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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 1  |  Page : 43-51

Piloting mutual health association establishment in Enugu State, Southeast Nigeria: Lessons learned


1 Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; Partnership for Transforming Health Systems Phase 2 (PATHS2), Enugu, Nigeria
2 Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; Department of Preventive Dentistry, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
3 Partnership for Transforming Health Systems Phase 2 (PATHS2), Enugu, Nigeria
4 Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
5 Department of Community Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
6 Annunciation Specialist Hospital, Enugu, Nigeria
7 Federal Ministry of Health, Abuja, Nigeria
8 Department of Physiology, University of Nigeria Enugu Campus, Enugu, Nigeria
9 Partnership for Transforming Health Systems Phase 2 (PATHS2), Enugu, Nigeria; Department of Physiology, Nnamdi Azikiwe University, Awka, Nigeria

Date of Submission31-Jan-2021
Date of Decision18-Apr-2021
Date of Acceptance26-May-2021
Date of Web Publication3-Dec-2021

Correspondence Address:
Nkoli Uguru
Department of Preventive Dentistry, Faculty of Dentistry, College of Medicine, University of Nigeria Enugu Campus, Enugu.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_4_21

Rights and Permissions
  Abstract 

Background: Predominant out-of-pocket financing of health expenditures in low- and -middle-income countries (LMICs) remains a major setback to achieving universal health coverage (UHC). Nigeria has been attempting to bridge the gap through health insurance schemes targeting both the formal and informal sectors of the population. Objective: This paper aimed to provide a roadmap to assist in establishing community-based health insurance (CBHI) in any religious Nigerian Community. Materials and Methods: A cross-sectional descriptive design using qualitative methods was used for the study. The study areas were local government areas (LGAs) that make up the Catholic Diocese of Enugu. Extensive advocacies were used at various levels of the organizational structure of the Diocese to ensure buy-in. Organizational structure of the scheme was set up with nine major stakeholders who played active roles in the advocacies and the design of operational guidelines. Training of the stakeholders was conducted and two types of benefit package were adopted. A mutual health association (MHA), called Ndubuisi MHA, was approved and incorporated based on the NHIS model called intermediary method. Results: Nigeria’s first faith-based CBHI-Ndubuisi MHA with over 3000 enrollees was set up, approved, and registered with Enugu North LGA, Enugu State Ministry of Health and Corporate Affairs Commission. The scheme is running conveniently with a purpose-built administrative structure, monitoring and evaluation plan, and benefit packages. Conclusion: Establishing CBHI through faith-based organizations is possible and sustainable with underlying equity principles. The model used in this study can be implemented in any organization that has an element of mutual solidarity and existing administrative structures that can be used as a platform.

Keywords: Community-based health insurance, health insurance, mutual health association


How to cite this article:
Obikeze E, Uguru N, Ilika F, Iwuora I, Ojiako T, Idoko A, Chioke JF, Okoronkwo N, Yisa I, Anyaehie B, Nwobodo E. Piloting mutual health association establishment in Enugu State, Southeast Nigeria: Lessons learned. Int J Med Health Dev 2022;27:43-51

How to cite this URL:
Obikeze E, Uguru N, Ilika F, Iwuora I, Ojiako T, Idoko A, Chioke JF, Okoronkwo N, Yisa I, Anyaehie B, Nwobodo E. Piloting mutual health association establishment in Enugu State, Southeast Nigeria: Lessons learned. Int J Med Health Dev [serial online] 2022 [cited 2023 Feb 8];27:43-51. Available from: https://www.ijmhdev.com/text.asp?2022/27/1/43/331725




  Introduction Top


Universal health coverage (UHC) is a major goal of the World Health Organization (WHO) and a priority for many countries. Out-of-pocket payments (OOPs) as a major source of financing for healthcare especially in low- and middle-income countries (LMICs)[1],[2],[3] reduces access and remains a major obstacle toward meeting health development goals. UHC seeks to ensure that every individual, irrespective of socioeconomic, political, demographic, and gender differences, has equal “access to key promotive, preventive, curative and rehabilitative health services of good quality at an affordable cost”.[4],[5],[6],[7]

Across the world, countries are establishing community-based health insurance (CBHI). It is envisaged that health insurance is imperative when one considers the risk of falling sick as resources are inadequate. CBHI facilitates access to care and offers financial protection against the cost of illness. It also helps to overcome inequities in access and socioeconomic status by reducing existing gaps between the poor and the less poor.[8] However, there is evidence in Asia and sub-Saharan Africa indicating that CBHI has been less effective in securing equity than expected, with unabated preexisting inequities in access.[9] The major challenge for CBHI therefore is how to secure greater equity across socioeconomic groups, in terms of both enrolment and access to services.[10]

