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Delta: Moving Towards Health For All

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February 24, 2014, was a special day for Dr. Ifeanyi Arthur Okowa, then a serving senator and chairman of the Senate Committee on Health. 

It was the day his landmark National Health Bill (NHB) was passed at the red chamber, and became a vehicle for revolutionising healthcare delivery in Nigeria. 

Addressing journalists shortly after the bill was passed, an elated Okowa, a medical doctor, who took his Hippocratic Oath at the young age of 24, told Nigerians the law will provide the framework for the regulation, funding, development and management of the national health system. 

It is also aimed at setting standards for health services in the country. More importantly, it laid the legal and financial framework for the establishment of the National Health Insurance Scheme (NHIS) that made health care more accessible and affordable for participants in the scheme. 

As governor of Delta State, Senator Okowa had a ready blueprint for improved healthcare delivery in the State.

Beyond the easily visible physical structures associated with the health system, Okowa keyed into using creative measures to maintain the structures already in place and improving the quality of service delivery. 

The state of primary health care delivery, one of the pillars of the health sector is of utmost importance. While there are over 24,000 Primary Healthcare Centre (PHCs) in the country, less than 5,000 are functional. 

Okowa introduced the Access to Finance Framework initiative that engenders a Public-Private Partnership (PPP), as a panacea to lack of quality service delivery at the primary healthcare level.

He gave the green light for the implementation of the initiative that birthed a solid partnership between the State government, through the Delta State Contributory Health Commission, the Bank of Industry, financial institutions and the PharmAccess Foundation, a private healthcare organisation in November 2017. 

The initiative is a framework that supports outsourcing of defunct and abandoned healthcare facilities to the private sector to revitalize and provide services to the participants of the health insurance scheme, especially in the rural areas. 

In addition, through a matching fund arrangement between the Bank of Industry (BoI), and the State government, the private sector players would have access to loans with concessionary interest rates to renovate these facilities. 

The Medical Credit Fund of the PharmAccess Foundation was selected to provide partial guarantees to the lenders for the loans they provide to the private sector players in addition to business development support to ensure sustainability. 

The facilities would also be quality assured through the adoption of the SafeCare methodology of the PharmAccess Foundation. 

Over one year, stakeholder meetings resulted in the selection of reputable private sector players to take over 25 defunct health facilities. 

 Olorogun Isaac Apkoveta, Board Chairman, Delta State Contributory Health Commission, (DSCHC), speaking at the handover ceremony in Asaba, where agreements were signed between the partners for renovation, operation and transfer, said: “With this agreement, the private sector will take over the running of the centres, equip them to standard and ensure that they are operational 24 hours for our people who have enrolled in the contributory health insurance scheme”. 

The agreements enabled the private sector to have access to funds at a single digit interest loan from the Bank of Industry to fix and run the abandoned health centres.

The innovative product also ensures the availability of 24 hours quality healthcare services across Delta for the State’s Contributory Health Scheme, enables continuity of healthcare services during strikes and other industrial disputes and more healthcare service options for residents of Delta State. 

Giving further insight into the novel healthcare approach, Okowa told delegates at the second National Health Summit in November 2019 in Abuja that it was time to adopt the patient-centred care (PCC) model in service delivery. 

PCC, according to him, is about treating a person receiving healthcare with dignity and respect and involving them in all decisions about their health. 

He said that PCC had great potential to produce much better outcomes in a cost-efficient manner, reduce system errors and increase patient satisfaction. 

The State also launched the Contributory Health Insurance Scheme for all Deltans with government paying for the Under 5, pregnant women and the elderly in society. 

Currently, according to Charles Aniagwu, Commissioner for Information, the Delta State Contributory Health Commission (DSCHC) has a total of 702,413 participants comprising Formal Health Plan – 168,516, Informal 

 Health Plan – 11,187 and Equity Health Plan – 522,710 and counting. To give vent to the Universal Health Coverage in the State, the Okowa administration has completed rehabilitation work on 63 Secondary Health Care facilities and 110 Primary Health Care centres including the engagement of 52 standard Private Health Care providers for the scheme. 

Under the scheme, everybody that contributes is enrolled and receives an identity card. Such a person receives a defined benefit package of healthcare service from accredited healthcare facilities closest to them and of their preference. 

Premium contribution for the formal sector is a percentage of salary for those working in organizations with a payroll system to cover the principal participant, spouse and four biological children below the age of 18 years. 

Premium contribution for the informal sector is N7,000 per year to cover only an individual. Family registration will attract a discount. Those in trade unions and associations will be enrolled under the identifiable group taxation programme. 

Premium contribution for the equity sector comprising of the vulnerable people in society will be paid from a pool of funds comprising the Federal and State government grant to the scheme and contribution from philanthropists and international donors. 

