Dr Simon Onyemaechi, executive secretary Anambra State Health Insurance Agency, ASHIA, is a man passionate about his portfolio. In this interview with Fides crew of Jude Atupulazi and Chioma Ndife, Onyemaechi introduces ASHIA to the people, giving copious reasons why it is beneficial to the populace and how it can be accessed.
Can we meet you?
Good Evening, I am Dr. Simon Belonwu Onyemaechi, Executive Secretary, Anambra State Health Insurance Agency (ASHIA).
So, tell us, what is this Agency all about? We believe a lot of people are not yet very much aware of its functions and all that
Thank you. This is an agency that is established by a law of Anambra State to provide quality, affordable and equitably distributed health care to people who reside in Anambra State. It is a mandatory scheme implying that the law setting it up insists that every individual who lives and works in Anambra State must come onboard this scheme to ensure that, yes, people have health care without having to feel the pain financially. To remove all the financial encumbrances that would have limited people accessing quality health care. Because what we have currently is a situation where people spend out of pocket, very exorbitant amount, to pay for health care. But because people do not spend this money at once, they don't take note that they are actually spending a huge sum on health care. People go on the road side to buy drugs off the shelf from patent medicine vendors, go to community pharmacies, do self-prescription, self-medication and all of that, and these have brought in a lot complications, a lot of high incidence of kidney failure and all of that in Nigeria, Anambra State inclusive. These are factors that are associated with people going just across the road to get whatever medication they feel is right for them. Now, when you are enrolled into a scheme like ours, it affords you the opportunity to be seen by medical expects; you get the services of a medical doctor without having to pay consultation fee, without having to buy a card, without having to bother yourself about the lab test, without having to think too much about the medication because at the end of the day, you will get to see a health care provider. And about 65-70 percent of your health needs will be taken care of.
Within the package that we have, the only cost you will incur after paying your premium to come on board our scheme is just 10% of the cost of medication and I can tell you that this is the cheapest thing in medical visits. What cost money are not the drugs, what usually cost money are the lab investigations, the amount you pay to see a specialist and all of that. The cost of drugs itself is very infinitesimal. When you talk about health care cost and with enrollment in our scheme, you are only going to pay 10% of the cost of medication.
I break it down, if you are to see me in the hospital as a doctor, you cannot sit down without paying N1, 500 consultation fee to see me and then I will send you for investigations. Maybe you will run a test that will cost up to 10, 15, 20 thousand, then I give you drugs after I must have found out what is wrong with you. Appropriately that will cost three thousand naira at the most.
So you realize that for all this I have said, which will cost about 28,000 naira, only about 2,000 naira goes to drugs and if you are enrolled in our scheme, all you are expected to pay is 300 naira which is 10% of the three thousand, the cost of the medication. So we cannot have a better legacy for any government as good as this. For me setting up this scheme, this is what is obtainable anywhere in developed clans. Unarguably for me, this is the best legacy our governor is going to leave. After so many years, roads may break down, buildings may collapse, as we are having it in Lagos after about hundred years or thereabouts, but today the NHS, National Health Service, which is the insurance scheme of the United Kingdom, has survived several decades. We have an agency that is established by an act of parliament, whether the next governor that comes in likes what he has done or not, you cannot stop the Anambra State Health Insurance Scheme. It is here to stay. And centuries that will come after his Excellence Willie Obiano will benefit from this, the same way we make reference to the founder of the National Health Scheme, NHS in the United Kingdom. That is the same way history will be very kind to him. Even when the roads he built must have been expanded upon, some of the buildings may have collapsed, this particular legacy will outlive him, outlive his children and outlive his generations yet unborn. This is the one thing that will change the health indices in Anambra.
By enrolling in the scheme, with 12,000 naira premium for yourself, pay another 12,000 naira for child, pay for your wife, whatever it is, one thousand naira per person per month, you will get quality health care. Very robust benefit package that is even more expanded than what the NHS package even contains.
When you were speaking, you talked about making it compulsory for Ndi Anambra, how do you intend to do this and make people to key into this project?
