HEALTH MATTER: Free Health Not Sustainable – Osun Lawmaker


By Francis Ezediuno

Honourable (Pharm.) Adeleke Ogunsola, Chairman, House Committee on Health in this interview with OSUN DEFENDER’S Francis Ezediuno, explains why at this time Osun needs to implement the health insurance scheme, steps he has taken to intervene in the impasse between doctors in the state service and other sundry issues.

OSDF: As the Chairman House Committee on Health, what are the areas of your oversight functions?

Ogunsola: All the health facilities in the state are under my committee. That is what we call oversight. We oversee what they have appropriated for in the budget estimates of the year and make sure that, that is what is actually being executed by the Executive.

The Appropriation law is what we oversee to ensure that it is actually followed to the letter.

OSDF: Is health free in Nigeria albeit the State of Osun?

Ogunsola: Health can never be free. In Nigeria, the National Health Insurance Scheme (NHIS) which is supposed to be a kind of relief is not even free. For some surgical operations, it may not be covered except the enrollee enjoys a special allowance apart from the general one.

Back to Osun, the progressives, main theme is that health care must be free for all and sundry at all levels. That is what the progressives would always want and pursue, but sometimes the economic reality would not allow it.

We have come to realise that health care cannot be free. To certain categories of people, that is, children, elderly and the pregnant women it can be free, but the working class has to pay for the health care services they enjoy.

Since the inception of the Rauf Aregbesola administration, health has been free, but for some few months now due to the paucity of funds and the inability of government to meet some demands which led to the agreed modulated salaries, it is certain that it could not be sustained. This has also affected the health care delivery system in the state. The volume and quality of services delivery has dwindled due to no fault of the state government.

On immunisation, Osun has been rated second nationally. Even the National Primary Health Care Development Agency (NPHCDA) has commended the State Government of Osun for being the first to pay its counterpart fund of N21 million.

Do not also forget that the government gave pregnant women Mama kits recently, while the children whether of the rich or poor and the elderly are also taken care of. All these categories of people fall under the vulnerable group and the state government ensures they enjoy maximum health care delivery for free.

Mr. Governor is the first governor to implement the ‘Agba Osun’ programme where the elderly are paid monthly stipends. This came about after the state government worked with a consultant Gerontologist from the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife on a research on the elderly.

In the overall, we are still saying that in Osun, health care delivery is relatively free.

OSDF: Health Insurance Scheme is still attributed to the working class, is that supposed to be the norm?

Ogunsola: It is supposed to be in stages. That is for the formal and informal sectors. You know when government wants to introduce such scheme, it is easier for it to be introduced to its personnel; the formal sector. In Osun now, the health insurance scheme will be introduced for both the formal and informal sectors. It will come on stream very soon.

Those who even need it most are those on the informal sector. For a token, they are going to enjoy professional care and advice, quality drugs and be attended to by qualified medical personnel.

I am very sure people in the informal sector will like to key into it because looking at the financial aspect, of the scheme they spend less for more care.

OSDF: Will the state health scheme be made compulsory for citizens or for only interested participants?

Ogunsola: The system we want to operate will make it voluntarily compulsory. In delivering a new thing to the people, they are usually scared of change but that is the only permanent thing in life especially to their health. I can assure you that there will be sensitisation that will make 99% of citizens both the formal and informal to take interest.

The State Ministry of Health is in the last stage and the scheme will be introduced very soon.

OSDF: How will enrollees access the services; will it be only in public health facilities?

Ogunsola: These things will be spelt out. I can assure you that during the sensitization and enlightenment programmes which will be well publicised, these things will be spelt out in details.

We have to come down to the level of the people at the grass roots. We want to pass the information and we also want them to comprehend it.

OSDF: There have been cases of staff who hardly report to their duty stations?

Ogunsola: You are very correct to a certain extent but usually people far away from the grass roots may not know what is happening. That is why the State Ministry of Health has a monitoring team in place.

This team’s job is to visit these remote stations even at night where the staffers are running shifts.

Government has gone to the extent of even introducing Sheriff Guards to monitor activities of health workers at these remote locations. The government is aware of this development and in order to support the orthodox method of monitoring, Sheriff Guards have been assigned to complement.

The government is also trying to encourage and motivate the monitoring teams in terms of logistics and other things.

OSDF: The impasse between the medical doctors in the state employment and the Ministry of Health vis-à-vis the state government, how have your interventions to resolve the crisis been?

