… Says greatest challenge is convincing enrollees, providers

… Expands benefit packages

•Says effective cure now in Nigeria

It is no longer news that many Lagosians are living below the poverty line but the news is what is being done to alleviate the sufferings of millions of residents in Lagos, especially in terms of access to health care. Findings available have shown that over 70 per cent of Nigerians pay out-of-pocket for their health needs, hence the need for the introduction of mandatory health insurance nationwide.

Today, States like Lagos are expanding access to essential services, releasing funds to enrol thousands of poor and vulnerable citizens into the State health insurance scheme.

The General Manager, Lagos State Health Management Agency, LASHMA, Dr Emmanuella Zamba, spoke to CHIOMA OBINNA on the key achievements of the Lagos State Health Management Agency, LASHMA. Excerpts:

Lagos State Health Scheme
The overall goal of the Lagos State Health Scheme, LSHS, is to ensure that all residents of Lagos have unhindered access to quality healthcare services in an efficient, sustainable, and equitable manner and this is why it is made mandatory for all residents, all employees in the public and private sectors, including the self-employed and the unemployed.

Let me also say that the LSHS comprises three components; Lagos State Health Plan (LSHP), now rebranded as ILERA EKO, the Formal Health Plan (FHP) being provided to Lagos State Public Servants and the Lagos State Private Health Plan (LSPHP) being marketed by all the Lagos State based private Health Maintenance Organisations (HMOs) in Lagos State.
Benefit packages

We have the cheapest health plan. Our standard plan is N8, 500 for an individual per year and 40,000 for a family of six per year. That is father, mother and four children under the age of 23. It used to be 18 but with the feedback that we got from the public and we all know, you’ll have children of 20, 21 that are still at home being fed by parents and still dependent. So we had to increase the level of coverage from 18 years now to 23. So if your children are under 23, you can bring them in on your family plan.

We’ve also expanded our bouquet of services based on feedback with the public. We have what we call our senior plan where residents over age 60 can come on board the scheme. And that with that offer, not only do you have the services under the standard plan or you’re able to do like a yearly screening test that would help you if you have cancers, etc, which we know, is very important as we get older. So we have that as an individual plan of N34, 000 and as a couple which is daddy and mummy that comes to N65, 000.

We’re very mindful of the fact that we also have families that are more than six. If you have a family that is more than six and the additional family member is less than 23 years, it would come at the cost of 6,000 per child. If the additional family member is over 18 years of age, the individual price of N8, 500 applies. The beauty of insurance is that sickness doesn’t inform anybody before it comes. Nobody knows when he or she will fall ill.

This plan will cover non-communicable diseases such as hypertension, diabetes mellitus, malaria, febrile conditions, surgeries, antenatal care, delivery, lab investigations and medicines related to conditions covered, among others.

The attached premium of N40,000 or N8, 500 is relatively reasonable when compared to out-of-pocket payment. An individual may pay more than that at once for just malaria treatment.

We’ve also come up with what we call Ilera Eko standard plus and that provides an additional bouquet of services over and above the standard. And that was also based on feedback from the general public including even sick public servants who want something a bit more. So that is also available for people to come on board and that is, as a cost of N12,000 for an individual per year and N75,000 for the family of six.

We have now moved the Eko Telemedicine forward, instead of having to go to the hospital every time you just simply call. It’s a toll -free line, and speak to your doctor. Then if they feel that you need to go into the facility, you can now go in for care. So that is also available to the general public. That is something that will be working with one of the tertiary institutions in Lagos state very shortly to launch.

Achievements
Following our mandate and since assumption of office, Governor, Babajide Sanwo Olu, the Scheme has recorded over a 100 per cent increase in enrolment; from 5,000 lives to 623,183. Again, the number of providers has grown from 40 to 250, both the primary and secondary (public and private) healthcare providers.

Telemedicine in action
To ensure that we deliver care in the height of COVID, one of the first activities was to establish some sort of system that would keep people away from the hospital and we would be able to cater for their needs.

So with the approval of the Governor, the Agency established what we call EKOTELEMED, which is the state’s telemedicine platform. That platform was mandated to provide virtual health care to Lagos residents free of charge at the time. People don’t need to walk into a hospital except if it is an emergency and we have doctors speaking the languages 24 hours to attend to you.

So we reduced essentially the people that were going into the hospitals and tried to at least do our bid with regards to reducing the spread of COVID, that telemedicine has now grown to become the backbone of the Scheme.

And we’ve also established what we call the public servant sinking fund which helps to provide additional services over and above the standard plan which they are on right now, that is the Ilera Eko standard plan. So if you are a public servant and you have something else that is outside of that plan, you write to the agencies and it’s brought to our attention those things that are within the bouquet, we can now do that for the public servants. So that is also an achievement.

Governor’s support
The Governor has been extremely supportive of the Agency. This was one of his campaign promises and he has been very consistent in ensuring that this Agency tries to deliver on its mandate in terms of expanding Universal Health Coverage across the state.

The Agency through collaboration has provided health insurance for over 180,000 vulnerable and indigent residents of the State who have registered under ILERA EKO Scheme.

Since the 2021 date, the state government through the Equity Fund has approved and released a total of N750,000,000 equity funds for the payment of health insurance premiums of the vulnerable residents of Lagos State.

As part of the efforts to monitor the quality of care delivered to her enrollees, we piloted a quality monitoring programme by engaging 20 quality officers who are responsible for effective monitoring of the quality of care rendered under the scheme and engagement of 5 full-time Quality Officers as Divisional officers.

Also, through EKOSHA, an innovative financing initiative designated to mobilise resources for vulnerable courage, the State government under the scheme flagged off of Basic Health Care Provision Fund, BHCPF, to onboard 55,000 poor and vulnerable on Ultra Eko in collaboration with the National Health Insurance Scheme, NHIS, the Agency carried out the launch of the Basic Health Care Provision Fund to onboard 55,000 poor and vulnerable residents in the State on Ilera Eko.

In 2021, the Agency revised the LSHS marketing strategy, as part of an effort to increase awareness and uptake of the Scheme resulting in the creation of over 200 jobs and employment through the Scheme. Currently, we have facilities that have up to 10,000 lives, 6,000, and 5,000.

Grassroots coverage
We have established a grassroots presence. So if you’re working with the grassroots, you have to be close to them. They have to have somewhere they can come and make inquiries, make their complaints and so on. So we started off in August last year. We established five divisional offices in the five divisions of the state. So, we have a whole team that sits in that office and they go out into that division. They are responsible for bringing lives in those divisions. We are actually delivering on that promise.

Vulnerable groups
We are also partnering for instance with LASUDA that’s the Lagos state office for disability affairs and through them, we get more of the names of vulnerable disabled who we have quite a number of them currently on the scheme.

With regards to the vulnerable, the state government has earmarked N750 million which has been disbursed so far. We just got the last chunk of the N750 million which is N300 million and as I said, we are going to roll out into communities and start enrolling people, we are just in the planning stages now.