In Nigerian, health indices remain poor, low per capita public expenditure on health by government has made the private sector a predominant player.[11],[12] Public and private sectors require OOPs for most services where available. Nigerian National Health Insurance Scheme (NHIS) is currently implementing various schemes; however, it is mainly people in the formal sector of the economy such as federal government employees and other employees of some private sector that are covered. NHIS is expected to also regulate CBHI, but so far uptake has been very insignificant hampered by low enrolment rates, limited resource mobilization, and poor sustainability.[12] Poor implementation of formal sector health insurance has also diminished the capacity for buy-in of the populace into community health insurance schemes.

Enugu State of Nigeria has a variety of financing sources that include government budget, health insurance (social and private), external funding, and out-of-pocket spending.[5] But there is currently no effective system that socially protects people against unexpected healthcare spending. The state Ministry of Health with the support of Partnership for Transforming Health Systems II (PATHS2) in 2012 conducted a feasibility study for CBHI in the state.[13] The results showed the existence of insurable health risk and a potential number of people willing and able to participate if assured of sustainability. A key determinant of sustainability for them trusted on the operators, and this trust was very high for their religious leaders when compared with leaders of their community associations and traditional institutions. The predominant religious organizations were churches, so we hypothesized that due to the existing tradition of mutual solidarity and trust showed in the feasibility study, the church can serve as a platform for CBHIS implementation. The Catholic Diocese of Enugu was also found to have been making attempts to register a mutual health association (MHA) toward implementing a faith-based community-based health insurance (FB-CBHI). Enugu State has a population of 4,100,000[14] with more than 90% of the inhabitants Christians, whereas Muslims and traditionalists share the remaining 10%. The State has three Catholic Dioceses, headed by Bishops. Each Diocese is made of Deaneries as subadministrative units. Each Deanery is also made up of several parishes (group of churches) and every parish is headed by a Catholic Priest. This work represents the product of supporting the catholic diocese of Enugu in piloting the first Nigerian FB-CBHI. The paper highlights the challenges and proposes a method that can serve as a roadmap and for the establishment of sustainable CBHIS in communities that have the traditional structures of voluntary cooperation and not just the sharing of a geographical area.


  Materials and Methods Top


Study design and population

This study was conducted using qualitative methods. A detailed review of documents was conducted to provide the needed information on how CBHIS has been implemented prior to this study. Processes of establishing the scheme were also delineated.

The study area comprises the Catholic Dioceses in Enugu State, Southeast Nigeria. Enugu State has a population of 4,100,000[14] and was carved out of the old Anambra State. It has an area of approximately 12,727 km2 and is surrounded by six states, namely, Abia and Imo states in the south, Ebonyi and Anambra states in the east and west, respectively. In the north, it shares boundaries with Kogi and Benue states. More than 90% of the inhabitants are Christians, whereas Muslims and traditionalists share the remaining 10%. The native population is entirely Igbo with few Igala near the borders with Kogi state.

The study was conducted in both rural and urban areas that make up Enugu Catholic Diocese.

The state has three Catholic Dioceses with each headed by a Bishop. The Dioceses in the State are Nsukka Diocese, Awgu Diocese, and Enugu Diocese. Enugu Diocese was purposively selected for this study because they had already laid down structures for CBHI start-up. Enugu Diocese is made up of three local government areas (LGAs) in Enugu urban and four LGAs in the rural. The urban LGAs are Enugu North, Enugu South, and Enugu East, whereas the rural LGAs include Nkanu East, Udi, Ezeagu, and Nkanu West.[15] Enugu Deanery is made up of Enugu North and Enugu South LGAs. Nkwo Nike and Emene Deaneries are both in Enugu East LGA. Agbani Deanery covers two LGAs––Nkanu East and Nkanu West LGAs; Udi Deanery covers Udi LGA, whereas Aguobu Deanery covers Ezeagu LGA. Each Deanery is also made up of several parishes (group of churches) and every parish is headed by a Catholic Priest and a parish catechist who acts as a deputy to the Priest in the FB-CBHI.

Processes in establishing community-based health insurance

Establishment of the faith-based CBHI took some processes. The processes include review of documents on existing CBHI; advocacy visits to the stakeholders; setting up of the Diocesan

Board of Trustees (BoTs); provision of structure for the FB-CBHI; sensitization of parishioners; and training and facility visits and benefit packaging.