Ogunsola: Medicine is a noble profession and taking a look at the Hippocratic Oath medical doctors take, they should not allow themselves to be used by politicians or even allow their own profession to be politicized. The difficulties we are experiencing as a state is not peculiar to Osun, the situation is the same all across the country with regards to the economy which we have severally explained to them.

We think that they would have been well informed to know that what is happening is not a deliberate action taken by the state government.

We have to give kudos to the governor and he has given directive that anything that has to do with health must be given top priority; their entitlements, equipment and their work environment.

We found out that their union which is supposed to understand and enlighten members more about the group’s aim is also falling short because of the prevailing circumstances.

Therefore, my committee’s intervention as a parliament include bringing the leadership of the state’s Nigerian Medical Association (NMA) to the House of Assembly for Mr. Speaker’s intervention on three occasions and we have extracted commitments from them only for them to go back and rescind on what we have agreed on.

We will continue to intervene. They have even promised that by the end of this month, we will have cause to smile in my dialogue with the leadership.

OSDF: As the Chairman House Committee on Health, have you sponsored or supported any health related bill?

Ogunsola: Yes! OSACA Bill was from me but I allowed Dr. Atolagbe, a member of my committee to make it a private bill. What is more important to me and the government is that health care should be delivered adequately at the local level.

We also have the State Primary Health Care Development Bill for the establishment of the State of Osun Primary Health Care Development Board which was graciously signed into law by the governor last year. Despite the paucity of funds, the Osun government paid N21 million counterpart fund to the NPHCDA so that our children could be immunized to prevent the childhood killer diseases.

We have made a lot of resolutions, some of which have led to the rehabilitation of the nine state hospitals in all the three senatorial districts in the state.

The one thing that is germane to me is that of preventable diseases. From day one, I have made sure that all the local governments benefitted maximally from it. There are other ones we have done that we did not need to sponsor a bill to make resolutions but we did it through our oversight functions. It has helped the state and the House of Assembly.

O’Ambulance has done well and it is a pride to Osun. Through them, many lives have been saved by their emergency interventions.

{MAGAZINE} Health: Domesticating Health Insurance In Osun

Restore Healthy Living is one of the six-point integral action plan of the administration of Governor Rauf Aregbesola in the State of Osun, and in line with this, the state government has made arrangements to domesticate the Health Insurance Scheme with a view to making healthcare system readily available for all. FRANCIS EZEDIUNO writes on the efforts made so far by the state government in this regard.

Nobody saves money for health issues, but when it does come knocking, scarce resources are made available to get the best treatment one can afford. However, in a case where money is not available and the best health care is absent, what does one do?

The question of health should be of utmost concern to every human being, because the human body is like a machine which needs adequate maintenance. If left without regular maintenance, there is tendency for the supporting mechanism to start showing signs of wearing off, so also, is the human body. There is need for constant medical check up because as the body ages, there is the need for total revamp in terms of medications to boost healthiness and vitality.

African governments have been known to have the populace-welfare agenda and therefore people have on several occasions enjoyed free education and health policy, but emphasis being more on health. Subsequent governments therefore, because of some financial constraints took steps to restrict the free medical treatments for mother and child; particularly pregnant women and breastfeeding mothers and children under the age of 0-5 years.

This policy had worked for some times until recently when reality dawn on governments at various levels such that it has made free health care services and provision became nearly impossible.

What now is the way out? True to fact, government’s aim is to provide free basic medical services for its citizens.

Wisely, the federal government provided a soft landing by way of enacting a health insurance policy. Free health is not the norm again and health insurance is the way out.

Initially, the free health scheme had worked successfully for previous administration in the state of Osun, a major reason why the present administration deemed it necessary to make it a part of its six-point integral action plan of ‘Restoring Healthy Living’.

Originally, the implementation of the free healthcare system in Osun went smoothly, as various health based programmes were rolled out one after the other, in accordance with the stated aim and objectives of government plans. The major beneficiaries of the free health programme in the state were the aged, children under the age of 5, women and the vulnerable.

Unfortunately, due to no fault of government, the free health programme became undesirable which necessitated the steps being taken by the state government towards localising the National Health Insurance Scheme (NHIS).

The NHIS was established by the administration of Chief Olusegun Obasanjo in 2004 and it has enjoyed some level of successes, but the lack of enlightenment amongst the citizenry has kept the programme at the far corner from the people it’s meant to cater for.

Already, the NHIS has been viewed as an elitist programme due to inadequate enlightenment on the part of government but surely, the way out of the myriad health challenges besetting the nation is to domesticate the national health insurance policy, bring it to the state level, so that even the poor of the poorest could afford health at a relatively low cost.

