Background

The Universal Health Coverage, is a global health policy that aims to ensure that all indi- viduals and communities access essential health services without suffering financial hardship.

It is a critical component of United Nations Sustainable Development Goals (SDGs) especially Goal 3, which aims to ensure healthy living and promote wellbeing for all at all ages.

According to the World Health Organisation (WHO), Universal Health Coverage is access to quality health services by every individual, without suffering financial hardship as a result.

It includes the full range of essential services, from health promotion to prevention, treat- ment, rehabilitation and palliative care.

Improving healthcare delivery

The Ebonyi State government led by Governor Francis Nwifuru on assumption of of- fice in May 29, 2023, accorded priority to improving the health status of the citizenry, under the People’s Charter of Needs Mantra.

In order to actualise this agenda, Nwifuru revitalised the Ebonyi State Health Insurance Agency (EBSHIA), to minimise huge amount of funds people spend in acquiring healthcare services.

The State Health Insurance Agency (EBSHIA) was established by law in 2018, to implement the state health in- surance scheme, provide easy and equitable access to quality healthcare services, to all residents without exposing them to financial risk. The Executive Secretary of Ebonyi State Health Insurance Agency Dr Divine .O. Igwe, stated that the agency mode of operation has changed from manual to digital.

He expressed optimism that the state shall achieve universal health coverage through health insurance without exposing anyone to a financial hardship.

According to him, “EBSHIA has the mandate to enroll all residents of the state into the health insurance scheme. It has rolled out programmes for different segments of the population.”

Further,”Governor Nwifuru employed additional 195 health workers into the 13 general hospitals to ensure that the hospitals were viable for the beneficiaries of health insurance.

“In all, we have enrolled 136,831 enrollees into health insurance, to benefit from health insurance of the state, accessing care free of charge in all the hospitals.

“In 2019, the state received the Basic Healthcare Provision Fund (BHCPF), the governor has approved the state health insurance counterpart fund for the enrolment of additional 11,000 enrollees. “Nwifuru purchased SUV vehicles for doctors, with N150, 000 monthly allowance for its maintenance to achieve optimal performance.”

EBSHIA has embarked on aggressive health insurance awareness creation and marketing to the informal sector as a way to expand and increase enrollment in the state.

Igwe highlighted that engagement with the organised labour has commenced, this is in addition to engaging with the relevant leadership of the unions to create more awareness.

He said; “advocacy has been done at the state government level for the commencement of the formal sector programme. EBSHIA has deployed a robust Information Technology (IT) platform for health insurance administration in Ebonyi State.

“Through the increase in enrolment and revitalisation of the healthcare facilities, our service utilisation has tremendously increased as compared to when we started.

“Over 4,076 pregnant women were enrolled into the programme of the wife of the Governor’s wife, Mrs Nwifuru, to access free medical care and reduce child mortality/morbidity.” Also, Igwe announced plans by the government to integrate all state owned tertiary institutions to the health insurance scheme.

Challenges

The Executive Secretary spotlighted some of the challenges facing the agency to include lack of activation of the formal sector, need for more funds to increase financial risk protection among the vulnerable groups in the state.

“None compliance of law establishing the agency, which states that health insurance is mandatory, in addition to lack of adoption of lives,” Igwe noted.

Appeal to political leaders

To further the mandate of the agency, Igew appeal for the assistance of everyone in the state, including Civil Society Organisations (CSOs) and the political leaders in particular, which he said has a wider reach by virtue of them being in control of the political structure and organisations in the state.

This is as Igwe said,”every political leader should consider making health insurance a constituency project. Every company/organisation should use health insurance as a Corporate Social Responsibility (CSR) ànd staff motivation strategy.’’

Intervention

In a bid to complement the laudable efforts of the state government toward the realization of its commitment to provide free medical care for the citizens, the wife of the Governor Mrs Maudline Nwifuru, on November 15, 2023, officially flagged off her pet project, tagged; Better Health for Rural Women, Children and Internally Displaced Foundation (BERWO).

Addressing the gathering in Abakaliki, the capital city, Mrs Nwifuru restated that her office has health insurance for sickle cell patients, in addition to free medical checks (genotype) of children in secondary schools.

According to her, “BERWO is a non-governmental organisation (NGO) that cares for everyone, everybody deserves better health. My mission is to stop Gender-based Violence (GBV), child trafficking, women abuse, and child labour among others.

“I am determined to stop this menace, health is everything. We need to take care of our women, men and children. The NGO will work towards creat- ing an equitable society, we are committed to waging war against Gender-based Violence and to lift people out of poverty.

Reactions

In their separate reactions, some of the enrollees, who were beneficiaries of free surgery, including Mr Okorie Akpu and Mrs Linda Ofoke, lauded the state government for the initiative, describing it as commendable.

“This is a big relief, am happy for this opportunity, many people lack access to quality healthcare, we have seen dividends of democracy getting to the downtrodden.

“I have been afflicted with this hyenia for years due to lack of money to access proper med- ical care, it has been disturbing me for a very long time.’’

In an interview, some of the surgeons that carried out the surgery expressed appreciation to the governor and his wife, for touching the lives of the people.

“The programme is impact- ful and laudable, the burden of funding is a global issue, according to WHO, many people lack access to simple surgical care,” noted one of the surgeons.

Recommendations

The Executive Secretary of EBSHIA Igwe, recommended among others, the release of the state equity fund, mandatory health insurance operation and the operation of the adoption model where the strong should carry the weak.

Sustainable Development Goals

Ensure healthy lives and promote well-being for all at all ages. Goal 3 aims to ensure healthy lives and promote well-being for all, at all ages. Health and well-being are important at every stage of one’s life, starting from the beginning.

This goal addresses all major health priorities: reproductive, maternal, newborn, child and adolescent health; communicable and noncommunicable diseases; universal health coverage; and access for all to safe, effective, quality and affordable medicines and vaccines.

SDG 3 aims to prevent needless suffering from preventable diseases and premature death by focusing on key targets that boost the health of a country’s overall population. Regions with the highest burden of disease and

neglected population groups and regions are priority areas.

Goal 3 also calls for deeper investments in research and development, health financing and health risk reduction and management. UNICEF’s role in contributing to Goal 3 centres on healthy pregnancies (maternal mortality and skilled birth attendant), healthy childhoods (under-five and neonatal mortality) as well as vaccine coverage.

UNICEF also contributes to monitoring elements of the universal health coverage indicator. UNICEF is custodian for global monitoring of two indicators that measure progress towards Goal 3 as it relates to children: Indicator 3.2.1 Under Five mortality rate and Indicator 3.2.2 Neonatal mortality rate.

UNICEF is also co-custodian for Indicator 3.1.2 Proportion of births attended by skilled health personnel and for Indica- tor 3.b.1 Proportion of the target population covered by all vaccines included in their national programme.