In an insightful interview with Vijon International Magazine, Dr. Isaac Akpoveta, Director General and Chief Executive Officer of the Delta State Contributory Health Commission (DSCHC), delved into the formation, progress, challenges, and future initiatives of the health insurance scheme in Delta State.
Dr. Akpoveta, a seasoned insurance professional and former Chairman of the Commission, has been instrumental in advancing healthcare accessibility and affordability in the state. This interview took place at the DG’s office on DBS Road in Asaba. It was conducted by Ben. Anthony Edejor, the Publisher and Managing Director of Vijon International Magazine, along with Emmanuel Enebeli, the magazine’s Contributing Editor. They discussed the formation, progress, and challenges of the commission, as well as the management’s efforts to increase awareness. The goal is to help residents of the state gain access to affordable, and in some cases, nearly free, medical services.
Excerpts
VIJON: What progress has been made in expanding healthcare under the Delta State Contributory Health Scheme in the past one year?
AKPOVETA: In 2015, His Excellency, the former governor, Senator Ifeanyi Okowa set-up a committee to draw the Bill, I headed that technical committee, and when that was later passed as a Law of the State, I was made the Chairman till 2023, which I was till when it was dissolved in June/July 2023. First, when we came in, we started at zero level.
This is because in 2015, when Okowa was campaigning, he noticed the level of poverty in all the communities in the state. He has a vision, to ensure the people have accessible and cheap health delivery. And this was very dear to him. This is because one of the factors that perpetuate poverty in the society, is illness, when one of us gets ill. Not only that he can’t bring more fund to the home, you will drain all the resources you have, to take care of the illness, and it will not be available, without also selling properties or family properties to get well.
This is because everyone must struggle to get well, and in the process, poor people become poorer, and poorer in health. And the only way you get them better health is to give them Health Insurance. And that was what His Excellency did. That vision is converted to the visible structure we are today, and a visible system of health Insurance, which had been a success due to the governor’s political goodwill, financial supports, my humble self as the Director General, and today we have a health Insurance first above all others in Nigeria. We have achieved a lot generally up till now. We are number one in all pillars of health Insurance, which we have 11 pillars till today.
To answer your questions directly, since I took over in 2023 as the Director General, the present Governor, being a system person, has been interested in Health Insurance, since he was a speaker of the Delta State House of Assembly. In fact, when he was the Speaker, the Bill was passed into Law, and being one who had also attended a lot of Health Insurance conferences across the nation, before he became Governor, he realized, that there would be a need for continuity and sustainability in the Health Insurance.
I was therefore pleasantly, surprised and happy that he appointed me as the Director General, and he said to me, Dr Akpoveta, go and do what you know best to do, and ensure that the Health Insurance is stable and today I can tell you, I met a figure of about 1.7 million beneficiaries, and we have built the figure to 2.3 million and above in the last six months since I took over.
And what did I do differently? I realized that after a serious assessment of my performance in the first 7 years, I accessed myself in the affairs of the commission, and discovered that the popularity of the commission is low. People were not aware of the commission. So, I took it up as a challenge and I invited you guys, the press, to ensure that the people are aware of Health Insurance and the value of Health Insurance to everyone.
Of course, I started some new initiatives, apart from the ones that were operating before. I started the indigent adoption initiative, the artisan inducement initiative, and the Tertiary Institution Social Health Insurance Programme (TISHIP), among others. Particularly, the indigent inducement initiative has gained ground, because, in that, I made a clarion call to Deltans of goodwill, Deltans of note, as well as philanthropists in the society to come to the aid of the poor, the aged, the vulnerable, and the indigent people. Every one of us has an indigent person in our home.
In Africa, you have one rich man, and 90 percent of the family will be below the bar, and he will need to go home and help our people. And I am glad that a lot of prominent Deltans agreed, and they have been adopting and paying for Health Insurance for our people. May God bless them. And so that is one of the major processes.
I also ensured that the system here is working very well. We have improved on the smooth running of the scheme, ensured that every little money we have we pay the providers, also talk to the providers of the healthcare facilities to ensure that they give health care and good services to our enrollees. All these put together have increased the awareness of the scheme. People walk in now and say, I want to register. I want to register. And we have registration centres in every local Government in the State.
We have 300 agents round the state, and of course we have our enrollee centre in the Headquarter here. With all this put together we are moving faster; we were crawling before like a new baby of 7 to 8 years. Now we are moving a bit faster, and I am sure that very soon, with the support of the Governor, who is very interested in Health Insurance, we will reach where we want to go.