It is not me who made it compulsory. The law setting up the agency has made the scheme compulsory for every resident of this state. In this initial stage, because there is this issue of trust for government business, Gov Obiano has demonstrated political will. When there was this accident, the tanker accident that killed people in Onitsha, when he went to see the victims at Toroto Hospital, he said people were not registering with the scheme. When you register with the scheme, this kind of medical bill will be taken care of. He not only talks about Anambra State Health Insurance Scheme whenever he goes, he has demonstrated commitment to ensure that the scheme works. Now, what is left is the aspect of us enforcing the mandatoriness which is what the law has given us. But the governor also has realized that with the leadership of the Commissioner for Health, we are working together to ensure that people begin to access our services. The taste of the pudding is in the eating; let people access our services and then begin to testify to others that this service is working. We are not the first state that started mooting the idea of health insurance scheme; several states had started before us but we have started and right now we have over 30,000 lives registered on our scheme. The governor paid for 10,000 lives to be put on the scheme and has made some money available for people to key in as counterpart funding to enjoy the scheme. Now, those people who have started enjoying the scheme have actually started telling others that they are enjoying the scheme because I know there are agencies that are of government, an arm of government that did not want to join our scheme, but just last week, they wrote me formally requesting that they joined the scheme. What is the reason? People in other sectors that have joined the scheme have started telling them that this scheme is here to stay. People have gone to do surgeries and have worked out of the hospitals paying only the cost of medication. Pregnant women have delivered under this scheme, just in the three months life span that we have enjoyed since we opened our doors to hospitals. Within just that time, several people who were not interested in keying in, are now rushing to key in. We are happy with that because as at December, we were about 14,000 lives; but today we are about 30,000 lives. Within a space of three months, an extra 14, 000 were added to the scheme. So let us get the confidence of the people and then we go out to enforce what is in the law.
But for now we want to make the scheme as attractive as it can be. Let people come to understand that this really is for their own good. Once we establish that fact, market the scheme enough, then we will actually activate the relevant sections of the Anambra State Health Insurance Scheme Law, 2016, to enforce the mandatoriness which is contained there.
Now let's go to specifics. You said that in each family, per head is 12,000 per year. So do you think they can pay 1000 monthly as they may have problems raising that amount at once?
It is an express answer: it is not possible. It's not peculiar to Anambra State Health Insurance Scheme. This is what is obtained everywhere in the world if you are not in a formal setting where deductions are made from source and remitted to the insurance agency or scheme or administration, as the case maybe. Whatever terminology that might be used, you are expected to pay your premium at a go, lump sum. The reason is this; if you decide to make your scheme pay as you go, which is what making monthly payment is, it is actually pay as you go. People will only pay when they need to use your services. They pay you. Someone could pay you 1000 naira for this month and for next month pay another one thousand naira and goes to have a surgery for say, 150,000 naira for paying only 2000 naira. You are losing 148,000 naira. If everybody begins to do this, you cannot have enough pull to pay. The way insurance business works is this: everybody pulls their resources. It's like the isusu model. We all pay our monies to somebody and every month somebody is there to collect. That is how insurance works. You may not be sick today, but because you have paid, the day you need it, you draw from that Isusu. That is the way it goes. But if you do it monthly, there will be a high rate of drop out. If you have high dropout rate from your scheme, it cannot survive. We don't want to have a scheme in Anambra that will start and then within a very short time, the scheme goes under.
Government already has bad reputation for doing business; now people believe that government has no business being in business. So we cannot give the general public a reason to believe that they are right in that assumption. It is good to say to people that we can do services a, b, c d. We give it to you and we live true to those words. But if we run a scheme, whereby people can come in and go out because they are paying 1000 naira every month and drop out when they like and there are no resources to use and off set hospital bills, you can get to the health care provider and they deny you service. The next is for you to turn around and say that the scheme has failed. What is worth doing is worth doing well. Let us pool resources and do the right thing so that this scheme will actually achieve its purpose.
So where does one go to enroll? In hospitals or government offices? What are the procedures?
The process for registration has been made very easy. We have offices in all the 21 local government areas of Anambra State. The heads of departments, primary health care in all the local government areas, are our focal persons. They have their desk officers who work for them and we also attached N-Power staff. To get to us, you call our number, 08021810222, or you call our second number on 08144445376. If you call us on any of these numbers, we will tell you based on your location where you will go to register. But the registration is not free, you have to pay your premium of 12,000 naira, then 500 naira for ID card. There is an ID card we will give to you that will enable you to access health care when you go the hospital. 12, 500 naira is what you will pay into our bank account, then we tell you where to go to with your teller. When you get to that point, you are captured and then get registered and given an ID card from that point.
Before now we were registering in our office in Awka here but now we have decentralized across the 21 local governments of the state. That is the point where we are now, when you contact us, we will give you our account number for you to go and pay. If you don't want to come to us at all, you also can pay in the comfort of your bed room by logging onto our website www.ashia.an.golf.ng. If you log into that web site, you have a section that will prompt you to buy a health plan, so you click on that and follow the instruction to plan the informal sector health plan. You will just use your ATM card details and purchase online, then the platform will send you a mail giving you a reference code. With that reference code, you call us and we tell you where to go to and when you get there we will check on our system, confirm that, yes, with that reference code that we have received the money, and then we register you. So that's the much we have done.