Document review:

There was reviewing of recent and gray literature including international, national, and state documents. Literature on processes and challenges of establishing CBHIS and lessons learnt were reviewed. The review helped to determine the existing healthcare financing mechanisms in Nigeria and beyond. It also helped to determine the level of health insurance in Nigeria and actions that have been taken to improve on financial risk protection and establishment of UHC in Nigeria.

There was also review of national legislation such as the National Health Insurance Scheme Decree of 1999 and the National Health Act of 2014. Other relevant documents include the National Health Policy of 2004, the National Strategic Health Development Plan Framework (2009–2015), the Ward Minimum Health Care Package (2007–2012), the CBHI Implementation and Training Manual (2011), and Blueprint for Community-Based Social Health Insurance Programme among others.

Also reviewed were the Legal framework for the establishment of Enugu State Primary Health Care Development Agency (PHCDA), the Report of previous CBHIS in Enugu state, and the Enugu state public–private partnership (PPP) policy document. Evidence from all these reviews informed the design and implementation of the FB-CBHIS in Enugu State as a model for funding health care for communities.

Advocacy visits to the stakeholders

The Catholic Church worldwide consists of about 2500 Districts called Dioceses each of which is headed by a Bishop.[14] Each of these Districts (Dioceses) is further subdivided into smaller individual communities called Parishes that are headed by Parish Priests. A group of neighboring parishes constitutes a deanery. For Enugu Diocese, four deaneries were earmarked for the pilot of the scheme. These include Udi, Agbani, Enugu, and Nkwo-Nike deaneries. Bishop of Enugu Diocese and Diocesan council were also consulted.

The Enugu Diocese already had a “Diocesan” health insurance scheme that had a working relationship with the NHIS. This scheme, though still in its infant stage, was called the “Ndubuisi” scheme and had an active nine-man BoTs that existed at the diocesan level. The “Ndubuisi” scheme however needed technical support and this need for support formed the basis of the Enugu State government/PATHS2 intervention.

Advocacy visits were made to the deaneries with attendance to deanery pastoral council meeting with all the regional deans and parish priests of all parishes in the deanery present. The selected representatives of each parish, women, men, and youth groups were represented. The upcoming scheme was introduced. A deanery sub-BOT chairman was selected and was mandated to see to the sensitization of members of the deanery.

There was an advocacy visit to the Diocesan BoTs to ascertain how far they had gone in setting up the scheme; their successes and challenges. This was done in order to determine the major areas where technical support was needed. There was discussion on plans and strategies for setting up the scheme and the church hierarchical structure was discussed and used to help develop a governance structure of the scheme.

In order to make administration of the scheme easier at the various hierarchical levels, a “sub” BoTs was proposed to exist at the “deanery” level and “parish health coordinators” at the parish levels. This process was repeated in all the deaneries. There was collaboration with the State Ministry of Health officials and speeches were delivered at various community fora such as the Umuavulu-Abor community summit, the annual “August meetings” of the Catholic Women Organization (CWO), and the Guild of Private Medical Practitioners (GPMP) in Enugu.

Furthermore, advocacy visits were paid to the executive officers (including the Honorable Commissioner for Health) in the Enugu State Ministry of Health to update them on the progress as well as to stimulate collaboration between the State and the Faith-based Organization. Agreements detailing the collaboration between the state and the MHA as well as between the MHA and the private providers were also developed. A generic operating guideline for CBHI schemes in Enugu state was also developed. An agreement detailing this collaboration was submitted and assented to by the Ministry of Health.

Diocesan BoTs:

The study observed that Enugu Catholic Diocese had an existing BoT that was registered with the local government but was not accredited with NHIS although they had invited NHIS and received Terms of Reference. The Diocesan MHA was not also incorporated with the Corporate Affairs Commission (CAC). These processes were consolidated with the Corporate

Affairs Commission approving the name as Ndubuisi MHA. Approval from the Enugu North Local Government was also secured.

