Some states are not responding badly on the need to extend Universal Health Coverage to its citizens. It is cheering news to note that national laws and policies that support the right to health of the citizens are being domesticated in most states. One of such law and policy is the establishment of the Mandatory Health Insurance scheme and the provision of the one percent Consolidated Revenue Fund for the Basic Health Care Provision Fund. The domestication of these laws and policy is the only vehicle to which Universal Health Coverage can be attained. Using Sokoto State as case study for this write-up, The Sokoto state Contributory Healthcare Management Agency (SOCHEMA) was established by Law No.2 of 2018 to provide affordable, accessible and equitable healthcare services to all residents of Sokoto State. It guarantees the provision of needed healthcare services It is based on the Islamic Insurance called Takaful. Its objectives are amongst others; To ensure that every resident of Sokoto State has access to good healthcare services without financial hardship, To protect families including those in the informal sector from catastrophic spending on health, To limit the rise in the cost of healthcare services, To ensure equitable distribution of health care costs among different income groups and To ensure efficiency in health care services. The scheme provides the following programs and plans; The Formal Sector Contributory Healthcare Program: for the following group of people: Sokoto State Public Sector Employees (State and Local Government), Organized Private Sector (OPS) for organizations with a minimum of five (5) staff, Sokoto State Tertiary Institutions Contributory Health Program (STICHP), Uniformed service men and Retirees.
In the Law that established the Scheme {Section 19(2), The Sokoto State Government shall provide initial take off grant for formal sector fund; comprising of contributions from students, public and private sector employers who shall contribute 10% and employees not more than 5% of their basic salary. Elected officers and political office holders shall contribute not more than 10% of their basic salary. It is interesting to note that some emoluments from political office holders are used to fund universal health in Sokoto State.
The Informal Sector which consists of: Community Based Contributory Healthcare Scheme for a cohesive group of households /individuals or occupation based groups is also not left out. The group is formed on the basis of mutual relationships and members take part in its management.
The state contributory health scheme also established an Equity plan which is for vulnerable groups: Persons with Disability, Children Under 5, Pregnant Women, and Prison Inmates. The Fund for equity plan is derived from: Not less than 2% of the State Consolidated Revenue Fund (CRF), not less than 1% of Local Government Consolidated Revenue Fund, Funds from Zakat, Donations from Philanthropists, NGOs, individuals and any other source and 1% levy of any capital project contract in the State. Interestingly this presents another innovative means of generating funds for universal health adopted by Sokoto State Government.
To expand coverage, Sokoto State have been able to accredit 141 PHCs in collaboration with NHIA to cover all 244 wards. This expands coverage and increase the number of beneficiaries to 54,637 and with the recent release of the 50% of the 3rd trench of BHCPF, the number will rise to more than 63,000. To further expand coverage, Sokoto State commenced the implementation of Sokoto State Tertiary Institution Community Health Program STICHP, with 12 state owned and 10 private tertiary institutions. It also target informal sector enrolment with support from IHP targeting 50,000 enrollees and 10 associations were recently engaged by SOCHEMA under the informal sector. Partnership with the UN SDG Joint Fund through UNICEF also integrated 6,000 vulnerable people into the equity plan of the scheme for 12 months in 2022 and another 3,000 vulnerable people for 6 months in the current year. It also engages on Mobilization of Philanthropists in the state to contribute to the equity fund.
In addition to the above, the benefit package offered by the Sokoto State Contributory Health Management Agency SOCHEMA includes a single universal plan for all residents of Sokoto State to be called the Sokoto State Health Plan. The plan consist of a basic, defined minimum benefit package of healthcare services for primary and secondary care from both public and private health care facilities who shall refer if necessary to designated tertiary health facilities. To guarantee quality assurance, it established a 24/7 toll free call center for complaints and feedback.
In conclusion, the gains recorded in Sokoto state can be replicated in most states if there is a political will in the part of stakeholders in charge of health care in the states. There is need to collaborate with divergent stakeholders such as Labor Leaders, Civil Society Organizations, Donors and Philanthropist to expand health insurance in the states.
Victor Emejuiwe
Program Manager, Good Governance
Writes from Centre for Social Justice Abuja
08068262366
