Achieving Universal Health Coverage In Anambra

By Raymond Ozoji, Awka
The attainment of Universal Health Coverage in Anambra state was the Crux of the matter at the world press conference held at the conference hall of the Anambra State Health Insurance Agency (ASHIA) Government House Awka. The whole media parley was that Universal Health Coverage would be achieved as envisioned by the state governor Professor Charles Chukwuma Soludo judging from the innovations introduced to the social health insurance scheme intended to guarantee increased access to affordable quality health care as well as save citizens from high out-of-pocket health expenditures that could potentially impoverish them. That was the meat of the discourse to commemorate the 2022 World Universal Health Coverage Day as the Managing Director and Chief Executive Officer of the Anambra State Health Insurance Agency (ASHIA) Dr. Simeon Beluonwu Onyemaechi reeled out achievements of the state social health insurance scheme in relation to the realisation of the Universal Health Coverage in Anambra state using the Solution model.
The United Nations General Assembly had on 12th December, 2012 endorsed a resolution which urged countries of the world to accelerate progress towards attainment of Universal Health Coverage. Universal Health Coverage on its part, is such a time when everyone, everywhere would have access to quality health care that is affordable. However, to lay claim to Universal Health Coverage, healthcare must be affordable, accessible, of good quality, equitable and sustainable. The theme for the 2022 celebration of Universal Health Coverage Day is “Build The World We Want: A Healthy Future For All.” On the other hand, the Anambra State Health Insurance Law 2016, which is a product of an executive bill, established for Anambra state, a social health insurance scheme to be administered by Anambra State Health Insurance Agency.
Eversince the official launch of the scheme on 14th September, 2018 and commencement of access to health care by beneficiaries on 1st January, 2019 from a network of about 100 public, private and mission hospitals across the state, government has continued to save lives through affordable healthcare services. The number of healthcare providers under the Anambra State Health Insurance Scheme has grown to over 200 facilities. Hence, accessing health care through ASHIA has significantly improved the health seeking behaviour of the populace. The main reason therefore for positive health seeking behaviour of the people was affordability of care and availability of quality care including quality drugs as well as presence of medical personnel in health facilities. This is evident in the massive recruitment of health officers by Governor Soludo to end the era of hospitals in Anambra state operating without doctors, nurses and other medical personnel.
Moreso, with the realisation that over 85% of the citizenry belong to the informal sector, the Anambra State Health Insurance Agency developed what it called the adoption model with a view to catalyze activities around enrollment of that segment of the society. The adoption model according to ASHIA boss Dr. Simeon Beluonwu Onyemaechi, has yielded fruits as over 180,000 persons have been enrolled into the state social health insurance scheme out of which 35% are from the informal sector. Onyemaechi however explained that the adoption model is indigenous to Anambra state. He said it is effectively solving a local problem of lack of health insurance culture as ability to pay for health insurance is gradually equating the willingness to pay.
Onyemaechi at the World Press Conference to commemorate the 2022 World Universal Health Coverage Day informed that the European Union and the World Health Organisation have adjudged the Anambra State Health Insurance Scheme as the best performing informal sector health insurance scheme in Nigeria. He also disclosed that 8 Nigerian states have visited Anambra to understudy her health insurance scheme for onward replication in their respective states. That ASHIA has equally provided technical support to at least 8 other states in the country in running their health insurance schemes. It is however worthy of note that the National Health Insurance Authority Law has recognised adoption model as an innovative method of reaching the informal sector especially the indigent and the vulnerable in the society.
To this end therefore, the present administration of Professor Charles Chukwuma Soludo has taken ASHIA coverage to another level by introducing what is called the Solution Care for Road Transport Workers in Anambra  who are compliant with payment of monthly/weekly levy to operate. ASHIA on her part, has enrolled over 200 compliant road transport workers and equally poised to upscale the number to thousands. Onyemaechi stated that it was the first of its kind in the health ecosystem of Nigeria; where tax-for-service model is introduced for the citizens. He also said that ASHIA holds the record of never defaulting in paying health care providers under her scheme their capitation and fee-for-service. This he said was to enable healthcare providers prioritize care to ASHIA enrollees.
Onyemaechi noted that ASHIA introduced the first fully end-to-end electronic system for both pre-authorization and claims management by a State Health Insurance Agency in Nigeria. That ASHIA also revised her medicine tariff upwards in August 2022, the laboratory services tariff in September 2022 and the eye care services tariff in October 2022. That the revisions were to reflect current market realities that would ensure enrollees accessed quality care promised them without suffering financial hardships. Onyemaechi equally disclosed that ASHIA has decentralised her administrative services especially enrolment and local resolution of enrollee issues to General Hospital Onitsha, General Hospital Ekwulobia, Immaculate Heart Multispecialty Hospital Aguleri, Our Lady of Lourdes Hospital Ihiala, St. Felix Hospital Nnewi, Immaculate Heart of Mary Hospital Nkpor, St. Joseph Hospital Adazi Nnukwu, St. Joseph Hospital Ifite Ogwari and Idemili-North local government headquarters. He therefore charged all philanthropists to pay premiums for the downtrodden using the adoption model to enable them to access quality health care services without having to pay for exorbitant medical bills through their nose.
However, research findings have shown that the Anambra State Health Insurance Scheme has indeed improved the health seeking behaviours of Ndi-Anambra especially the rural populace as clearly evident in the investigation conducted by Uche Ezenwaka, a research associate with Health Policy Research Group of the University of Nigeria Nsukka. Ezenwaka in her investigations, found out that about 71.9% of the beneficiaries of the state social health insurance scheme changed their health seeking behaviours in terms of when to seek care when they are sick as well as where to access health care when they are sick. The research consultant also discovered that people now adopt positive attitudes in going to hospitals to seek care when they are sick because they have registered with the Anambra State Health Insurance Scheme.
According to Ezenwaka, Ndi-Anambra no longer patronised patent medicine vendors popularly known as ‘chemist’ but now rush to the hospitals under ASHIA to have their bodies properly examined and to get quality health care because of the presence of doctors, nurses, drugs and very well equipped health facilities. She therefore posited that from her research, 71% of the beneficiaries of the Anambra State Health Insurance Scheme are very happy that they no longer have to pay for health care once they are sick while extending profound gratitude also to the governor Professor Charles Chukwuma Soludo for his strides and innovations in the health sector of Anambra state. Meanwhile, the foregoing are subtle portrayals of the manifestations and justifications towards the attainment of Universal Health Coverage in Anambra state as health and well-being of Ndi-Anambra are top priorities on the agenda of Governor Charles Chukwuma Soludo.

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