Setting up administrative structure in collaboration with the catholic structure at deanery level

Model and Structure of the Enugu State FB-CBHIS:

The NHIS has a model called the intermediary method. This was used to set up the MHA called Ndubuisi. The organizational structure of the scheme [Figure 1] is in line with the organizational structure of the church, but it is replicable in any setting or context. The FBCBHIS has nine major stakeholders namely:
Figure 1: Management structure of FB-CBHI

Click here to view


  • The overall regulator––NHIS


  • The state government––via the Enugu State Ministry of health


  • CBO’s and development partners


  • Diocesan BoTs


  • Deanery sub-BOT


  • The technical management team (TMT)


  • The Parish health coordinators (PHCs)


  • The healthcare providers


  • Enrollees/beneficiaries


  • The management structure ensures that individuals or organizational philanthropists are free to contribute to the scheme and promote its equity fund. The state and LGAs are also involved in the Scheme by providing the necessary support through provision of both primary and secondary health facilities under government control. They also participate in accreditation of health facilities particularly the privately owned for the scheme. NHIS is the overall regulator of the scheme. Diocesan BoT, Deanery Sub-BoT/TMT as well as Parish Coordinators are the core managers of the scheme. The Bishop has an oversight function to the scheme. When available, the Bishop chairs the Diocesan BoT although there is an appointed Board Chairman. The Diocesan BoT is made of the Board Chairman, the CBHI manager, the Secretary, data manager, the Financial Secretary and the PRO. The Deanery sub-BoT is made of the Chairman, secretary, PRO and the financial secretary. A Deanery monitors the activities of the parishes under it. Each parish in the CBHI arrangement has two parish coordinators made of a parishioner and the parish catechist. Facility Health Committee (FHC) members are appointed by the community where the accredited CBHIS health facility is located and the committee is statutorily enshrined in the town union. The major responsibility of the FHC is to ensure compliance from the health worker, availability of health commodities, and overall supervision of activities in the health facility. Although the FHCs have no mandate to sanction erring health officials, they have channel through which they report activities of the health workers to higher authorities.

    Enugu Diocesan BoTs was inaugurated with the Bishop having overarching supervisory role. The Diocesan BoT oversees the CBHI activities in the diocese with such functionaries as Chairman of the Board, Manager, Treasurer, Secretary to the Board, and the Public Relation Officer. The Catholic Diocese of Enugu appointed Umuchinemere Pro-credit Micro-finance Bank to be the hub for collection of premiums for the scheme.

    Following the Diocesan BoT, is the deanery BoT with Chairman, Secretary, and Treasurer. The deanery BoT oversees the activities of the parishes that make up the deanery and ensures that premiums are remitted by the enrollees through the parish coordinators. Parish coordinators on the other hand have the responsibility of mobilizing parishioners and getting them enrolled with the scheme. The scheme also has provision for TMT which can be used if a CBHI decides to use Health Maintenance Organization (HMO) instead of BoTs.

    In the course of the activities being discussed, consultants with input from PATHS2 and other stakeholders developed a training toolkit consisting of training modules for the BOT, TMT, and Parish health/community health coordinators. The kit contains amongst other things, modules on Basic bookkeeping in the financial management of CBHIS, Basic banking procedures, and Memorandum of understanding for CBHIS healthcare providers.

    Sensitization of the people (parishioners):

    There were series of dialoguing and interacting with the various stakeholders who would play key roles in the CBHIS. There was sensitization of stakeholders about the scheme and what it would offer to communities and how it could be run with adequate mechanisms for sustainability. NHIS provided their Technical Partners. Program officers from PATHS2 and officers from the Health Insurance Desk in the State Ministry of Health were involved at this stage. A series of sensitization were made to the heads of the Catholic Diocese of Enugu. The Bishops of Enugu, Awgu, and Nsukka Dioceses were met for their permission and support for the proposed CBHI scheme. Further meetings were fixed with Diocesan priests and pastoral council (consultative bodies that advise the parish priest or bishop) members to inform them about the proposed scheme, its importance, and also their support for the proposed health insurance.

    Training and facility visits

    Intensive trainings for the major stakeholders of the health insurance scheme with support from NHIS and Health Insurance Desk of the Enugu State Ministry of Health was conducted. The trainings were conducted for the BoT, potential TMT members, and PHCs. The trainings were conducted in the three deaneries and participants were selected by the deaneries from the parishes under their jurisdiction.

    A modular method of training was used and after each session there was a question-and-answer session. The roles of each stakeholder were emphasized and elaborated on when that particular stakeholder was being trained, for example, BoT roles emphasized and elaborated on during BoT trainings; sub-BoT roles emphasized and elaborated on during sub-BoT training, etc. The training sessions were interactive and respondents were free to air their views on any aspect of the training. After the BoT training, elections were conducted in order to select members of the BOT. This was done by secret ballot. Twelve BoT members were elected per deanery. The positions of BoT Chairman, Secretary, Financial Secretary and PRO for each BoT were filled, also by election.

