By Chinedu Ekeja

Like many market women in Benin City, Nosa Nosakhare, a trader at new Benin Market, has no knowledge of what a health insurance is. So she felt cheated when — after paying through her nose to fund her husband’s surgery at the University of Benin Teaching Hospital (UBTH) — she saw that a fellow patient was discharged after presenting “just a “card”.

In Nosa’s mind, she had seen yet another form of inequality and unfair treatment common in public institutions in Nigeria if you are not “connected”. She had wondered why somebody got discharged by presenting a card, but when she tried to know how and why, she was told “insurance” — a completely new term on her.

“Everything was free for them, including drugs, test and check up after surgery,” she said while narrating her experience without hiding her pain.

She was even pained the more when she remembered that she had gone to Esusu, a cooperative society, to borrow money to offset the husband’s hospital bill.

Since then, she has been on the lookout for an opportunity to put her family under an insurance cover. But with no knowledge of the Community-Based Health Insurance Scheme (CBHSI), she had concluded that such privilege like insurance was perhaps not meant for people like them since neither she nor her husband was a civil servant.

Nosa is one of several market women in Benin, the Edo state capital, who have expressed desire in joining the CBHIS. The women, under the Traders Welfare Union Of Nigeria, Benin City Chapter, gladly embraced the idea when some of their executive members were interviewed at their secretariats at New Benin Market on Tuesday, June 27, 2017.

They said they had no knowledge of such healthcare package, adding however that they were ready to pay between N1,000 and N2,000 monthly premium or more if a platform emerges and will lure their friends to be part of it.

‘OUR UNION WILL LIKE IT’

Lucky Orukpe, President of the Traders Welfare Union, welcomed the CBHIS idea, expressing confidence that thousands of market men and women would embrace it.

“If you check our market today, we have thousands of traders,” he said. “It’s a thing they will welcome because health is wealth. As President of this union, I personally love it and I know our union will like it.”

Orukpe complained that the only challenge is awareness, as his people have not been given proper information about the workings of CBHIS.

“The only challenge I see is that when people are not informed, they will not accept it, but when they are properly informed, they will  gladly accept it,” he said.

“What our people need is information, because information is access to progress.”

With her experience at the UBTH, Nosakhare needs not much orientation to embrace the idea, she is ready to bring others as well.

“This community-based health insurance, I love it very well, and I will join whenever I see any one formed,” she said.

“At UBTH in 2013, I experienced how insurance works. In fact, I will be the number one person to join and even bring more people to join.”

LESS MONEY, HEALTHIER LIFE

For Beauty Akhigbe who trades on footwear at the new Benin Market, she will join and bring her family along.

“I like the idea, I take my children to the hospital regularly and I know how much I spend. If finally one is formed, me and my family will be part of it,” she said.

Phenomena Orji, who trades in foodstuffs, said she hardly visits hospital because she rarely falls sick. However, she said her family will be covered as she loves the idea.

“Well for me, I don’t go to hospital. For about three years now I have not visited hospital or taken drugs,” she said.

“But I like the idea of CBHIS because we will pay less money. I will make sure my family joins, especially my children.”

As the dream of achieving a Universal Health Coverage continues to elude Nigerian government, federal and state citizens have continued to spend their hard-earned money to access health care services, through a difficult-to-sustain Out-of-Pocket (OOP) Model.

But as discussion continues to gain momentum across the country about the importance of having a health care financing model that guarantees a reliable, sustainable and affordable health care system, CBHIS is favoured as the best option for the informal sector.

ONLY TWO INSURANCE PACKAGES SO FAR

Currently, there are only two existing health insurance programmes covering the informal sector under the Community Based Health Insurance Programme (CBHIS) in Edo state.

The two groups are only in Edo North, while none exists in Edo Central and Edo South.

They are Auchi Allied Mutual Health Association, which has membership strength of 2,332 people with a monthly premium of N300 and First Akoko Edo Ilera Health Foundation, which has membership strength of over a thousand and five hundred and a monthly premium of N150.

According to Patricia Oviawe, State Coordinator of National Health Insurance Scheme (NHIS) in Edo State, there are at least four other groups going through the process of establishing theirs in the state.

Under the vital contribution Social Health Insurance Scheme (VCSHIP), only 540 people have enrolled so far in the state. They pay N15,000 premium per annual.

She said there was an improvement in enrollment rate, with about 100 enrolling this year alone so far.

These statistics show that only a negligible portion of the population, which is less than one percent, has a health insurance cover. This leaves greater chunk of the population, representing over 98 percent to their fate. They survive through either out-of-pocket (OOP) or self-help as could be seen in most rural communities where primary health care system facilities have gone obsolete.

Anticipations are already high, as residents of Edo State await the coming of the state Health Insurance Scheme.

INSURANCE FOR EVERY CITIZEN

On May 1, 2017, Godwin Obaseki, Governor of the state, announced plans to introduce statewide Health Insurance Programme while addressing workers at the Sam Ogbemudia stadium.

The scheme, according to the governor, will hasten the Sustainable Development Goal (SDG) that targets Universal Health Coverage (UHC) for every citizens.

Speaking on the anticipated scheme, Odi Odiko, State  Director of Primary Health Care, said the State Insurance Programme would be all inclusive, as it will cover not only those in the state workforce, but also those in the informal sector.

“We have the civil servants who already have a data base, we know who they are, but they are not the only people who should benefit from health insurance. You also need other people to be part of it,” Odi said.

“There are people who work in the private sector who should benefit from health insurance; there is also need to take into consideration the market women, the Okada riders, the artisans who all need to benefit.”

However, he said all these would not be feasible until there is a legal backing to the scheme, which the State House of Assembly is currently doing.

Traders Welfare Union has more than 7000 members in Edo South alone, spreading in more than 10 markets within Benin metropolis.

If Auchi Allied Mutual Health Association, with less than 3000 members, can pay N300 monthly premium and the minimum collectable premium is N150, any group numbering 500 can buy insurance.