VIJON: How has the implementation of the Health Insurance Scheme impacted access to health services across different demographics in the State?
AKPOVETA: First let me explain what we mean by contributory Health Insurance. Contributory Health Insurance simply means that you have to pay a small amount of money to the government. The Health Insurance organisation is a finance organisation. It’s not a medical treatment organisation, we pull resources, and we pull money together. From individuals, from philanthropists, from donors. We pull funds from what we call the Fund. And from there we pay for services. I can tell you that we have pulled huge amounts of money in Billions, across this country, across this state. And I am happy to announce that many of the hospitals have improved on their facilities, expertise, and their ambience. I know of one that had bought an X-ray machine from the funds it got from us. Some of the hospitals get about thirty Billion a month, and after deducting cost implication, they can afford to employ more Doctors to themselves, buy equipment, and renovate the environment and much more. So, it is impacting seriously, and positively in the health sector in Delta State.
Again, we have treated more than 1.7 million pregnant women and children under 5, over the last 7/8 years, and that has reduced the death rate of mothers during delivery and children under 5. Let me say something. When I was young, you would find out that a mother has eight children and probably only two will survive, or probably three. But now if they make the mistake of having eight children, the eight children will live. Because the Health Insurance is to ensure they don’t t die at the age of 0-5 years.
You will agree with me that the [old superstitious] idea that there’s a force probably killing the children in the family, is gradually disappearing. This is because the 4 to 5 years children will be alive into adulthood and thanks to the Governors of this state, Uduaghan, Okowa and Sheriff Oborevwori, who introduced the mother and Childcare before we inherited it. Delta has the lowest number of child deaths, under 5 deaths and deaths in pregnancy, especially during delivery. It’s impacting very, very well in the state, and very soon we are going to do research to revalidate it in terms of figures, and statistics of impact, and you will see that Delta State will be number one of lowest deaths in the country at this level of under 5, pregnant women and so on.
VIJON: Sir, the indigent enrollee adoption seems to be gaining ground, what do you have to say about the artisans?
AKPOVETA: The indigent enrollee adoption is gaining ground because Deltans have a Big Heart. We are the Big Heart. The word Big Heart means a caring heart, a loving heart and when you appeal to people that they need to help and they see the value of the money they are spending, they are encouraged when they see that they are bringing value to people’s lives. I will not be surprised that people are buying into it because of what they have seen and the value it’s bringing to people’s lives.
Then there is the artisan’s enrollee inducement programme, I coined the word inducement. The artisans you know are people like Okada riders, Barbers, and market women at the low level. Their fund inflow is piecemeal, and they find it very difficult to bring N7,000.00. They look at it as big money to pay at once, and we realized it is very difficult. So, we approached a lot of them, formed them into groups, and told them we would give them a small loan to pay for their insurance, and they would pay back a hundred naira a day. In ninety days or three months, they will finish paying the N7,000.00. You will be giving a fraction to the bank. It is a loan. We will guarantee that one.
We have finished with the bank, and they are ready to give us good money. The Bank of Industry and other commercial Banks are ready to release some money, which is an investment for them. So, very soon it’s going to take off from the Banks. Even at the moment about four thousand Okada riders have registered into the scheme. There are also market women already in the scheme. But I want to begin to boost it like the Indigent Adoption programme.
Meanwhile, why do I use the word inducement? We induce them to take a loan to let them enjoy the care for a year, and at the end of the one year, they will realize that they don’t need to take a loan, as they can afford N7,000.00. If you can put your mind, you can do it. It’s only if you are not too sure of the benefit, that you will resist, but after one year of experiencing this, you know that you can pay N7,000.00.
We are inducing them to come in, and we believe that at the end of the day, it will become a permanent thing, and you can renew the insurance because insurance is about renewal. And when you renew the sustainability of insurance, an organisation is certain. I am very systematic about this, and so I am taking my time, and when we have hit the ground running you will be surprised that a lot of artisans will key into it. I go around and see a lot of barbers that can gather N100.00 a day. And that is what I am just going to do. I will just do proper publicity on it, to educate the people on its benefits.
VIJON: On the Tertiary Institutions programme, apart from the students within the state, how do Delta Students who attend the numerous schools here and live outside the state benefit from this programme?
AKPOVETA: This scheme is an old scheme started by the Federal Government in 2014, but it failed because of many issues. And when I was approached for Delta State, I picked this up and studied it and discovered that many factors were missing. And just as students stay in school half of the year, they also stay outside the school in the other half so what happens to them, after paying such money?