    Once all the BoT trainings were concluded, PHCs in the three deaneries were also trained; 46 in Udi Deanery, 30 in Agbani deanery, and 40 in Nkwo-Nike deanery. These PHCs (two per parish) were selected by the parish priest and the lay members of the parish. Facility health coordinators and PATHS2 local technical assistants for behavioral change were also trained to help in sensitization of community members and increase visibility of the scheme.

    It was mutually agreed by all the stakeholders that deanery “sub” BoT could also be members of the diocesan BOT. Also, MHA members who had previous accounting or bookkeeping experience were identified and asked to apply to the diocesan BoT (who will take control of the interview process) for TMT positions. Health facility assessment checklist using a prototype from NHIS and initiated visits to health facilities in the various deaneries (LGAs) based on a list of health facilities compiled by members of the MHA in each deanery was also developed. Public, private, and faith-based facilities were visited.

    Development of faith-based community-based health insurance benefit package

    Two benefit packages namely basic health package (BHP) and the extended health package (EHP) were developed in the scheme: these were adapted from the existing NHIS benefit package. Common diseases and ailments predominant in the region were taken into consideration when adapting this package. Both the BHP and EHP contain primary (basic) and secondary (specialist) healthcare services and are further detailed in [Table 1] and [Table 2].
    Table 1: The basic health package (BHP)

    Click here to view
    Table 2: Extended health package (EHP)

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    The basic health package

    The health services covered by the BHP are detailed in [Tables 1].

    The extended health package

    The health services covered by the EHP are detailed in [Tables 2].

    Findings

    In the Southeast Nigeria, churches are important means of bringing people together and the Catholic Church in Enugu State has shown interest in the establishment of an FB-CBHI for its parishioners. The focus of this FB- CBHI with the Catholic Church is based on the following reasons as observed by Abt Associates (PATHS2) findings:

  • The Catholic Church comprises over 2,099,447 members in Enugu state (2012/2013). This is important in estimating the number of enrollees for sustainability as well as ensuring a significant impact on the population.


  • There is a very strong will and commitment from the Bishops of the three dioceses in Enugu state to provide affordable quality health care to all the vulnerable groups regardless of faith.


  • There is government support and commitment to the provision of affordable healthcare services to the poor.


  • Launching and flag-off of Ndubuisi community-based health insurance

    Faith-based CBHI known as Ndubuisi MHA was set up, approved, and registered with the CAC. The Ndubuisi MHA was formally launched by the Hon. Commissioner for Health Enugu state and the Catholic Bishop of Enugu Diocese. The launching focused on sensitizing the people of Enugu State and encouraging them to join the health insurance. The public affiliation of the Bishop and Hon. Commissioner to the scheme gave the credibility of the scheme a boost to enhance the Enugu state PPP vision as a tool for improving health outcomes and attracted a mass enrolment after the ceremony. In attendance were community members, NHIS officials, directors in the Ministry of Health, private health practitioners, HMOs, and other FBOs. The consultants with input from staff of PATHS2, Ministry of Health (who were the chief hosts) and the Ndubuisi MHA planned and organized this ceremony. Fliers, radio jingles, and various communication strategies were used to create awareness and garner public interest.

    Registration of people and monitoring of progress:

    Ndubuisi CBHI currently covers over three thousand enrollees. This cuts across the Enugu Catholic Diocese. One of the requirements by the NHIS is that any community that establishes CBHI should enroll at least one thousand enrollees before such CBHI could be flagged off by the NHIS. Flagging off also attracts equity fund of not less than five hundred thousand (N500,000.00) from the NHIS. The Ndubuisi MHA has registered over 3000 enrollees and has also put in place monitoring and evaluation processes. It is expected that benefit package would be examined over time to accommodate economic realities. Stakeholders who do not comply with the rules of the MHA will be sanctioned through the appropriate procedures.

    Lessons learned

    OOPs has remained a major means of paying for healthcare in the country.[16],[17],[18] UHC stands out as a sure means of ensuring that healthcare is provided to people irrespective of their socio-economic status.[15]The question that comes to mind is to what extent have people been able to receive the coverage? At the present count, it is only less than 5% of the population that is covered by any form of insurance in Nigeria.[19] In the formal sector, only those in the federal establishments and few private establishments such as banks and conglomerates have insurance, which represents an insignificant number of the total population. In the informal sector, there is little or no health insurance coverage. Unfortunately, the informal sector represents over 95% of the population with more people in the low-income quintile.[20] This again shows that those that are covered are in the high-income level and would be able to pay their health bills compare to those that are not covered.

