EASE Model. This research driven Model is an efficient approach for sustainable engagement of the Informal Sector in Social Health Insurance Schemes in Nigerian communities. The EASE model simplifies the process of engaging the Informal Sector population and it is designed to address the cultural and socio-economic challenges facing their enrolment on Social Health Insurance Schemes. It also ensures Social and Behaviour Change towards communal ownership and management of healthcare systems in Nigerian communities. EASE is an acronym for the 4 components of the intervention model stated as follows:
E – Engage the Community
A – Adopt Technology
S – Service Provision
E – Economic Empowerment
Community Based Social Health Insurance (CBSHIP)
One of our major areas of interest which we strongly believe is germane to achieving universal access to affordable and quality health care is sustainable health financing through financial risk pooling mechanisms especially in a country like ours where ability to pay severely limits access to health care. We understand clearly that to achieve universal access, user fees and other out-of-pocket payments (which can be impoverishing) must be reduced drastically if not eliminated completely. We strongly believe that a comprehensive, widespread and transparently managed social health insurance scheme that covers the formal and informal sectors, urban and rural areas as well as the high and low end social class of our country is the panacea to most of the challenges facing our health system. To achieve this, we have been accredited by the National Health Insurance Scheme (NHIS), since 2016, to serve as Technical Facilitators / Program Managers / Third Party Agents on Social Health Insurance Schemes in Nigeria.
As part of our drive for evidence based approach to program planning and implementation, we have been able to carry out a comprehensive Statewide Willingness and Ability to Pay for Community Based Health Insurance Survey in Ondo State. The result of the survey, which was carried out in 2014, has been shared with NHIS and the State Ministry of Health. We are also utilizing the result of the survey to strategically plan our intervention and we have commenced community mobilization for the scheme in Ondo State. We believe that we will create a financial pool that will meet the health needs of the community, especially the low income and informal group. The scheme we are implementing is unique in that will provide an opportunity to support the enrollees with income generating activities through skill acquisition and access to microfinance. This income-generating scheme is specifically targeted at empowering women who are usually the most vulnerable in the society. This scheme will not only ensure access to health care but also help eradicate poverty.
We successfully set up the Moferere Oja Mutual Health Association, a CBSHIP initiative in Moferere Oja Community in Ondo West Local Government Area of Ondo State, with almost 1000 enrollees since inception in 2015. We also engaged the Ondo Diocese of the Catholic Church in setting a CBSHIP scheme for its parishioners. The Catholic Church scheme currently has over 1000 enrollees. We are leveraging on available technology to introduce Mobile Money Technology to entrench cashless processes into premium payments. This enhances ease of payment, transparency and accountability.