I am using this opportunity to call on Ndi Anambra that are philanthropist to please extend their hand of charity towards paying health insurance for people. There are people in our community who cannot afford this 12, 000 because they are vulnerable, they are indigent. I call upon our philanthropists to redirect their milk of charity towards paying for people in our families, in our communities. If you can pay for ten people, you pay; that's 125,000. If you can pay 20, 50, 100, any number you can pay for, you pay that money; supply us with their information, we will confirm the payment and we will come to the community where they are and to register them, they don't need to move. If you can pay for up to 50 lives which is 600,000 naira every year; that is 650,000 naira, including their ID card every year, we will come to that community to register them. You just tell us. Once it's above fifty and you paid for it, we will move our staff to come there and register them. They don't need to go to our offices in the local government; you just inform us and I will mobilize my team and we will come there and register them and that will be it.
This Lenten season it will be a good time to sow some of your charity money by paying for health insurance for people. You buy the person a bag of rice, he will finish it and calls you tomorrow when he falls sick to help him. You spend your money to organize medical outreaches, which is what most of our billionaire from Anambra do. They want to give to society. They call doctors from everywhere in the country, pay for people to come, they spend 10 million, 20 million to organize free medical outreach for two days, three days, whereas this money you can channel it into paying. You can imagine someone who spends 20 million naira for outreach, you can spend that same amount of money to pay for health insurance for about 1,700 people over a whole year. Nobody will call you again for health care, but you will spend that type of amount just for one week to do medical outreach. People who will come there might be people who are not sick who will just come and collect all the drugs and go. While not stopping such outreaches, channel such money into paying for lives of indigent people in various communities in Anambra State. That is our own Anambra Life adoption model. This is the most important charity you can do for anybody as a philanthropist.
Can you tell us how many Hospitals are registered and where they are located?
Oh! Thank you. Currently we have over 260 hospitals, both private and public, across Anambra State accredited to provide services under our scheme. If you go across the state right now, you will see hospitals with their posters indicating ASHIS accredited provider. Right now we have over 260 of them in every local government area of this State both public and private, all 21 local government areas. All the general hospitals in the state are part of our scheme; 35 of them. All the mission hospitals in Anambra State like Regina Caeli in Awka; Iyienu in Ogidi, Waterside, all the mission hospitals, are part of it.
Name them, prominent hospitals in this state and then we have very busy Primary Health Care centers also included. We are present across the entire state and people are receiving services from these hospitals.
Finally, is there any ceiling, or maximum to the kind of health services people can benefit?
Thank you so much for this important question. Our benefit package has some limitation but suffice it to say that about 65 to 70 percent of the common day to day health needs of the average onye Anambra is already taken care of. I am a medical doctor and I'm speaking as one. Our package covers services for under 5 children, for adults, diseases. Let's start from the common things: malaria, typhoid, that someone is having diarrhea, you are having fever of any kind, you need to attend antenatal, labour, delivery even if the delivery needs to be caesarian section, we will pay for it. Certain other operations, surgeries, we pay for them. Like you have appendicitis, we pay for it; it is covered in our scheme. Herniorrhaphy, the one people commonly say is hernia, there is nothing like hernia. Medically what I know is hernia but people say is hernia, the surgery for hernia, herniorrhaphy, we cover it. Lumpectomy, even minor procedures for the eyes, including giving glasses. We have a limit, we can provide glasses of 5000. People have collected glasses under our scheme, we even pay for admissions; you don't have to pay for admission yourself. If there is a need for you to be hospitalized for a whole year, we pay for admission up to 15 days. You guess is as good as mine, the illness that will keep you in the hospital for more than 15 days in a year, you will know how serious it is. So we cover all of that. It ranges from medical to surgical, we treat diabetes, we treat hypertension. So it's a very robust benefit package and the good thing with our scheme which other schemes in Nigeria are not yet doing is this: even for conditions that we are not covering, we go out to purchase on your behalf. The fact that you are registered with our scheme, if you require a service we don't provide, we already have agreed traffic with our health care providers both for what we provide and what we don't provide. We did that as an added package is done in some parts of the world. So we decided to bring it into the Anambra Scheme. Whereby for example prostatectomy, am just using that as an example, you need to do surgery of the prostate, prostatectomy, we don't cover it. Whereas you are going to pay on your own 350,000 we will purchase it on your behalf and maybe you do prostatectomy, you might end up paying a 120,000. So whichever way, is a win win for you being on our scheme, because for the things we do not do, we will still go out and purchase on your behalf. And hospitals will render services to you and then you pay them through us, even though it is excluded. That is the way it works, so you cannot beat this design. That's exactly what it is. It includes also laboratory investigations, we do lab test, certain ranges of lab test within our scheme, but of course we don't cover cancers. We don't cover aesthetic procedures like you want to go and do liposuctions to remove fat, those things are for beauty sake. No, we give you healthy life style advice and tell you what to do to shed weight. But if you want to do liposuctions, those things that are for beauty, we don't do, we don't get into such things. But every other procedure, yes. If we cover this much, I tell you, about 65, 70 percent of health needs of Ndi Anambra will have been taken care of. And if you can treat all of this, you can rest assured that those big, big ones; those more serious health challenges, will not arise because you have taken care of these things at an early stage. Then we will have a healthy Anambra.