Nkiru Odinkemelu
The Lagos State Commissioner for Health, Prof. Akin Abayomi has said that the state health insurance scheme is suffering a set back because 66 per cent of Lagosians are living in the poverty bracket and unable to sufficiently pay out of pocket for their healthcare needs.
Abayomi, made this known while addressing journalists at a media parley held recently in Lagos.
He said that only 33 per cent who are well-to-do can afford the scheme even as he expressed disappointment that those 33 per cent prefer to access healthcare outside the country due to lack of confidence in the health care facilities in the state.
His words: “I’m not surprised that the scheme is struggling to take off. We have two major health issues in Lagos which is one, addressing the health of the underprivileged which according to Lagos Bureau of Statistics are living under the threshold of one or two dollars per day. In other words we feel that they are one step away from extreme poverty.
“The second is lack of confidence in the platform by the 33 per cent who are able to afford the insurance. People are a bit weary to go to the public primary health care facilities because a lot of them are in a state that is not absolutely desirable. There is a shortage of man power within these facilities so if you take your family to a PHC and there’s no doctor there, what is your confidence about that facility?
“Out of the 330 PHCs, only 57 have doctors, most people will go to such a facility and say there’s doctor around am not coming back here because I expect to see a doctor, not that we are undermining the role of our nurses, they are fantastic, we have apex nurses that can do much as a doctor but the general perception is I want to go to the doctor.”
The commissioner however stressed that to get things right at this juncture there is need to revamp the primary healthcare system on which the insurance scheme will be riding on so as to boost the confidence of the 33 percent and also subsidise the scheme to bring in the under privilege.
“For an insurance scheme to be functional it needs to have a mandatory compulsion, we need to make it mandatory for all persons to be part of the scheme. The benefit for that is that it is a way of getting the more privilege people to subsidise for the less privilege.
“The other aspect is subsidy, if more than 60 per cent of your population is not able to afford the premiums, how are you going to enrol them? It is simple arithmetic, I can’t pay but you are making it mandatory. So who’s going to pay for the 66 per cent? That’s a major issue, what it means substantially is that state governments, the three tiers of government, the federal, state and local government have to carry 66 per cent of the population. When we did the mathematics, that figure over N60b in premiums alone, where are we going to find that? It requires an out of the box solution.
He stated that even if Lagos uses the equity fund – 1per cent of internally generated revenue – for the under privilege which is just over N6b, it’s only going to cater for 5 per cent of the 66 per cent, leaving another 55 per cent uncatered for.
“Federal Basic Healthcare Provision Fund is only N1b, Lagos can put N6b, federal is putting N1b, yet it’s nothing, we actually need N50 to N60b to rescue the less privilege and pay for their premium so that they can enter the scheme and on the other side pay another huge sum of money for the supply side to refurbish all the facilities.”
To achieve this, the commissioner however agreed there is need for Public Private Partnership (PPP).
Prof. Abayomi also registered his displeasure on the increasing rate of brain drain in the country/state, pointing out that it is an economic loss that needs to be addressed.