From Shuaibu Zubair Tatu,Birnin Kebbi
Dr. Jafar Augie Mohammed is the pioneer Executive Secretary of the Kebbi State Contributory Health Management Agency (KECHEMA). The Chief Consultant General surgeon and former CMD, turned Health Financing expert, in this interview disclosed how Kebbi state residents embraced the state social health insurance scheme, that was first introduced in Kebbi State, in 2019. Excerpts:
As a medical doctor, how do you cope as the KECHEMA Executive Secretary?
Well, considering the fact that even at the national level, social health insurance was first operationalised in the year 2005, and then decentralized to states ten years later in 2015, it is relatively something new to all of us. However, theoretically, health insurance is not new to a medical doctor like me, who is also a student of public health and healthcare financing. So, I must say that, it has been an interesting experience, and, so far so good. The social health insurance/contributory scheme is one of the remedial measures to address the numerous challenges bedevelling the health sector and especially, our journey towards universal health coverarage (UHC) which is the Target 8 of the SDG 3 (sustainable development goal 3 seeks to achieve good health and well-being). With the current trend, health is so exorbitant nowadays and without any prepaid health insurance scheme, it is virtually impossible for the common man to have access to quality healthcare services at any level of care. So, the Kebbi state Contributory Healthcare Management Agency, KECHEMA was created in 2019, four years after decentralization of NHIS to states, and incidentally, I was appointed the pioneer Executive secretary of the Agency in Kebbi.
- How do you and your team convince the general public to enroll into the health insurance scheme in the state because many people perceived this scheme as new ideology in the health sector in the state?
Yes, it is true, many people are skeptical about social health insurance for different reasons: some do not want to part with their money at a time they feel they’re apparently not ill; others have near-zero trust to any government programme that involves contributing money through a government agency ; others have religious reasons; others show sheer laziness; others view anything that is ‘free’ or subsidized by somebody or government as ‘substandard’. However , social health insurance scheme calls for people to come together and contribute into a common pool, their health risks are also pooled and equalized as the need arises. Thus, the rich takes care of the needy, the healthy takes care of the sick, the young takes care of the old, and do on. So, this is a way that will drastically reduce the out of pocket expenditure (OOPE) for health and ensure financial risk protection at the point of accessing healthcare services. The objective of universal health coverage is to avail all people irrespective of their socio-economic background to have access to quality health services without financial hardship. Despite the provision of sections 10 and 14 of KECHEMA Law and NHIA Act respetively, which makes participation in health insurance mandatory, many people are still not aware. It is therefore, important to join hands with you the media to enlighten the people about the benefits of the scheme.
Sir, can you give us the number of people already enlisted in the scheme in the state based on your data and record?
Presently, we have 83, 573 active BHCPF enrollees; 37,077 Formal sector enrollees, 24,543 Informal sector enrollees. We look forward to commence enrollment of 185,385 dependants of the formal sector enrollees from first March, if the Kebbi state Government releases the employer contributions. We are also set to commence the Tertiary Institutions Contributory Health Insurance Programme (TICHIP). Besides, Equity funds have been appropriated for, in the 2025 Budget. Hopefully, it will be released to enrol more vulnerable groups this year, to complement the BHCPF programme of the Federal Government .
So, I must say that so far, so good, a lot of lessons have been learnt and we are improving every day.
Since you started this scheme few years ago, what would you says are the major breakthroughs of KECHEMA under your watch sir?
The most important breakthrough that always gladdens my heart is the fact that KECHEMA has become a functional, competent and professional social health insurance agency. KECHEMA staff manage the enrollment processes ,we own our data, manage our claims processing, conduct the quality assurance and inspection visitations, receive feedback through our toll-free call centre, and many other things. KECHEMA is also good at effective collaboration with relevant stakeholders. Secondly, I’m happy with the way the traditional institutions in Kebbi state have accepted the Contributory Scheme. All the four Emirs in Kebbi state, are fully behind us. We have clients in all the 225 political Wards in the state.
Thirdly, the residents of Kebbi State have come to understand that, KECHEMA is not running a scheme for a select group, but rather it is a scheme for all residents, whether muslims, christians , kebbi indigenes and non indigenes, rich and poor, men and women, urban and rural, young and old. In Kebbi state, both Muslims and Christians have all embraced the scheme. In the KECHEMA Governing Board, we have a member representing CAN, and a member representing the State Council of Ulamas . They are all giving us their immediate support to make this scheme successful. As we always reiterate that this Scheme is meant to assist ourselves. The common pool, called Kebbi Health Fund Account, is meant to take care of any person that has registered. And one of the beauty of our scheme, I must say is that, in order to ensure equity, the beneficiaries enjoy one single benefit package. Those under the Basic Healthcare Provision Fund, those under the KECHEMA formal sector, those under the KECHEMA informal sector, all enjoy the same benefit package. I must remind you that KECHEMA was introduced concurrently with Basic Health Provision Fund, almost at the same time in 2019. The Basic Healthcare Provision Fund was established by section 11 of National Health Act 2014. The Federal Government decided to give at least 1% percent of its CRF as a grant to the 36 sates and Abuja to provide the basic minimum package of healthcare services to Nigerians. KECHEMA was created in May 2019, almost concurrently with the Basic Health Provision Fund and we adopted the same benefit package.
How accessible is KECHEMA services at the hospitals in the rural areas by the less privileged?
KECHEMA has enrolled across the 225 political wards in Kebbi State.in all the 21 local government areas in the state. Where a ward PHC is not accredited to participate in the Scheme, enrollees have a choice to access care at another nearby primary healthcare facility or a private provider or a secondary facility offering primary healthcare services.
Twenty four public Secondary healthcare facilities, and thirteen private facilities serve as referral centres.
Kebbi state is known as a home of Islamic scholars. How did you secure the cooperation of the Islamic Clerics to support KECHEMA ?
The scheme is accepted across both the Islamic and Christian Clerics. The contributory Scheme is based on mutual assistance, social solidarity and voluntary donations. Christian Clerics find the basis of this in Biblical teachings such as Romans 13:9, 2Cor. 9:7, 3John 2 and others. Similar texts are also quoted from the islamic holy texts by muslim scholars.
What are the challenges facing your agency and how are you addressing these bottlenecks sir?
One of the major challenges we are facing in KECHEMA, is the political will to release the equity funds that is already appropriated in the state budget.Secondly We are hopeful that this current administration will release the employer contrbution for the formal sector so that the dependants, households of civil servants would be enrolled into the Scheme. A third important challenge is in the implementation of BHCPF programme. It used to be hitch-free, but not any more. The funds are now being released in bits and not timely. This brings untold hardship and disappointment to the beneficiaries. Health insurance is about policy year, premium is calculated and paid as per annum payment. So, we are calling on the Ministerial Oversight Committee (MOC). to revert to the previous mode of disbursement because it’s more practical .
Does the scheme cover patients with cancer?
KECHEMA do not cover patients with cancer but it gives some palliatives to cancer patients. However, the Kebbi state government has created an indigent cancer fund under the Kebbi State ministry of health with peculiar guidelines.