Secondly, a student at home. Maybe just travelled home, or is on holiday at home, can receive treatment in any hospital in Delta state if he is in Delta. If he is in Lagos, or in Sokoto, but from Delta, he takes his card and goes to the hospital under the scheme of Lagos and a phone call is made to us, we confirm it in our computer system here, with that one, instantly we authorize his treatment. The bill is sent to us, and we pay Lagos state at their rate.
{Same thing applies} If it is in Kano, Sokoto, or Balyelsa, as we have already agreed at our meeting. And in packaging it, I met with the Vice Chancellors, the Rectors, and Registrars to study these big values in it. Apart from the fact that surgeries {and other medicals} can be undertaken, a student will be taken good care of by the scheme operated by these various universities coming in.
From our calculation, at the end of this academic session, it’s expected that from all the various higher institutions in Delta State, about 30 to 40 thousand students may have been enrolled into the scheme. And at the end of the year, we are expecting to have enrolled about 50,000 students. The Students Union were very happy when we gave them the benefit package of the scheme, from the school, to outside and to outside the state. It’s very comprehensive, and it’s doing well.
VIJON: What is the Commission Doing about areas with difficult terrains, like the creeks and Riverine areas where most of the cases have a Health Centre but with one Nurse?
AKPOVETA: We have been doing that for the last 2 to 3 years. In 2018, we had a collaboration between the Commission, Bank of Industry, Pharmacist Foundation of Holland, and Credit Fund. We pulled funds together and deposited them in the Bank of Industry. We did advertise for doctors to come from across the country, to run what is called PPP, public- private partnership on how we can get to “Hard to Reach Areas” of Delta State. The first is to go there to access the area, we identified 25 of them. There are areas you must travel by flying Boat for up to 4 hours before you get there, places like Oporoza, and Sandfield.
The former DG and I traveled to those areas, and we realized they had never seen a doctor in their life. And yet Chevron built health facilities in those areas which have been overgrown by weeds. When we returned, we discussed it with His Excellency the Governor, and he gave us the go-ahead. We then gave a loan to the Doctors to go and activate the health centres and run them under the PPP agreement. I am happy to announce that we have activated 18 of those facilities. One of these days we are hoping to take the press and tour some of these hospitals so, you can see what we have done.
This has brought accolades to the state, and at the national level, we have won awards. At the international level, we have been invited to the United Nations side meetings to present this. We have also presented to the federal ministry and the minister. Presently the Niger Delta Development Commission, NDDC is adopting that model of Delta State, for the nine states of the Niger Delta area.
In the area of Access to credit, access to finance facilities we make sure that Health Insurance is a Comprehensive health coverage. You can’t cover Asaba and conclude you had covered everywhere, or you have done health Insurance. We had gone far into the creeks, with Doctors from Lagos, Kano, and Toronto Hospital in Onitsha, have four hospitals like that in the riverine area.
It’s already running, and they have treated millions of children, pregnant women, children under 5, and even aged people who had never accessed healthcare in the past. It’s on, and it’s running well. We intend to increase the number.
VIJON: You have talked much about your growth, and we also expect some challenges. What have been some of your challenges?
AKPOVETA: One of our greatest challenges is manpower. The “Japa” Syndrome of our professionals going for greener pastures abroad is a big, huge problem for the health sector and in operating this scheme. This is not peculiar to Delta but to Nigeria. We will employ a nurse today, say five nurses, and within 3 to 6 months they are gone. Doctors do the same thing. This is almost in every profession. This is a huge problem. We are already considering paying more. Especially when you try to exchange N1,5000 for a dollar. This is a big challenge.
Another is fund flow. We have that challenge, and we are tackling it. In the healthcare facilities, we also have a very big challenge of human capital. For example, you will see a general hospital having only two Doctors. One is a Youth Corper, and the other a big Doctor. All these are system challenges and to tackle these, His Excellency the Governor has opened it up. If one Doctor lives, search for two and employ them. If two Nurses live, search for four and employ them. So, if two disappear, two will remain. So, the government is tackling this through continuous employment and reemploying.
Another challenge is the attitude and mannerisms of healthcare workers. Like many other civil servants, they need to be reoriented. So, we do a lot of advocacies, a lot of training. Health Insurance is different from ordinary Medical Care. In ordinary medical care, you walk into the facility pay money and get treatment. But in Health Insurance, it will depend on how you were treated before you renew.
So, when you go to the renewal component of it, you must treat the woman, man, or the child of a man very well, before he or she can say I will pay another N7,000.00 next year. So, we must talk to the top managers of the Health Centres to ensure they talk to beneficiaries nicely, and politely before you treat them.
