Community Based Health Insurance Scheme (CBHIS) for Microfinance Clients
In May 1999, National Health Insurance Scheme (NHIS) was set up as a contributory-based scheme to develop access of all Nigerians, which encompasses government employees, the organized private and informal sector irrespective of their socio-economic status, to good healthcare services. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. Goal of health insurance - To achieve Universal healthcare coverage (UHC), has been difficult to achieve in Nigeria, with large populations remaining over-reliant on direct (out-of-pocket, OOP) expenses that include over-the-counter payments for medicines and fees for consultations and procedures. The cost of healthcare has been a significant obstacle to utilization by the low income earners. Out-of-pocket payment for health care has also hindered many poverty reduction efforts when significant part of income is spent on healthcare. LAPO therefore believes that affordable access to quality healthcare has positive impact on healthy living, sustainable income and poverty alleviation efforts. Consequently, management of LAPO met with The South-South Zonal Manager on Wednesday, 4th September, 2013, to discuss the operations of national health insurance scheme (NHIS). It was concluded that the existing structures and spread of LAPO Microfinance Bank will provide adequate leverage for efficient achievement of objectives of community based health insurance scheme (CBHIS) across Nigeria. To determine willingness to participate and pay for health insurance among clients of LAPO Microfinance Bank, a survey to determine Willingness to Participate and Pay for Health Insurance. This study was conducted in March 2015 to ascertain the desirability and acceptability of a health insurance scheme to MfB clients by assessing their willingness to enroll (WTE) and willingness to pay (WTP) for health insurance under the auspices of LAPO. The study was conducted in Benin City, Edo State, where, at the time of the study, the MfB had 17 branches consisting of 2,252 unions that have about 50,000 clients. A total of 892 study participants from all the branches – one leader, one secretary and two members for each of the 224 unions were selected. The survey report recommended that a health insurance scheme be instituted for LAPO MfB clients and further identified the need to educate the clients on the scheme.
Implementation Partnership Model: The LAPO community health insurance scheme is coordinated through a partnership involving AIICO Multishield as the HMO and three organisations within LAPO group – LAPO NGO, LAPO MfB and Orange Insurance Brokers Ltd. cost-sharing model was adopted for each partner organisation to provide her resources towards achieving the scheme’s objectives. Programme reports are shared regularly among the partners especially as it concerns enrollees feedback on quality of healthcare received from services providers. Multishield, Orange Insurance, LAPO MfB, LAPO and all health facilities will be required to write separate reports of their activities and share same with partners in the scheme
Enrollees Participation: Participation in the scheme is through individual enrollment and family members will be registered separately as individuals. The scheme will target microfinance clients, members of their households and non-LAPO members in our target communities. Non-LAPO members will be required to pay the N1000 account opening fee while monthly contributions of N500 will be paid per enrollee in the scheme.
Benefit of Enrollees under the scheme: All enrollees will be able to access comprehensive primary healthcare services in designated health facilities. Services include:
Out- patients and inpatients care (Services provided under comprehensive primary health care are covered.
- Maximum of 10 outpatients consultation per year
- Maternity benefits up to postnatal care (include assisted delivery such as use of forceps, infant care for 6 week, exclude caesarian section)
- Maximum of 15 days of hospital stay per year
- Limit of liability per year of N100,000 although for some clients it can go beyond that but it is subject to approval from LAPO.
- Health education and annual medical screening which includes BMI measurement (Body Mass Index measurement), Blood Pressure measurement, Urine sugar measurement, physical examination
- Care for all emergency situation are covered under the scheme.