Ms. Adesimbo Ukiri, Chief Executive Officer, Avon HMO, comments on the National Health Bill.
Your comments on the benefits of the National Health Bill?
The Bill represents a genuine commitment to improving the health of all Nigerians. For too long, Nigerians have become weary from hearing report after report of dilapidated and ill-equipped General Hospitals, poor quality of care and the devastating effects of paying out-of pocket for medical treatment. The Bill will drive reform of our health system and kick-start much-needed improvement in the standards and quality of our healthcare services.
For the health insurance industry, we know that the National Health Insurance Scheme (NHIS) will manage 50% of the National Primary Healthcare Development Fund (funded by a one per cent deduction from the Nigeria’s Consolidated Revenue Fund) which was established to provide basic access to healthcare services. This Bill will help give the NHIS a much-needed boost as it will empower more Nigerians to get health insurance and subscribe to a health plan.
What are the challenges of implementation?
Success will hinge on several factors. One, there must be total commitment of key stakeholders to the successful realization and effective implementation of the Bill. Outside of the hospital providers, there are several professional bodies who operate in the healthcare space and there has often been a lack of clarity in regards to their responsibilities and accountability. This Bill aims to remove any ambiguity as it will define roles and responsibilities, outline limitations and encourage co-operation.
Secondly, there is the effective management of the National Primary Healthcare Development Fund. Thirdly, there is the role of the Private Sector and the impact this will have on them.
These challenges can be overcome by the development of Committee who will oversee the implementation of the Bill. There will be several questions that will arise and this Committee must be empowered to find solutions that is agreeable to all stakeholders but do not take away from the laudable aims of the Bill.
What does the Bill portends for women in particular?
Women remain one of the most vulnerable and underserved members of society. Inequality to quality healthcare continues to result in a lower life expectancy and unnecessary deaths. Too many women are dying in pregnancy and childbirth. Improving access to healthcare remains key to reducing maternal mortality.
This Bill guarantees pregnant women a minimum level of health care service. We know that affordable and accessible healthcare will go a long way in enabling women, as a whole, to fully participate in their communities – be it socially, economically or politically- and most importantly, in the lives of their families and loved ones.
What are the major successes recorded by Avon HMO?
Avon HMO has been operational for two years now. In this time, we have made great strides to become one of the leading HMOs in Nigeria.
Our focus on quality assurance is painstaking and we work very closely with Provider Hospitals to ensure that our enrolled members receive the best in healthcare services. For instance, Avon HMO Case Managers have scheduled daily visits to hospitals to engage with enrolled members on admission, overseeing the care they receive and providing further assurances. In addition, our Care Coordinators also work with Provider hospitals to achieve adherence to agreed Disease Management Protocols and Drug Formularies to sustain high levels of clinical and pharmacy quality to Avon HMO’s enrolled members.
All Provider Hospitals have a well-deserved right to adequate and effective remuneration. In recognition of this, we ensure that capitation and claims payments to Hospitals in our network are prompt. Our Hospitals have commended us for this.
In the area of customer service and complaints resolution, we have a robust Complaints Resolution Procedure in place and have streamlined our processes so that the resolution time for most issues fall within a 5 – 15 minutes window. With our 24-hour Call Centre and the provision of multiple channels through which we can be contacted, we have ensured that we are easy to access and responsive.