Nigeria
The Community Health Plan
The first Health Insurance Fund program was started in Nigeria in early 2007 under the name Hygeia Community Health Plan (HCHP). The program targets potentially 115,000 persons. This includes 40,000 market women and their families in Lagos and 75,000 farmers and their families of the rural Shonga community in Kwara State, around 500 kilometers north-east of Lagos.
Expansion of the program is planned with support from the World Bank and the governor of Kwara State. The World Bank will support expansion of the program up to 25,000 IT-workers in Lagos and the Kwara state government will co-fund program expansion with up to 71,000 farmers and their dependents. The benefit package provides coverage for the most common medical problems that are found among the target groups and consists of primary care, limited secondary care and medication, including HIV/AIDS treatment.
Executing partner
The local executing partner of the program is Hygeia, the largest Health Maintenance Organization (HMO) in Nigeria, which has a local network of over 200 clinics and hospitals throughout Nigeria and around 200,000 paying members. Hygeia has 20 years of experience in health care in Nigeria and is one of the HMOs executing Nigeria’s new National Health Insurance Scheme (NHIS). Hygeia is selected based on a thorough medical, administrative and financial assessment process, including a due diligence carried out by PricewaterhouseCoopers. As part of the program the Health Insurance Fund provides support to Hygeia to improve its administrative capacity.
Selection of clinics
Hygeia has contracted 19 clinics and hospitals for the Health Insurance Fund program where the scheme beneficiaries can obtain their medical services. 13 in Lagos and six in Kwara State. The clinics are selected on the basis of a medical due diligence carried out by PharmAccess and Hygeia.
Of the selected clinics 13 are private and six are public. Eight of the clinics provide only primary health care, and eleven are referral centers providing primary and secondary care.
Upgrading programs
In November 2006, prior to the start of the program, Hygeia and the providers, with assistance from PharmAccess, developed upgrading plans for the clinics. 13 of these providers, 10 in Lagos and three in Kwara State, are currently being upgraded. Of these facilities three are public and 10 are private providers. Within the program funding is also allocated for improvement of the physical infrastructure. In Kwara State the Governor has allocated funds from the State budget for two clinics, amounting to an estimated $75,000 per clinic, to rehabilitate them up to the required standards.
In February 2007 PharmAccess and Hygeia organized the first medical and administrative training for the medical directors, nurses, pharmacists, laboratory technicians and administrative staff of all health facilities involved in the program.The first monitoring and evaluation visit was carried out by PharmAccess in June 2007. The second monitoring and evaluation visit took place in January 2008. And respectively in January 2009 the third monitoring and evaluation visit was conducted.
Launch community Health Plan in Abuja
On 24 January 2007 Nigeria’s President Obasanjo launched the Community Health Plan in Abuja. Present at the launch were his ministers of Health and Social Development, representatives of Hygeia, the Health Insurance Fund, PharmAccess, the Royal Netherlands Embassy in Abuja, and the Dutch Ministry of Foreign Affairs. On 25 and 26 January, the program was also launched in Lagos and Kwara State.
Active enrollment
Since the launch of the scheme an active enrolment campaign is underway to mobilize and enroll target group members. Enrollment in the program is voluntary; registration is done per family. Special Hygeia ‘marketing teams’ go out into the field and assist people in the process of signing up for the scheme.
The teams use laptops to register beneficiaries of the program on the spot. After a person has paid, a photograph of him/her is taken, personal identification data are entered into the computer, and within a few minutes the portable printer produces the insurance ID card.
With this card the person can obtain access to health services in the designated health facilities nearby. By the end of 2008, more than 45,000 people had enrolled. The 19 clinics have, since the enrollment started in 2007, noticed a significant increase in the number of patients.
What's more?
In the coming period Hygeia will increase the numbers of enrolled persons in Lagos and in Kwara State. In the meantime Hygeia is working closely with PharmAccess to further upgrade the health facilities and improve and expand the level of care, enabling provision of good quality health care.
PharmAccess set up a local office in Lagos in order to support and monitor the program. Regular field missions to Nigeria by teams of experts from PharmAccess Amsterdam are carried out to assist this local office and Hygeia.
Heineken, Zain (former Celtel), Unilever and Shell, all of whom have operations in Nigeria, provide local support by insuring their employees through Hygeia. In this way Hygeia’s risk pool is further increased, which contributes to the sustainability of the schemes.
Click below for the different schemes in Nigeria
The Community Health Plan for farmers in Kwara State
The Community Health Plan for market women in Lagos
World Bank/ GBOPA program for IT-employees