Dr. Uchenna Ewelike, Executive Secretary/CEO, Imo State Health Insurance Agency, Explains Issues

Imo State Public Enlightenment 

Dr. Uchenna Ewelike, Executive Secretary/CEO, Imo State Health Insurance Agency, In A Discussion With Prince Eze Ugochukwu, Special Adviser, Public Enlightenment On Milestones Recorded So Far By The Agency

"I encourage people to buy into the Imo care health insurance program in the event of illness. We do not know when we will be sick and whether when we are sick, we will have the resources or not. That is the difficulty of health. That is what we call the uncertainty in health. So people must have health insurance for themselves so that, in the event of ill health, they will be able to access health services" ~ Dr Uche Ewelike

*Q*:   Sir, may we get to know you, your background, and your status with the Imo State Government.

*ANS*:   My name is Dr Uchenna Ewelike. I am a Senior Health Economist and I am the Executive Secretary/CEO of the Imo State Health Insurance Agency. I come from Ehime Mbano local government area. I did my primary and secondary education in Mbano. I am a medical doctor by training. I also went into public health where I obtained a master's in public health and because of my bias toward administration and management, I also have a master's in Business Administration. I also have a masters in International Affairs and Diplomacy. I am a fellow of the Royal Society of Public Health in the United Kingdom. I also have a PhD in Health Economics from the University of Nigeria Nsukka. Before 

I was saddled with the responsibility of providing financial risk protection through the Imo State Health Insurance Agency for the good people of Imo State, I was a deputy director with the National Health Insurance Authority in Abuja.

*Q*:   Health financing has always been an issue for both the sick and even for healthcare service providers themselves. How are you able to balance these two demands from the point of view of the sick person without enough money; how do we take away the burden of financing from the indigent citizens of the State? 

*ANS*:   Among the five key objectives of the Imo State Health Insurance Agency is to reduce out-of-pocket expenditure. You know that out-of-pocket expenditure is very regressive and it makes people go into a virtuous circle of disease, poverty and sometimes death. So our responsibility is to ensure that people can access health care services without suffering financial hardship. That is currently what we are doing in the four key programs we are implementing in Imo State and we have done a lot to demonstrate that.

*Q*:    Towards achieving universal health coverage, the government of Imo State established the Imo State Health Insurance scheme to be administered by the Imo State Health Insurance Agency to improve access to quality healthcare for Imo State residents. How far has your agency gone to achieve this mandate? 

*ANS*:  All thanks to His Excellency, Distinguished Senator Hope Uzodimma, for finding it worthy for asking us to come and demonstrate the importance of financial risk protection to the good people of Imo State  Currently we are implementing key programs that will address what is in the Act establishing the agency. One is the basic health care provision fund(BHCPF) which is a product of earmarked funding from the National Health Act of 2014. Imo has currently enrolled 66,003 people who are currently assessing care in the 305 words in Imo State. As of today, about 20,000 and above people have utilised the services. We have over 150 deliveries, cesarean sections, paid, appendectomies, surgeries and all forms of interventions paid for within this period. So we are trying as much as possible to utilise the Basic Health Care Provision Fund to reduce out-of-pocket expenditure, more especially for those who are vulnerable in our rural communities. 

The next program we are currently doing which is designed by the administration is the "Imo Care". Imo Care targets 85% of our population in the informal sector and it is expected that people will subscribe. Volunteers and philanthropists can also help to get people enrolled. Some cohorts of the population can also get themselves enrolled and they will be able to access care at very affordable rates. 

The third program we are also doing is the formal sector program. You are aware that the Governor has made commitments to ensure that Imo State civil servants get enrolled and have access to healthcare  We have concluded the design, we have done the desegregation of the population and we are about to commence the full utilisation of the services. 

And last but not least is the Tertiary Institutions Students Health Insurance Program(TISHIP), which we are currently implementing at the Imo State University and we plan to extend to other state-owned institutions.

*Q*:   I know that your agency in terms of health care service also has provisions for students. There is a requirement that students who can contribute some money can get all their healthcare needs. What are the implementation plans as it affects students in tertiary institutions - are you working with Vice-Chancellors and Heads of tertiary institutions in the state?

*ANS*:   Yes. There is a committee on the Tertiary Institutions Students Health Insurance Program(TISHIP) and the committee includes people from the universities. The Heads of medical teams in the universities are part of the committee. Currently for Imo State University, we are implementing a PPP arrangement. We have people who are interested in upping the game and improving the level of service utilisation and quality of care. So they are all part of it. The challenge we are having is that some students don't pay school fees when they are supposed to pay, so that reduces the number that we have on our database for TISHIP. But so far, so good - a lot of persons have enrolled for TISHIP and they are all accessing care currently at the hospital at the Imo State University.

*Q*:   Your agency has highlighted their relationship with Health Care Providers(HCP) to attain your goals. So who are these healthcare providers; how are you interfacing with them? - Do they have associations or organisations representing their collective interest or are you dealing with them individually? 

*ANS*:  For the first time in the history of the state, we have service-level agreements prepared by legal teams and signed by all healthcare providers who are using our database for service delivery. We have both public and private healthcare providers. The condition for you to get involved and for you to sign the service level agreement is that you must be accreditated by the National Health Insurance Authority. So we must have that standardization as stipulated in the operational guideline both for the Imo State Health Insurance Agency and the National Health Insurance Authority. We want to ensure that the facilities we are using for our services are facilities that can be able to render optimal services. These are the ones doing secondary services for us and the ones that will take up the primary services for both Imo Care and the formal program.

*Q*:  For indigent persons; Your agency some time ago announced that for as low as 15,000 naira per annum, a citizen can enjoy certain health services. Can you elaborate on this? Is it affordable? 

*ANS*:   Yes, it is affordable because you cannot compare it with somebody who is paying out-of-pocket. The beauty of insurance is that it is a collective pool. All of us cannot be sick at the same time, so we use the resources of the healthy to take care of the sick. So 15,000 Naira per person per annum will be able to take care of the standard benefits package we are currently implementing for Imo Care. I encourage people to buy into the Imo care health insurance program in the event of illness. We do not know when we will be sick and whether when we are sick, we will have the resources or not. That is the difficulty of health. That is what we call the uncertainty in health. So people must have health insurance for themselves so that, in the event of ill health, they will be able to access health services. It is affordable considering the standard benefit package that covers everything apart from cancer chemotherapy. 

It is good enough.

*Q*:  The Governor and the Government have prioritised issues about health and have tremendously done well in terms of rehabilitation of the health centres across the state. As far as assisting your agency implement its programs for rural dwellers, has the government done enough?

*ANS*:  I have to express my appreciation to His Excellency, Distinguished Senator Hope Uzodimma for the efforts he has made on revitalizing the primary Health Centres (PHC). When 

I took up this appointment I was considering if and how I was going to implement the Basic Health Care Provision Fund. I don't know the level of supply-side readiness, in other words, what is happening at the Primary Health Centres. But as we commenced the implementation and with visits made to these facilities, I am happy with the level of the revitalization of the Primary Health Centres. I am quite happy and it is making our work very seamless. Nevertheless, we will still ask for more on improving the Primary Health Centres so that they can take up more numbers that we are going to have very soon that will enrol in the primary health centres.