The Lagos State Government has announced the signing of a comprehensive Health Insurance Executive Order by the Governor, Mr. Babajide Sanwo-Olu.
The directive, issued on July 16, 2024, aims to transform the healthcare system through an innovative partnership between the Ministry of Health, Lagos State Health Management Agency and the private sector. It is mainly about health insurance for social protection.
At a press briefing, Commissioner for Health, Prof. Akin Abayomi, detailed the key provisions and goals of this transformative policy. He emphasized that this initiative is set to significantly improve the health outcomes for Lagos State residents by establishing a structured, regulated, equitable, and sustainable health insurance scheme that is inclusive of all Lagosians. The initiative aligns with the objective of the National Health Insurance Authority Act 2022 – making State level social health insurance mandatory to achieve Universal Health Coverage (UHC).
Social health insurance, universally practised in various forms, has numerous socioeconomic benefits. It pools contributory funds and spreads risk across a large group, minimizing individual financial exposure and enhancing protection. Such schemes provide social safety nets with equitable components aimed at achieving Universal Health Coverage (UHC).
Social Health Insurance schemes are typically mandatory to ensure wide coverage, maximizing collective benefits to society. Contributory premiums are modest, supporting the government in providing a standard level of care to all citizens regardless of socioeconomic status. The Lagos State Social Health Insurance Scheme is called Ilera Eko, which is managed by the Lagos State Health Management Agency (LASHMA).
Conversely, private health insurance is typically voluntary, private sector driven, competitive, and profit-driven, offering a wide range of services based on affordability. By creating synergies between social and private health insurance pathways, Lagos is promoting a platform for widespread uptake and sustainable healthcare coverage.
Universal Health Coverage (UHC) ensures that everyone in a region has equitable access to essential healthcare services without financial hardship.
In a statement by Tunbosun Ogunbanwo, director, Public Affairs, key characteristics of UHC include a comprehensive range of services covering the common needs of the community, such as preventive care, diagnostics, treatments, and medications. Services not covered by the basic health package of Social Health Insurance (Ilera Eko) can be supplemented by approved private health insurance packages or state-supported medical assistance programmes.
The Executive Order signed by Mr Governor outlines several critical components aimed at revolutionizing healthcare delivery in Lagos State. These components are designed to ensure comprehensive, equitable, and sustainable health coverage for all residents:
1. Promotion of Health Insurance: The government will launch an extensive campaign to encourage the culture of adopting health insurance as a social and economic necessity. This campaign aims to educate the public about the benefits of health insurance, highlighting its role in protecting individuals from high out-of-pocket expenses and reducing the risk of financial ruin due to unexpected illnesses.
2. Enforcement Grace Period: Following a six-month period of intensive public sensitization, the government will begin to enforce the health insurance mandate. The public will be encouraged to access enrollment in either the Lagos State Social Health Insurance scheme (Ilera Eko) or an equivalent State approved and accredited private health insurance plan that includes the bouquet of services contained in Ilera Eko. This removes the complexity of duplication of enrollments in two schemes to be compliant with the Executive Order and the NHIA law.
3. Public-Private Synergy: The initiative seeks to create a harmonious relationship between the government’s Social Health Insurance scheme (Ilera Eko) and private sector health insurance systems. By leveraging additional resources and expertise of Health Maintenance Organizations (HMOs), the government aims to expand and improve access of comprehensive health protection to all citizens, ensuring that everyone is covered by at least a basic level of social health protection, reducing administrative costs and simplifying processes.
4. Technical Working Group: The implementation of mandatory Social Health Insurance Scheme will be overseen by a dedicated Technical Working Group (TWG)within the Lagos State Ministry of Health.
This group will include executives from the Lagos State Health Management Agency (LASHMA), experienced professionals, consultants and key stakeholders from both the public and private sectors. Their responsibilities will include overseeing the blended health insurance scheme, ensuring it operates efficiently, meets its objectives, and maintains high standards of service delivery. Through the TWG, the Lagos State Ministry of Health would release shortly an operational guideline that would determine the interplay and relationship between the Social health Insurance Scheme and the Health Maintenance Organizations as mandated by Mr. Governor through the Executive Order.
5. Funding for the Vulnerable: The collaboration between government and private sector stakeholders will result in an expanded pool of funds. This will enable the government to provide social health insurance to an even larger number of vulnerable residents in the State. Additionally, this component addresses the challenge of funding emergency medical care for unidentified patients in urgent need of life-saving interventions.
6. Regulation and Oversight: The government will step up its regulatory role, ensuring both social and private sector health protection schemes operate effectively, therebyimproving the experience of Lagos residents.
7. Quality Assurance and Monitoring: Regulatory oversight to ensure a higher standard of healthcare service delivery will be heightened by our Health Facility Monitoring and Accreditation Agency (HEFAMAA). Healthcare providers participating in the scheme will be expected to meet these standards to be enrolled into the scheme as providers of healthcare services.
Abayomi said, “No Lagosian should have to choose between healthcare and other basic needs. This scheme is designed to eliminate those barriers and ensure everyone can receive the care they require, when they require it.”
He called on healthcare providers, civil society organizations, the private sector, and the public to join in this transformative journey. “We are building a healthcare system that serves everyone, and we need the support of all stakeholders to make it a reality”, Abayomi said.
The Commissioner thanked Mr Governor for his visionary leadership and unwavering commitment to the health and well-being of Lagos State residents. He said, “We are profoundly grateful for Governor Sanwo-Olu’s bold vision and steadfast support for healthcare reform in Lagos State. His leadership in issuing this Executive Order exemplifies his dedication to ensuring every resident has access to quality healthcare. This visionary step will undoubtedly transform healthcare delivery in Lagos State and set a benchmark for others to follow.”