The aim of domesticating the health insurance policy in the state is to act as an alternative to the free health programme embarked upon by the state government which for the economic situation ravaging the country, could not be sustained.

There is also a political will to it as a popular saying goes; “where there is a will, there is a way”.

The Rauf Aregbesola administration wants to leave behind a lasting legacy that would be a reference point for future administration in the state, the Southwest geopolitical region and indeed the whole of Nigeria.

The health insurance policy works in this way; the rich will pay and the poor will also pay; medical attention would be based on the principle of equity, where at a certain pocket-friendly amount, sound healthcare will be made available to all and sundry either in a public or private health facility. Accessing health care either at the primary, secondary and tertiary levels would be made affordable.

Taking a look at the society, illiteracy and ignorance have been an hitching factor and when health challenges come knocking, the poor and vulnerable prefer to resort to either self medication, local health initiatives and by the time the health status worsens, it would have been too late to render any adequate medical intervention. By then, death will be inevitable.

Many Nigerians may see the idea of contributing a certain amount of money for health insurance as a waste of money due to the fact that some may stay for months without having any health issues.

Alas, when it finally comes knocking and a comparative analysis is made, the actual amount paid for the health insurance scheme would be little compared to the total cost of securing good medical intervention.

The services may be attributed to the poor, but what of the rich who may think that in the event of such, they would simply seek medical care from the medically advanced countries with good health care track records.

What is National Health Insurance? According to UNICEF: “it is a government managed insurance plan, seeking to enrol the entire population into some financial and risk pooling insurance mechanism or set of mechanisms with the aim of removing the financial barriers to attaining Universal Health Care (UHC)”.

A visit to medical institutions in the state will reveal a parlous state of affairs.

How can one fathom a situation where in a public health facility, the rich have money and they cannot access health care, except they visit a private facility; and the poor who do not have the financial wherewithal hence patronising these public health facilities but do not have money to get essential drugs they need. Added to this is also that they do not have the money to procure expensive treatments from private facilities and they end up dying a needless death.

These and other problems are why the health insurance scheme needs to be implemented nationwide and domesticated in the State of Osun.

The number of needless deaths amongst the state’s poor and vulnerable population is increasing and it is not because some of them are ignorant of the need for adequate medical care, but it is due in part to the fact that “the spirit is willing but the flesh is weak”, meaning the financial resources is lacking to get drugs and health care and when death comes, they ignorantly accept it as the will of God.

The earlier the health insurance policy is domesticated the better.

In the recent past, the state government has strengthened other organs of the Ministry of Health by constituting the State of Osun Hospital Management Board, creating the State of Osun Primary Health Care Development Board and with the recent move by the state government to bring UHC nearer home. The creation of the Osun State Health Insurance Scheme (OSHIS) and its mother agency became inevitable with the appointment of a competent hand as the Executive Secretary in the person of Dr. Niyi Oginni who has been saddled with the responsibility of running the affairs of the new agency.

With the track records of the new Executive Secretary, one would hope and pray that the crises befalling the NHIS would not be the case of OSHIS.

The government of the day has not hidden its desire to send a Bill to domesticate the health insurance scheme in the state.

Already, the agency to supervise the scheme had been created and staffed, hence, what is next is the Bill which would be sent from the Executive to the legislature.

Last week, a consultative forum was held in Osogbo where experts from the NHIS, state Ministries of Health, Finance, Justice and other partner agencies brainstormed for two-days before arriving at a draft Bill which had been forwarded to the State Executive Council for approval.

As the Executive Bill is yet to be sent to the Osun State House of Assembly, a media enlightenment session was held recently where journalists were educated and sensitised on the advantages and the need to embrace the health insurance scheme whether at the national level or when the state starts its implementation.

Dr Ogini while speaking at an awareness programme stressed that public health services should be considered part of the social safety net which is the responsibility of government to provide for all people.

“Governor Rauf Aregbesola wants free health care services for his people but at the same time he realises that it cannot be totally free, he knows that it cannot be hundred per cent possible, hence the creation of the Osun Health Insurance Scheme becoming a necessity.

“It is the desire of the Governor to deliver quality health services to the people of the state on a basis of equity, I want to assure the people of the state that through the O’HIS, the death of children under five will be greatly reduced in Osun.

“The scheme would be operated on equity where those who do not have money can have access to quality health services and we want it to succeed so that Osun will be an example to emulate”, Ogini stressed.

Another question which will be left to answer will be whether the scheme should be made optional or compulsory.

The writers opinion on this is that it should be made compulsory because it is a part of the core component of this administration’s policy thrust.

