Universal Health Coverage: A Flashback to the Kwara Model

In the era of boom, quality healthcare for those in the informal sector was terrible. With the nationwide recession, it is much worse. The thought of how to overcome the difficulty and provide for the masses gave birth to the  Kwara Health Insurance Scheme, initiated over a decade ago by Dr. Abubakar Bukola Saraki as […]

In the era of boom, quality healthcare for those in the informal sector was terrible. With the nationwide recession, it is much worse. The thought of how to overcome the difficulty and provide for the masses gave birth to the  Kwara Health Insurance Scheme, initiated over a decade ago by Dr. Abubakar Bukola Saraki as Governor of Kwara State in 2007.

It is fitting that Saraki now President of the Nigerian, will blaze the trail in the introduction of a Health Insurance Scheme to Nigeria. A medical doctor, whose father, Abubakar Olusola Saraki was also a medical doctor, with a long history of having compassion for the masses, the younger Saraki inherited this trait.

Therefore, concerned about the health challenges of Kwarans, especially those in the informal sector, and their lack of access to quality and affordable healthcare, Saraki’s first programme shortly after he was sworn in as the governor of Kwara State in 2003 was the introduction of the Kwara Health Insurance Scheme.

 The scheme has continued to benefit thousands of Kwarans. As Senate President, Saraki recently canvassed for the introduction of a similar scheme for those in the informal sector across the country. While receiving World Health Organization (WHO) Regional Director for Africa, Dr. Matshidiso Rebecca Moeti, who was accompanied by the Hon. Minister of Health, Prof. Isaac Adewole, Minister of State for Health, Dr. Osagie Ehanire, and other top management staff of the Federal Ministry of Health, Saraki said that one of the strategies to achieve Universal Health coverage was to provide a health insurance scheme to the informal sector of the country.

“The Universal Health Coverage is something that is dear to my heart. I remember when I was Governor of Kwara State, I introduced informal health insurance scheme to those who are unemployed in rural areas as I have always believed that the formal sector can take care of itself”, he said. What Saraki, a modest man who rarely sings his own praise, did not tell his audience was that when he became the governor of Kwara State, he inherited a healthcare system that was worst than hospitals being mere consultancy centres.

Kwarans died in thousands because they could not afford the cost of medical care which made them resort to herbs and traditional healing, which in turn caused more damage instead. Working with local and international partners like the Dutch Government, The Health Insurance Fund, Hygeia Community Health, PharmAccess Foundation and others, Saraki started the pilot project in one of the 16 local government areas in the state.

Upon payment of N200, then in 2003, every individual was entitled to medical treatment for the rest of a financial year. Beneficiaries enjoyed free consultation, supply of drugs, medical investigation, blood transfusion, ultra sound scan and minor surgeries such as Caesarian Section, appendectomy, circumcision, evacuations and others. 

The insurance scheme also covers maternal and child care, chronic diseases, hypertension and diabetes, minor surgeries such as hernia as well as the treatment of lifestyle and some non-communicable diseases and other primary healthcare activities.

The then state government also designed a scheme that worked through community leaders. There is a Board of Trustees for each community, usually headed by the traditional ruler. The board  mobilised the community for participation and manage the scheme for optimum performance.

In Edu Local Government, where the pilot project took off, the scheme enjoyed tremendous patronage. The General Hospital in Tsonga that previously hardly attended to 10 patients in a day had over 5000 patients in the first month. Nearly everyone in the town, from the traditional ruler to the peasant farmer, registered for the scheme.

Buoyed by the success of the pilot scheme, Saraki expanded to other local government areas in the state before he handed over to the current governor, Abdulfatah Ahmed, in 2011. The scheme had covered 10 out of the 16 local government areas with 400 communities. Within the same period, over 3,000 births and more than 600 Caesarean Sections were carried out. The scheme was limited to rural areas because Saraki was concerned about how to subsidise healthcare and make it affordable for those living on one dollar and below per day.

With ‘Legacies Continue’ as his campaign slogan, Ahmed built on this laudable health programme of Saraki  and by 2015; almost all the nooks and crannies of the state had been covered. 

Like every good work, the success recorded by Kwara State Government with the Community Health Insurance Scheme has not gone unnoticed. The scheme was one of the global top-ten finalists for the Development Assistance Committee (DAC) Prize organized by the Organization for Economic Cooperation and Development (OECD). At the awards ceremony held in Paris, France on October 7, 2014, the OECD praised the sustainability of the programme and commended the significant approaches that the Kwara State government has been utilizing to overcome the barriers that often lead to market failure in such endeavours. The scheme had also received commendations from the UN and Bill Gates Foundation for its creative approach to pro-poor health care.

Saraki’s feat has also led to Kwara State being described as the home of Community Health Insurance Scheme due to its pivotal role in spreading healthcare delivery to the grassroots.

A student doctor who did his internship and youth service in rural Kwara once said to this writer that “I had a firsthand experience of Kwara Health Scheme and it’s enormous benefits to the poor. Where I work now, up North, I have lost many patients due to their inability to pay for drugs. Many don’t even bother to come to the hospital. A national application of the scheme will help millions in the informal sector”.

Beyond calling on other state governors and the Federal Government to embrace the scheme, Saraki must take it upon himself to start a national campaign, appealing to leaders to embrace the scheme. I know the Senate President lack executive powerS, but he should use his influence as the Number Three man in the country to work out a system that will enable the federal, state and local government councils  create a functional funding window to support Health Insurance Scheme for those in the informal sector nationwide.

This will save many lives and for Saraki, it will be an eternal legacy like that recorded by Chief Obafemi Awolowo in education in the old Western Region.

Fatigun is a former Chairman of Ekiti LGA in Kwara State.