Public and private healthcare facilities will be accredited and registered by the commission to ensure they meet the standards required to provide quality healthcare service in Delta State. 

Participants will be able to access healthcare services 60 – 90 days after confirmation of their payment, to allow for time in completing the registration process, avoid adverse selection and comply with other necessary requirements. 

Access to healthcare services starts from public and private primary healthcare facilities as the service entry point. Health service requirements that are beyond the capacity of the primary healthcare facilities will be referred to secondary and tertiary healthcare facilities, as required. 

Beyond the institutional approach to healthcare, Okowa has invested resources in the supply and installation of critical tools and equipment in numerous health facilities in the State. 

At the College of Health Technology, Ofuoma, Ughelli, the governor purchased medical and laboratory equipment and effected infrastructural repair to meet accreditation requirements of its academic programmes. He also remodelled and rehabilitated the Renal Dialysis Centre at the Central Hospital, Warri. 

Dr. Okowa has also invested resources into the building and equipping of tertiary healthcare institutions. One of the newest is the Asaba Specialist Hospital. The Chief Medical Director, Dr (Mrs) Peace Ighowese, said the hospital which is virtually completed save for minor finishings in some sections has already started admitting patients. 

“The maternity ward, theatre and the accident and emergency wards are open and operational. It’s a huge relief to the people of Delta State because they now have access to affordable and accessible healthcare of very high standard. Most of the facilities in tertiary healthcare institutions in the country are in the new Asaba Specialist Hospital,” Dr. Ighowese said. 

According to her, the Sickle Cell Centre at the hospital has state of the art facilities. 

“We are able to provide tertiary level of care to sickle cell patients in all areas of their needs at the centre. In addition, the hospital provides free healthcare to children below the age of five in line with Dr. Okowa’s Equity Health Plan. 

“The Delta State Contributory Health Scheme enables civil servants to access quality healthcare at no cost to them. It must be said that the free healthcare for pregnant women from conception to delivery and six weeks after has been strengthened by the governor. This has considerably reduced maternal and child mortality in the State,” Dr. Ighowese said. 

Some of the major projects executed at various health institutions include the renovation and re-equipping of Children’s Ward at the General Hospital, Patani; renovation, equipping and upgrading of Cottage Hospital, Abavo to the full status of an ultra-modern General Hospital in addition to the procurement of a brand new ambulance. 

Also on the list of completed projects include: procurement of nine Oxygen Concentrators and installed in selected general hospitals spread across the three senatorial zones in the State; supply of 10,000 units mama kits to health centres in the State; renovation and remodification of Central Hospital, Agbor; repair of faulty medical equipment in ten hospitals across the three senatorial districts; special grant to Delta State University Teaching Hospital, DELSUTH, for major equipment repairs, including MRI, CT Scan, Mobile X-ray equipment and rehabilitation of power supply system; establishment of Sickle Cell Clinics at various hospitals in the State including those at Ughelli, Sapele, Eku, Oleh, Patani, Agbor and Kwale among others. 

The outbreak of Corona virus caught the global medical community unawares in terms of knowledge of scientific palliatives and cure for the disease. But with a medical doctor at the helm, Delta State’s tale was different. 

It was among the first to adopt defensive measures to combat the scourge. Well ahead of the discovery of the index case in the State, facilities for the isolation of confirmed cases and testing centres were set up. 

In addition to attractive motivational packages for healthcare personnel, insurance cover was also procured for them to address occupational hazards. 

According to the State Commissioner for Health, Dr. Mordi Ononye, life insurance was taken for a total of 2,557 health workers as part of a motivational package for those regarded as first-line charge in the fight against the COVID-19 pandemic in the State. 

“We have continued to be mindful of the welfare of health workers including providing the needed Personal Protective Equipment, PPE. We are also engaging with them and their unions to ensure that their allowances are paid.” 

Dr. Ononye, who is also the Chairman, Delta State Technical Committee on COVID-19, said: “Adopting a hands-on approach to the management of the pandemic, Okowa was always on the front line along with members of the task force. When it was officially announced that he and some members of the task force had tested positive to COVID-19, it was not entirely surprising. 

At the National Health Summit, organised by the Nigerian Medical Association, NMA, on November 5, 2019, in Abuja, Okowa’s effort towards providing the Basic Health Care Development Fund, BHCDF, to Deltans, which has been largely achieved through the State’s Contributory Health Insurance Scheme, was lauded. 

The governor has also been attentive to labour related issues of medical doctors. Dr. Onome Ogueh, Chief Medical Director of the Delta State University Teaching Hospital, DELSUTH, Oghara, said the health programmes being implemented by the Okowa administration contributed greatly to the Secretariat of the Nigerian Association of Resident Doctors, NARD, moving to DELSUTH, Oghara on 24 September 2020. This is the first time that the Secretariat of NARD is coming to a State Teaching Hospital in her 40 years history.