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UNDERSTANDING THE LAGOS STATE HEALTH SCHEME Adeyinka Gbemibade

Deji (not the real name), a resident of Lagos State, has just lost his job as a factory worker. His wife, Shade (not real name), a petty-trader, who was six months pregnant, took over the responsibilities of taking care of the family, including their aged parents and siblings. This really overwhelmed her, but she tried to cope as much as she could. Sadly, the weight of the burden became too enormous for her. Soon, she developed high blood pressure which complicated her pregnancy. 

In spite of her several trips to the hospital for ante natal, her blood pressure kept rising and few weeks before delivery, she was advised to undergo caesarian operation.

Alarmed, her husband ran helter-skelter, looking for money to settle impromptu medical bills. Unfortunately, he couldn’t muster the needed financial muscle to save her wife and the baby. He lost them both. Quite a sad episode.

But then, as sad as the episode was, such could have been averted if the family had made efforts to key into the Lagos State Health Scheme (LSHS).  Regrettably, just like it is with the Lagos State Residents Registration initiative, many residents are yet to fully come to term with the immense benefits of signing on to the State Health Insurance Scheme.

Globally, Health Insurance is the premium paid by an enrollee to cover the whole or part of his/her medical care for a period of time. 

The history of Health Insurance in Nigeria dated back to 1962 when an attempt to present a Bill in parliament for its enactment in the then Lagos area was rejected.  It was until 1988 that another effort, which eventually led to the birth of the present day National Health Insurance Scheme (NHIS), was made. 

The law establishing the NHIS was signed in May 1999, but due to some hiccups, the scheme never came up until June, 2005. The Scheme was formed to ensure universal health coverage for Nigerians. 

In Lagos State, the plight of the State government in ensuring access to healthcare services, financial protection, physical access to effective and quality health care services as well as protecting families from the financial hardship of huge medical bills, prompted the State government to enact the Lagos State Health Insurance Scheme (LSHS) Law No 32 in May, 2015. 

Section 6 (1) of the Law stipulates that the Scheme applies “to all residents of the State, all employees in the public and private sectors, including the self-employed and the employed”. This makes it mandatory for all the residents in the State irrespective of social divides.

Since July, 2019, enrollees in the Scheme, have been enjoying the benefit of the treatment of certain health issues or conditions such as registration and consultation, treatment of common ailments peculiar in the State such as malaria, diarrheal, simple skin diseases, sickle cell and asthma.

Out of the desire to ensure good health care system to the elderly in the State, the Lagos State government recognizes their vulnerability to certain old age diseases like hypertension, diabetes mellitus, sickle cell and asthma among others. Therefore, old people on the LSHS are given adequate leverage to treat such diseases.

Management and treatment of sexually transmitted diseases, Haematology, radiological investigations, ultrasound scan (obstetric scan, ECG and cervical cytology), clinical chemistry, dental and eye care, HIV/AIDS, minor and major surgeries (Heyrniotomy Herniorrhaphy, Appendectomy (Appendicitis), POP application, emergency salpingectomy and repair of vesico-vaginal/recto-vaginal fistula among others are covered on the scheme. 

Expectant mothers also have additional benefits on the scheme. These include taking care of childhood illnesses, child welfare services, neonatal services, gynecological prenatal care and delivery, blood transfusion for maternal cases only and family planning services.

To benefit from the scheme, an enrollee must register through any of the Lagos State Health Management Agency (LASHMA) enrollment points, platforms, licensed Health Insurance Agents or LASHMA Wellness Ambassadors. In addition, such enrollee must produce the Lagos State Residents Registration Agency (LASSRA) Identity Card or any other valid proof of residence in Lagos State. 

The enrollee is then expected to choose any of his or her preferred facility (Hospital) out of the over 200 under the LSHS platform in the State. Choosing a particular facility is strictly the duty of the enrollee.

After registration, the enrollee must pay the premium on or before the 25th of the month in order to enable to access care the following month. Such payment can be made in any of the health insurance plans.

The first of such is the Family Plan which consists of between two and six people viz the father, mother and four children below 18 years. With the payment of #40,000 only per annum, a family will enjoy LSHS for 12 months. 

However, large families with additional child less than 18 years will pay #6,000 per annum in order for the child to benefit from the scheme while additional child or adult in the family over 18 years old will pay an extra #8, 500 per annum.

Under the Individual Plan, which covers persons residing in the State, an individual pays the sum of #8, 500 per annum to enjoy the scheme.

Premium Payment could either be made through any of the banks in the State (physical or online) or through mobile payment on phones or via scratch card obtained from LASHMA Health Insurance Agents and USSD Code. Online payment is made via www.lashma.lagosstate.gov.ng.

After payment has been made, an enrollee is required to sign the Terms of Agreement, which will be sent via the phone number used for registration, following which enrollee’s Policy Number, which is personal and confidential, will be forwarded. 

Thereafter, enrollee will be assigned to the hospital of his/her choice where he or she is expected to visit before a Medical File will be opened. Then, the enrollee can access quality healthcare and enjoy the dividends of democracy the State government.

For those who register for individual plan when they are single, after marriage they could change from single plan to family plan. However, in emergency situation, LASHMA is committed to saving lives, therefore, enrollees can access care in any of the nearest LSHS hospitals, not necessarily the enrollee’s facility.

Children, individuals or philanthropists can purchase any of the plans for their parents, loved ones or less privileged in the society. In view of the universal saying that health is wealth, the scheme could be offered as present or gift to friends, relatives or colleagues to commemorate landmark events such as weddings and birthdays, graduations among others. 

Nobody prays to be sick. But then, being human, illness could be inevitable. The onus, therefore, lies on us to make adequate plan for our health, just as we do in other areas to avoid the misfortune of paying huge medical bills or running helter-skelter when faced with sudden medical condition.

Gbemibade is Head, Public Affairs Unit, Lagos State Health Management Agency (LASHMA)

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