10 May 2022

As part of Universal Health Coverage (UHC) commitment monitoring, we want to tell the real stories of UHC as experienced by people across the globe. This is the story of an initiative to increase access to quality and affordable health care services.

Health care staff looking through medical records

The majority of Nigeria’s population lives in poverty. Poverty is especially severe in the rural areas, where social services and infrastructure are limited or non-existent. When people in the rural communities are sick, the first and nearest health facility to them is the Primary Health Centre, but unfortunately most people cannot access services at these health facilities because of fees for service (out-of-pocket payment).

In order to eliminate the out-of-pocket payment that makes access to quality and affordable health care services inequitable mostly among the indigent vulnerable groups (pregnant women and children under five years old), the Ukana West 2 Community Based Health Insurance (CBHI) Scheme was launched on 21 August 2014 in the Primary Health Centre, Ikot Ideh, Essien Udim Local Government Area, Akwa Ibom State, Nigeria. CBHI is a non-profit organization that provides risk pooling (protection) to cover the cost of health care services. The programme is managed by democratically elected members of the community and supervised by different stakeholders.

CBHI is actively involved in resource mobilization and health sensitization programmes in the communities. It also partners with the National Health Insurance Scheme and other relevant organizations to identify the indigent vulnerable groups and ensure that they have equitable access to quality and affordable health care services in the Primary Health Centre, Ikot Ideh. In this scheme, every financially-able person in the community pays ₦5,000 (12.95 USD) per person per annum to benefit from the programme.

Before the inception of CBHI, the Primary Health Centre Ikot Ideh had many problems, including: inefficiency, lack of drug supply, high fee for services, lack of staff, poor service uptake as well as poor documentation of service uptake. Mothers therefore resorted to fraudulent medical practitioners for health services. Since the inception of CBHI in 2014, there has been a lot of improvement, including an increase in the service uptake by pregnant women and children under five years old in the health facility from qualified medical attendance.

Women and children in a waiting area

Having CBHI in a Primary Health Centre and allowing the community to own and manage the programme ensures that the health facility is functional and accountable. CBHI ensures that there is equitable access to quality health care services for all, irrespective of their financial status. It also ensures the availability of drugs, access to certified medical professionals and quality maternal and child care.

“CBHI ensures that there is equitable access to quality health care services for all, irrespective of their financial status. It also ensures the availability of drugs, access to certified medical professionals and quality maternal and child care.”

Within CBHI, many babies are delivered in the health facility. Additionally, CBHI advocates for improved health financing, for the establishment of the State Health Insurance Agency, health sensitization programs, and partners with relevant organizations to provide trainings for community health, and provides incentives to health workers. In 2018 and 2019, CBHI received a supporting grant from the Global Universal Health Coverage Stakeholders to mark Universal Health Coverage Day in Akwa Ibom State, Nigeria.

Note: This story may have been edited for clarity and shortened for fit on the UHC2030 webpage.

Category: Civil society and communities

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