    Equity in healthcare provision means that those in equal socio-economic status should be able to get equal treatment, whereas unequal in socio-economic status should get unequal treatment.[21],[22] Faith-based organizations like churches are looking at a situation where the faithful are provided with equitable healthcare at all times. This includes ensuring that those who are better off among faithful making altruistic payments for those who do not have. This arrangement forms the bases for the establishment of Ndubuisi health insurance. The scheme currently covers those who made the premium contribution of N6000 (for the minimum cover) and have also made a choice of their healthcare providers. Extended benefit package is for N18000. It is expected that with time, the Ndubuisi scheme would be in a position to determine the indigents and extend health insurance benefits to them. This will be achieved by using deferral and exemption procedures to provide the scheme with the adequate list of those who are actually indigent and require coverage.

    Funding streams for health care in Enugu State are mainly through government budgets, external and internal funding as well as OOP. These sources as of now have not been able to provide adequate solution to poor health funding. Much as UHC has the potentials to provide a better health system, the practice has not been widely enforced. With low coverage across the country, efforts that aim at providing healthcare through insurance need to be fully advocated for by the WHO, sustainable development goals (SDGs), and the World Bank.

    It is clear that Catholic Diocese of Enugu has been able to establish a MHA with the sole aim of making healthcare delivery more accessible and more affordable. Establishment of MHAs, and recent formation of Ndubuisi CBHI and other faith-based initiatives are key ways of promoting health for all. Organizational structure of the church shows that the Diocese headed by a Bishop has a strong will in determining the effective management of schemes. Before now, churches have schools, hospitals, and other enterprises which have shown strength in business and competition with rivals. Having been established within his domain, the Bishop has an overarching responsibility to demand for accountability from the scheme management. His position also compels the technical managers to perform up to expectation. Because it is managed by the church, expectations are high. It is envisaged that the parish priests would be in a good position to instill compliance. This is already happening by way of getting the people to enroll with minimum requirement for equity fund from NHIS already achieved by the scheme.

    Following the Diocesan procedures, key stakeholders in the structure were trained by PATHS2 consultants. The essence of training was for them to have a sound understanding of the scheme and how it can be run efficiently. During the trainings, BoT members agreed that the TMT will be part of the sub-BoT and only two technical members would be used per deanery. TMT was basically made of those in-charge of the day-to-day running of the CBHIS. Also included in the training were the PHCs. PHCs are credible parish members based on parishioner’s trust for such people. It was also agreed that catechist of each parish should be included as parish coordinator.

    It was noted during the processes that accountability issues might creep in if Parish Health

    Coordinators were to collect premium in cash. The BoT agreed that the premiums will be paid by enrollees to the designated bank (Umuchinemere Pro-credit Micro-Finance Bank), which is also owned and managed by the Enugu Catholic Diocese.

    Training on registration of members, benefit package and enrolment of beneficiaries were conducted. MHA registration of N100 was agreed on to cover cost of printing ID card for registered members. The premiums of N6000 for basic healthcare package, and N18000 for extended healthcare package were agreed on during the training. All the BoT and PHC members had automatic registration with the MHA as evidence that they support and will be willing to participate in the scheme.


      Conclusion Top


    Evidence shows possibility of establishing CBHI through faith-based organizations in Southeast Nigeria. There is need for UHC through health insurance. UHC aims at getting healthcare delivery to all irrespective of their socioeconomic status. This paper presents a remarkable progress in establishing FB-CBHI without compromising the underlying equity principles.

    Authors’ contributions

    EO is the first author and was responsible for overall data collection and writing of the manuscript. NU is the corresponding author and part of the data collection and review of documents and contributed very well in writing of the manuscript. FI was part of the research through data collection, writing of the initial report, and vetting of the paper. II proof read the paper and made valuable contributions in both the spoken English and technical inputs. TO was part of the study data collection and literature search as well as providing support during the writing of the paper. AI participated in the literature review and reports on the advocacy visits. BA participated at all levels of the study and also proof read the manuscript. JFC was part of the paper review, sensitization, advocacy visits and writing of the benefit package. IY gave his technical support and participated in the study design. EN provided technical support, read the manuscript, and participated in the study design.

    Acknowledgement

    This study was conducted by Abt Associates project called PATHS2, supported by United Kingdom Agency for International Development (UKAID). Authors wish to acknowledge their funding for the study.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
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        Figures

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        Tables

      [Table 1], [Table 2]



     

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