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ASHIA, best thing to happen to Anambra health sector – Onyemaechi



EXECUTIVE Secretary, Anambra State Health Insurance Agency(ASHIA), Simeon Onyemaechi, was a guest speaker at the  three-day productivity and orientation workshop tagged ‘Workplace Relationship, Workers’ Life and Productivity,’ organised by Anambra Newspapers and Printing Corporation (ANPC), publishers of National Light, Ka O Di Taa and SportslightXra newspapers.

Dr. Onyemaechi, shed light on the activities of his agency, describing his agency’s health insurance scheme as one of the best things that ever happened to the state’s health sector. He likened the scheme, whose principal objective is to promote, regulate, supervise, implement, and ensure  effective administration of the state’s health insurance scheme to the traditional isusu done in Nigeria,

where people pull resources together and everyone benefits from it; but differs in the sense that when someone falls sick, he benefits from a subsidised medical treatment. In this instance,  he said, Anambara State Government subsidises the scheme.

“There is no way in the pool that everyone would fall sick the same day. At any time, there are only 15-30 per cent of the populations that will be sick or that will require seeing a medical doctor. Therefore, if we all contribute to the scheme this month, about 15 or 30 per cent of us would go to the hospital this month or any other one. No matter the issue with all these people, the contributions would take care of it.”

The ASHIA boss who described health as a basic need of man encouraged people to register with the scheme, allaying fears of the scheme going under some day. “To set up Anambra State Health Insurance Agency (ASHIA), Gov Obiano decided not to do a routine thing or issue policy statement that after he leaves, the next government comes and doesn’t like the programme, jettison’s it.

So, he institutionalised it by a bill to the state House of Assembly after going through the process of a proper bill, which he accented to, to become a law establishing Anambra Health Insurance Scheme to be run by Anambra Health Insurance Agency giving a minimum of 0.5 percent of consolidated revenue of Anambra State to that goal.

“What that means is that any amount of money accrued to Anambra State is set aside and dedicated to Anambra Health Insurance Scheme to run what we popularly call today ASHIA. There is never going to be anytime in the future that it will not exist. The scheme is a creation of the state law whether any governor or government that comes after him likes it or not, it has come to stay.”

Dr. Onyemaechi said for any worker who contributes five percent of his or her salary; or  for someone who contributes N1,000, each month, to get the whole process of healthcare delivery, it is from the N12,000. Say for example, somebody is  billed for appendicitis operation, or a woman goes for antenatal from the amount contributed.

“There lies the fact that there is subsidization from government. And from that functional health insurance scheme, we also do what we call cross subsidization that is the rich subsidizing the poor, the healthy subsidizing the sick, that way you cannot finish the resources in the pool. What that says is that the man who is a director, for example contributing five percent of his salary as his premium and the woman who is  a cleaner contributing five percent of salary will receive the same set of services,”

Dr. Onyemaechi, having practiced at that level at the national level stated that the state health insurance package is expanded and cheaper than the National Health Scheme (NHS).

Speaking on the choice of hospitals and teaching hospitals are not on the list, Dr. Onyemaechi said such hospitals were reserved for referral purposes. “The practice in Nigeria cannot continue. What the Western world has done to get their society right is using the platform of health insurance to standardize healthcare.

Healthcare graduates from primary to secondary and then to tertiary care. What we have in Nigeria is that somebody has malaria and goes to a teaching hospital to treat malaria. That is an anomaly and shouldn’t happen; it means that the health system has collapsed.

“You go to a primary health provider, the way they say in the United Kingdom what they call the GP – General Practitioner. The GP says what the issue is and takes it up to the next level of care. When you get to the next level of care and they cannot handle it, they will refer you to the tertiary level. That way, the specialists and professors who are in the teaching hospitals will focus on difficult issues.”

He maintained that a typical consultant in a teaching hospital doesn’t see more than 10 patients a day, but in Nigeria, a consultant will see 50 patients in a consulting room in a day. Such, he said, doesn’t contribute much to his residency and the medical field continues to suffer, because those other professors who have something to hand over no longer have such. “To correct this anomaly, we must have a refined heath package.

The only adjustment we had only recently at the instance was scale down the teaching to secondary level for a purpose that is only when it is necessary. There are standard things that are not done but thank God for insurance. Those in the scheme are enjoying it.

In Medicine, no one who is a first timer as a pregnant woman should be seen by anyone less than a consultant and for the fourth or fifth pregnancy and above, which the womb can rupture, such case is reserved specifically for a consultant. We are trying to use this to rearrange the system.”

Dr. Onyemaechi further stated that Nigeria is the only country where every year, the government doles out money to upgrade hospitals. “How did West get to where they are today? They did health insurance. It is a competitive thing.

We have many hospitals in our scheme and any one that doesn’t perform optimally, we delist them, and the hospital loses. If everyone decides to go to Hospital XT as their primary health provider and every month, we pay them  45 per cent of the capitation that goes back to them.

When you are not satisfied with services you are getting, you reserve the right to opt out of that hospital and if everyone begins to move out, the hospital is bound to ask what they are not doing right. They will be forced to invest in their services and facilities depending on where they are lacking without anybody giving them extra money. If that hospital gets to a point that they can no longer survive, they begin to look for collaboration. Then we begin to have multi clinics springing up. That was exactly how multi clinics sprang up abroad; you hardly have one man practice outside his country.”

“If a single clinic will not come but when you have multi clinics, pull resources together, build big facilities and then you can offer quality health services to the people. Overtime, health insurance has potential to have that going.

At the point of filling your form, you will see all these facilities and you will choose anyone of your choice, which will also address the challenge of substandard drugs. We have our 24 hours call number to address any issue and it is at the back of the card you will be issued. Why we have to do this is  that once you receive poor service, instantly you call that number. “

The ASHIA boos said people would be wondering how fast his agency responded to emergencies.

“Some couple of weeks ago, we got a call from Umunze, and my staff said it’s past three in the afternoon, should we just call them or go; because I said once it is before 4pm, any complaint we receive, we attend to it.

We got to Umunze after 5pm and engaged them. The hospital management was so apologetic. The person who called us complaining also joined them and said that he had sorted things out with the hospital. People like creating problem in this country.

You called us citing a problem and joined them to say that they have done you well. We cannot make progress as a people. This is the bane of our society. One complaint I heard in this room is that some people went elsewhere to spend money to take care of themselves.

“The amount an Igbo person spends out of pocket where he doesn’t want to waste his time is way too much; we need to cut it. What that person would have done is spend N100 to call that emergency number, because I’m sure that person must have spent between N3,000 and N5,000, where he could have had  patience and that helps solve societal problems.”

Dr. Onyemaechi reiterates his agency’s stand to delist any hospital that tries to undermine the mandate of ASHIA. “We have delisted three hospitals from our scheme, even when we started service in January this year. That isn’t to say that we are doing a good job. That’s to tell you how proactive we can be.

We have taken a decision to delist to tell you that you are not doing well. Most of the facilities we delisted were managing 500 lives. You know that that means to that hospital in terms of cash flow. We have to make a decision to stop it at once, and we do it to serve as deterrent to others. If you know that we can come down on you, then you are good to go.”

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