Osun Sensitises Residents Over Health Insurance Scheme

The training of medical personnels, provision of drugs, localising of health insurance scheme in the state are all steps taken by the government of the State of Osun towards the launching of the Osun Social Insurance Health Scheme (OSHIS).

This was revealed by the Commissioner for Information and Strategy, Adelani Baderinwa during a one day sensitisation meeting with media practitioners in Osogbo on Wednesday.

Speaking further, the commissioner stated that the state health insurance scheme which is now fully functional is established so that its benefits and advantages would be enjoyed by both the indigenes and residents of the state.

“The scheme was established for the sake and purpose of everybody in the state as its coverage is universal.

“Nobody is excluded from the scheme for any reason. It is for everybody to access.

The commissioner also revealed that modalities had been put in place to ensure that the scheme enjoys all round success and that people which it was meant for would access it.

In his opening remark, the Special Adviser to the governor on Health, Dr. Gbenga Oyinlola stated that the need for the sensitisation meeting arose as a result of creating awareness as to the kick off of the health insurance scheme in the state.

He noted that the health insurance scheme when accessed by everybody would be an avenue to make healthy living realisable in the state.

According to him, “the need for universal health coverage for all is irrespective of class, status and gender”.

“For the State of Osun, one of the modalities of grading good health is through the health insurance scheme and media sensitisation is very important because people will know the benefits of the programme as it gets to the public sphere”.

Also, the Executive Secretary of the Osun Social Health Insurance Scheme (OSHIS), Dr. Niyi Oginni stated that the idea behind the scheme was to start a process that will make health services universally available to all and sundry in the state.

“The scheme would be operated on equity where those who do not have money can have access to quality health services and we want it to succeed so that Osun will be an example to emulate”.

Osun Govt. Provides Health Insurance For Citizens

By Nofisat Marindoti

The State Government of Osun under the leadership of Governor Rauf Aregbesola has embarked on an Health Insurance Scheme as part of efforts to make the people of the state have access to quality health care delivery without financial impediment.

Governor Aregbesola appointed the former Chairman of the Nigeria Medical Association, (NMA) Dr Niyi Ogini, as the Executive Secretary to pilot the scheme christened Osun Health Insurance Scheme (O’HIS).

Speaking at a sensitization meeting to educate the media and civil society organization on the scheme, the Special Adviser to the Governor on Health, Dr Olugbenga Oyinlola said the scheme was carefully designed to help the less privileged get treatment in the hospitals.

Oyinlola who noted that quality health care delivery was one of the responsibilities of the government, said nobody should be denied quality healthcare.

He added that there was need for media practitioners and other stakeholders to come together and map out ways by which the people of the state can have access to quality healthcare without financial impediment.

One of the facilitators at the sensitization, Dr Funto Ogundapo while presenting an overview of the health insurance scheme, said provision of quality healthcare delivery is a right of the people and urged them to participate actively in the scheme.

She explained that the scheme will prevent the burden of catastrophic health expenditure and encouraged the people of the state to access to quality healthcare at the appropriate time.

Declaring the workshop open, the Commissioner for Information and Strategy, Mr Lani Baderinwa urged the media to propagate the scheme so that the people of the state would key into it.

Baderinwa also used the occasion to debunk the news making the rounds that there was case of lassa fever in the state, saying there is no outbreak of Lassa fever in any part of the state.

He said there has not been any report on the spread of the disease by the medical personnels who are observing patients in hospitals.

According to him, “There is no reason for anybody to panic on the report of a suspected Lassa fever case in the state. What was reported is an isolated death case of a young man who came from a neighbouring state. The young man who was suspected of carrying Lassa fever disease from the neighbouring state died at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife.

“As a proactive measure, the medical personnel had to quarantine those who had contact with the strayed deceased for observation. This is a normal medical procedure, and does not mean the quarantined people are possibly carrying lassa fever disease. As at today, there has not been any other confirmed Lassa fever case except that of the young man from a neighbouring state that died at the OAUTHC.

“All necessary steps to prevent the outbreak of this disease or any other one in Osun had been pro actively taken. Filth and dirt’s are been regularly taken care of, while medical personnel had been on red alert to ensure any unexpected disease outbreak is contained.

“As far as prevention is concerned, Osun government has been proactive while all curative efforts are already set in place. We urge people to make sure that their environment is clean and keep their foodstuffs away from rodents,” he said.

He, therefore, urged the people of the not to panic, as there was no spread of Lassa fever in the state.

Our Correspondent gathers that a nongovernmental organization, Health Finance and Governance in partnership with the National Health Insurance Scheme would be providing technical supports to the state on the scheme to make it successful.