EXCLUSIVE INTERVIEW:Ebonyi Pregnant Women No Longer Patronize Traditional Birth Attendants, Says EBSHIA Executive Secretary, Dr. Divine Igwe

Dr. Divine Igwe is the Executive Secretary (ES) of Ebonyi State Health Insurance Agency(EBSHIA), and a fellow of Institute of Health Insurance and Management Care of Nigeria. in this explosive intervew with Panafric Reporter, Alex Odeh, in Abakaliki, Dr. Igwe said EBSHIA has successfully enrolled not less than twenty thousand (20, 000) pregnant women, thereby reducing the patronage of traditional birth attendant in Ebonyi State. He spoke on other sundary issues, including the cross-subsidization of health services to individuals in the state and the drastic reduction of maternal mortality rate. Excerpts:

Can you explain to us the full operation of Ebonyi State Health Insurance Agency (EBSHIA)?

One thing about the type of work I do is that it is on record both in videography and any other thing. So if I tell you I have treated twenty persons, you will see them on video coverage. Except I have not had time to go to the field to go and get them and provide all of them and video them. Now, in the media conference that I had, I did explain the difference between health insurance and the hospital management. We purchase services. We don’t supply service. We are not trained to supply services. What we do is to purchase services and give to our clients. And they say, now you have health insurance contracts with me. In other words, I will give you health insurance for one year. Go to the hospital and you’re receiving services for that one year. My own is anytime I’ve gone to the hospital, we will pay the hospital that you have already gone to receive services. However, they treat you in that hospital is not the major part of my business with you.

Can a client re-make choice of hospital if the services from the initial hospital is not satisfactory?

If they treat you wrongly and you don’t want that hospital again, you now report back to me that I don’t want to continue with this hospital again. Kindly change me to another hospital and I will do so. But when you come telling me that you have gone to this hospital and the hospital, there’s no doctor in that hospital because of that, you will now say it’s not functioning. No, it is not my duty to keep a doctor in a hospital. It is my duty to ensure that if you have been satisfied with activity you receive, I can pay the hospital for having treated you. But if this report is coming before the payment, I can stop their payment because they did not treat my client well. So we have to demarcate these lines so that they will not be mistaking me as hospital management board or primary health care or office of the commissioner. My duty here is simple and I understand my work and that is what I am doing. So my work is enroll somebody into health insurance and refer the person to a specific hospital, probably the choice of the person and monitor that the person is actually receiving services. And then give the person attentiveness whenever a complaint will come so that you will resolve it. There’s nothing in this world that will not have a complaint. So when that complaint comes, the most important thing is how you were able to attend to that complaint.

What is the status of maternal mortality rate in Ebonyi State when you came on board and currently?

Now, on the issue of maternal mortality, I would equally want you to understand that before we came on board, maternal mortality for the state was 800 per 100,000 births. That simply means that in every 100,000 births, 800 persons will die. Yes, now that is what we made. But now the current status is below 400. That means that we have been able to cut it less than 50%. And now you know that part of the reason people die is because they don’t seek quality health care. Instead of them coming to the hospital, some of them will go to TBA, traditional birth attendant. And if they have postpartum hemorrhage there, they may die.

Why do they resort to going to traditional birth attendant and how has your office rise to this challenge?

Some of them is because they don’t have money to go to the hospital. And that is where we come in. We are to finance health care at the level that we can finance it. And to do that, we prioritize the pregnant women. As it stands now, we have enrolled not less than 20,000 pregnant women into health insurance. And that would tell you that those 20,000 persons are no longer thinking how much they will pay to the hospital whenever they go to the hospital because it is now free of charge. But you can equally recall that we have more than that number in the states. But it is the ones that we have the funds to enroll that we have already enrolled. So our care this time is to ensure that these ones that are enrolled, at least, are utilizing the services. And they are actually doing that, giving their babies good health care and every other thing going on well. So to that end, I would tell you that looking at what we have done, majority of people that would have gone to traditional birth attendant to patronize them are no longer going. Just because we have given them financial coverage and they can now go to a good hospital and have proper health care. So those are the strategies we have equally used.

What mechanism do you have in place to check the performance of these hospitals you have contracts with?

We do what we call monitoring and evaluation. Every month we go to different hospitals. And that’s why most times you don’t see me in the office. But we have to be visiting all those hospitals to ensure that the contract I have with you is kept. If you are not doing well, I will send you a warning letter that you are not doing well. If I send it up to three times, I will relieve you from the activities that we have together. So that’s what we are going to do.

Are there specific persons who are supposed to benefit from your services?

Just as I told you, when we enrolled 20,000 persons, I did mention to you that you may know that there are still other people. But they are not coming in because we don’t have the funds to enroll them. So we have enrolled the ones that we have the funds to enroll. How other people will come in is the way you are now as media. You can call on people that have the money, the well-to-do individuals in the state, the philanthropists. Instead of them throwing parties up and down, let them give us the money. Put into health insurance so that it will enable us to get more people in. So we enroll based on funds.

Can an individual be registered?

If a person wants to pay 15,000, we do what we call cross-subsidization. And that is the good thing that the governor of the state is doing. So now that he has already brought his own fund, your own fund will no longer be as big as it’s supposed to be. It’s exactly what happened in the time of fuel. We were enjoying fuel at 150 Naira or 15 Naira as the case may be, depending on the time you met it. Now, all of a sudden, fuel is now at 1,000. Why? Because subsidy was removed. So the time we were enjoying it, we never knew that there was something called subsidy. So government is already giving their own subsidy and that is why it is as cheap as that 15,000.

What about control of EBSHIA?
We have a board. We have a board and we have a commissioner for health. We have been the chairman of SOC, State Oversight Committee.

Can I ask a clarification before we proceed? I observed last week at NOFIC that pregnant women that give birth… If it’s not working, just move that place, please. After giving birth, they will request for your NIN and after you are able to submit your name, you will not pay for the delivery service. Is that also part of your service?

There is another thing the federal government started recently. They called it CMUNC. Now, that CMUNC is to give a comprehensive obstetric care for people that are having postpartum hemorrhage or anything that is called emergency. That is emergency care for pregnant women. When you get them, probably from rural area, they come to the place. Some facilities are selected. Our own duty now is when they have paid for that, they will bring the person officially to us to enroll the person into health insurance. That is why they are collecting the NIN of the person so that they will send them to us for us to enroll the person.