How Zamfara Contributory Health Scheme Is Reducing Maternal Mortality Rate – Executive Secretary

In order to reduce out-of-pocket spending on health service delivery, the Zamfara State Government created the Zamfara State Contributory Health Care Management Agency, ZAMCHEMA. In this Interview with NICOLAS DEKERA, the Executive Secretary of the agency, Dr. Ilyasu Sale Ahmed opens up on the successes of the Agency in Maternal Mortality. Nicholas Dekera brings the Excerpts

At the point of establishing this agency, there was a mission. And I know for sure that the mission was to change the mentality of Zamfara residents regarding out-of-pocket expenditure for health care service delivery. Now, after these years of establishment and your input into the organization, would you say that the activities have been in line with the mission statement?

We thank God that we’ve been able to do some modest improvements in the health sector. Just as you have said, the main aim of this agency is to reduce out-of-pocket expenditure because most people, when they are ill, will have to have money in their pocket before they visit the health facilities. And as long as that has not been done, we cannot achieve Universal Health Coverage. Universal Health Coverage is qualitative health care where you want it, when you want it, and at a cost that is not too prohibitive for you. So for us to achieve universal health coverage, we must have some form of health insurance, so that we don’t have to rely on what they have in their pockets before they go to the health facilities. And that is the mandate of this agency.

And so far, just as I’ve said, yes, we have said over these years, we’ve been able to contribute modestly to that aspect because a lot of our beneficiaries now have confidence that they can go to the health facilities, not minding the fact that they must have plenty money in their pocket, they’re not thinking of if ” I go I have to pay for card I have to pay for investigation no, no once you are ill just go to that facility so you have qualitative health care so,  yes I would say for those beneficiaries that are enrolled yes we’ve been able to achieve, it has been able to lessen that burden of out of pocket expenditure for them and they can now use their monies for more productive ventures.

How much is the minimum payment per family for this Health insurance scheme?

Well, it depends, for those in the formal sector, beneficiaries who are working with the government, three percent of their basic salaries for the formal sector because we have different schemes, we have the informal sector. The formal sector is those who have a structural salary package like civil servants, so for them, it’s three percent of their basic salary amount per month that is deducted and that three percent will cover their health care for them and their dependents then for the informal sector presently we are running on two established systems. We have the UNICEF system, under the UNICEF system beneficiaries, UNICEF is supporting about 89,000 beneficiaries, and then we have the Basic Healthcare Provision Fund that is actually supporting about 6,400 beneficiaries. There’s a premium that they pay, and the premium is just 1,000 per month.

So in a whole year, that’s like 12,000 Naira per year. And this 12,000 Naira will cover your family.  You know the thing about health insurance is that, it’s a pool and the idea is that only those that are ill that will go to the health facility so those that are not ill have subsidized the cost of health care for those that are ill because if you look at it 1000 per month if it cannot even treat malaria,  but of course when we have to do it with pulling that’s these resources are pulled if you have resources for the 3,000 beneficiaries that I talked about, the basic health care. There may be just 2,000 beneficiaries who actually have the need to go to the health facility. So if they have to go there, you see those that are ill, those that are not ill have subsidized the health care for those that are ill.

On average, what are the statistics as in the figure collectively that are enrolled in ZAMCHEMA?

We have about 99, 585  enrolled  into the scheme and they have all necessary equipment to ensure that when women or children go to these health facilities they can have qualitative health care and then overall that will now aim to reduce the maternal mortality that you have talked about and if you go to these rural settings most of them  don’t have that fear of going to the health facility

Before, when a woman is ill and she wants to go to the health facility, they have to look for money. They have to look for permission or what? But now, those who are enrolled know that if I go to the health facility, I don’t even have to go with a kobo. I just take myself to the health facility and virtually everything is provided for me.

How has ZAMCHEMA reduced maternal mortality in Zamfara state?

There are so many things that cause mortality. There are what we call delays. In fact, that’s one of the main problems. Sometimes delay in seeking health care.

In fact, delay in even deciding to go to the health facility. Then the delay is when you get to the health facility, before you collect the card, you do that, it’s under delay. Delay before you make money and all that. So for us, we have been able to reduce those delays. Because we wouldn’t have to think of money. In fact, sometimes  they say they have to wait for a certain person to come, it’s because possibly he’s the one who has the money but now people know that once you are enrolled into ZAMCHEMA you don’t have to have money in your pocket to go to the health facility so overall that has  seriously reduced maternal mortality and morbidities

We don’t provide services so we have no any research with the health facilities to actually give you that, when you go to the health facility they will be able to tell you okay this is what we have what we have been able to do yes okay so um aside

Aside from the reduction in maternal mortality, is there any breakthrough in terms of health care delivery for children?

Well you know just as I pointed out initially, we are not in the service delivery aspect we are in the aspect of creating demands, and so far we want to say based on the number because when we go out to  enroll, the the number of people that we see coming we know that yes that negative perception has been changed, in fact there was a place I went to that somebody said in their own their  you don’t go to the public health facility even if a woman is going to deliver, she will deliver at home so those things are still there, I wouldn’t say they are not there but of course they have reduced significantly and  based on the data the when we go to the health facilities and then the data we see of people that come to access care are beneficiaries we know that yes quite a number of people have actually turned to the health seeking behavior because that’s why we have a problem before that health seeking behavior of when somebody is sick  the first thing you think of is it you think  going to a imam or you’re going to the pastor, you’re not thinking of going to the chemist or for the health facilities. The health-seeking behavior has improved towards the right channels.

On your scorecard how will you rate yourself especially in actualizing the manifestos of the governor in terms of expanding health care services generally?

You know we have some key performance indicators for this agency,  the key performance indicators that will actually indicate whether we’re doing well or not is number one, enrollment.

Except that if people are enrolled in the scheme, then the issue of them even seeking care is not even there. And as our data has shown, it has actually improved. When Governor Dauda Lawal came into power, the formal sector enrolled just about 23,000. But now we’re talking about 99,585. That’s over 300% increase.

The same thing with the basic health care provision fund it was also very very low in fact as it is now we have exceeded the target. With over 64000

His Excellency Governor Dauda Lawal never removed a kobo from health insurance deductions.

One major challenge before was outside interference, somebody would just order you to release a particular amount for other reasons. Now, this Governor doesn’t do that.

Remittance from the Ministry of Finance to ZAMCHEMA has been regular. Governor Dauda Lawal has actually exceeded my expectations. With his support, we now have a toll-free line that was never there before.