GOMBE STATE AND THE ADVENT OF A VIABLE CONTRIBUTORY HEALTH SCHEME

The first thing he focussed his attention on, just after being sworn in as the Executive Governor of Gombe State in May 2019, is healthcare, and the need to prioritise healthcare delivery in the state. Discerning the deplorable health indices from the state, he promptly declared state of emergency on health. With the assurance that improving healthcare is equivalent to improving the livelihood of the people, Governor Muhammad Inuwa Yahaya set out modalities to boost healthcare infrastructures throughout the state and went beyond that by championing the creation of an agency, and with it a scheme, that will offer financial risk protection and leads to the attainment of Universal Health Coverage. 

According to the World Health Organisation (WHO), a health system consists of all organisations, people, and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A functional health system responds in a balanced way to a population’s needs and expectations by:

1.      Improving the health status of individuals, families, and communities 

2.      Defending the population against what threatens its health

3.      Protecting people against the financial consequences of ill-health

4.      Providing equitable access to people-cantered care

5.      Making it possible for people to participate in decisions affecting their health and health system. 

The main goal of Universal Health Coverage is to protect people from the financial consequences of paying for health services out of their own pockets, thereby reducing the risk that those people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow-destroying their futures and often those of their children, leading to financial catastrophe. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course. It requires removing barriers to health and improving affordability, accessibility, and quality of health systems. 

To actualize this, Governor Muhammadu Inuwa Yahaya initiated a Bill for the establishment of the Gombe State Contributory Healthcare Management Agency (GoHealth). The Bill gained a passage into the state legislature and was signed into law by His Excellency on 30th December 2019. This leads to the creation of the Gombe State Contributory Healthcare Management Agency (GoHealth) and the Gombe State Contributory Healthcare Scheme. The scheme aims to provide Universal Health Coverage to all Gombe State residents through an equitable and transparent mechanism for pooling resources to finance quality healthcare via several pre-payment systems. 

GoHealth started with a Technical Working Group which drafted most of the initial documents used in setting up the agency. After the inauguration of the Governing Board, the agency went to work. With strong executive backing and dedicated staff, GoHealth, in just over a year after its establishment, has gone on to achieve a monumental feat and with it transcended its peers from other states. 

The viability of any organisation depends on its clearly defined vision and mission, and of course, how these are effectively implemented. The commencement of the scheme came with attendant teething challenges, acceptability and ownership of the various programmes were stumbling blocks. However, robust advocacy, sensitisation, and mobilisation tremendously helped in considerably abating these challenges. There were doubting Thomases who were sceptical of the overall impact of the scheme. After a few months of commencement, these same people became the agency’s informal ambassadors. Testimonies from these beneficiaries added colour and acceptance, and largely gives the much-needed impetus to the agency and the scheme. 

The scheme brought on board state civil servants whose monthly contributions give them access to qualitative and affordable healthcare within their reach and significantly reduce out-of-pocket spending. That premium covers not only the principal enrolee but his/her spouse and four biological children who are under the age of 18. Government employees could also enrol extra defendants with a token annual payment. 

Civil servants formed a meagre percentage of the population in Gombe State, to cover those not under formal employment by the state, the informal sector was set up to give access to farmers, artisans, etc, who pay a nominal annual premium. But then, not all these could afford to pay, no matter how little it is. For that, the government pays for the poor and vulnerable through the Basic Health Care Provision/Equity Funds. These funds are released from the Federal and State consolidated revenues.

In 2021, 25,565 poor and vulnerable people in the state were enrolled and they gained access to quality healthcare without paying for the services. In 2022, over 40,000 of such were enrolled into the scheme and the agency populated a Vulnerable Register which has over 100,000 entrants becoming the first, and so far, the only, state in the federation to have such documented register. 

The major thrust of the Gombe State Contributory Healthcare Management Agency is the utilisation of an indigenous ICT firm to institutionalise a vigorous ICT platform. This stout ICT becomes a reference point to the entire country and the pride of the agency. The agency also developed a mobile app, the first of its kind in the country, through which enrolment and other processes could be done in real-time. 

In the areas of Quality Assurance and Monitoring and Evaluation (M&E), the agency is not resting on its oars: A Quarterly Quality Assessment is carried out in all the accredited Health Care Facilities; quarterly Joint Integrated Supportive Supervision is conducted to improve the quality of care; monthly reports are collected from the health care facilities and transmitted appropriately promptly to the NHIA for the BHCPF/Equity programme. Timely transmission of data leads to the nomination of the agency for an award as the contributory healthcare agency with the best M&E structure in the country. 

Aside from sustained political support from the State Government, the agency’s other strongholds include a conducive working environment, experienced and dedicated Governing Board members and staff, availability of community structures, existing strong collaboration with the State Ministry of Health and other health-related agencies, and availability of public and private HCPs with basic requirements for service.   

The agency is on the verge of signing a memorandum of understanding with the state transport agency for the landmark Travellers Accident and Emergency Contributory Health Scheme. When this commenced, the state will be the first in the country to implement the programme. Other programmes in the pipeline include the formal sector programme for LGA employees, the pensioners' programme, and the tertiary institutions' programme, among others. 

Gombe State Contributory Healthcare Management Agency is here to stay and is well poised to actualise the attainment of Universal Health Coverage in Gombe State. This cannot be achieved at the moment, but with the strong political will, and the prioritisation of health by Governor Muhammadu Inuwa Yahaya, this will certainly materialise soon. 

 

U. Tanimu Umar 

Director Planning, Research and Statistics.

GoHealth