In 2007, the administration of the then state governor, Dr. Bukola Saraki introduced community health insurance in Kwara State. It was targeted at rural dwellers living in the state.

Kwara State has about one million rural dwellers and the scheme is expected to go round all of them before the end of 2018 after which civil servants would be included, as well as those living in cities in the state. The scheme Daily Trust learnt is the first of its kind in Nigeria with only about 120,000 subscribers, and there are 200,000 people that ever enrolled out of which some have died, while others have moved from rural areas to urban cities while some cannot pay for it.

The treatment according to the Senior Special Assistant to Governor Abdulfattah Ahmad, Dr. Nurudeen Akorede includes minor surgery, delivery, treatment of fever, and malaria among others. "It gives subscribers a year round medical care and their families which covers delivery, minor surgery, all sorts of sickness excluding major surgeries. It was limited to three local governments but when this administration came to power, they decided to extend it to ten local governments and increase the number of subscribers to 120,000 across the state.

Akorede said the government's intention is to extend it to civil servants across the state so that they can enjoy it too. But they will contribute higher premium than what people in the rural communities are paying while the state government augments it to have access to subsidized medical services, adding that the state government's intention is to extend it to one million subscribers by 2018.

Executive Secretary of Kwara state Community Health Insurance, Mr. Razak Abdulsalam, said the pilot phase of the scheme started in Shonga in Edu Local Government Area of the state and later extended to other local governments. The programme now covers Baruten, Mooro, Irepodun, Kaiama, Asa, Oyun, Ifelodun, Ekiti, Oke Ero, and Isin local government areas. "Initially the scheme was hundred percent free provided by the Dutch Ministry of Foreign Affairs, Trust Insurance Fund and the programme managers who are our health maintenance organizations. It was a partnership programme which first started as a 100% subsidy but it was later expanded," Abdulsalam said. He added that on the basis of the expansion, the Dutch government insisted that the state government must pay a co-premium and they started paying what is called counterpart funding to assist the programme.

According to him, "We started with ratio 20:80 percent. Kwara state government pays 20 percent while our partners pay 80 percent, now it has increased to 65:45 percent. We pay 65 percent while our partners pay 45 percent, Farm access foundation, health insurance fund in Amsterdam in collaboration with Dutch ministry of foreign affairs and HYGIEA that is our HMO to implement the programme." At the beginning of the scheme, subscribers accessed it for free but when it was later expanded they were charged three hundred naira and later increased to five hundred naira.

"Premium for the scheme is N6,250 and subscribers pay N500 which depends on the value of the naira to dollar. It was three hundred naira at the onset but when the state government considered it's sustainability, it was later increased to N500 and the payment is made once which allows subscribers and their families to enjoy uninterrupted medical service for one year both at the government and private hospitals," the executive secretary explained. The scheme which is currently operational in ten local governments of the state is expected to extend to all the sixteen local governments in the state to cover all estimated rural dwellers in the state.

As laudable as the scheme is, both the city and the rural dwellers in the state lamented over some issues posing a hindrance to their embrace of the programme. Mrs. Folake Adeniyi and Mrs. Rhoda Jonah, both from Irepodun and Asa local government areas of the state told Daily Trust that they are not aware of the programme adding that they are willing to subscribe if it is extended to their villages.

Another rural dweller, Mr. Moses A. Adeoye, from Agbonda community in Irepodun local government confirmed that the programme was introduced in their locality but they are not inclined to it because of the distance between their village and where the hospital they can assess it is located. "I have heard about it and it is a good idea but I will not subscribe to it because of the condition attached to it. The five hundred naira is nothing compared to our health but they didn't accredit any of the two hospitals we have in my community for the programme. In cases of emergency, ailing persons may die before we get to the accredited medical centre which is a little bit far from our village. The state government should consider bringing it to the hospital in my area," Adeoye said.

Some rural dwellers are traditionally inclined to the programme as many of them still believe in trado-medicine while some are waiting or expecting a politician from their area to pay for them. Others feel there is no point subscribing for it since they did not go to the hospital throughout the previous year which amounted to waste of the subscription fee. The Emir of Shonga, Dr. Haliru Yahaya, said the pilot programme started from his community, saying that his subjects have embraced it, and have since been working towards its sustainability.

"My people have accepted it as a community project and we are working towards sustaining it. Even though it is five hundred naira, we are looking towards increasing it to one thousand naira in order to sustain it. Although, we have physical, financial and socio-cultural barriers as challenges, I believe with education and enlightenment the barriers can be removed because many people are not properly enlightened on the programme," the Emir said The scheme has won international awards among which is UOCO award in Paris, people's choice award by saving lives at birth, USAID, Gate foundation, NORAD DFID) for innovation maternal and childcare .

On the challenges, the Kwara state government said it is doing everything possible to carry out awareness campaign to let rural dwellers know about it and hope that before the end of this administration, the civil servants in the state would be included. Meanwhile, the Nigerian Medical Association (NMA) recently advocated for the mapping out of the whole country into health blocks in order to achieve a universal health care which will assist in achieving the target of community health insurance like the one introduced in Kwara state.

"It is pertinent to noted that in order to achieve the goal of universal health care, the whole country should be mapped out into health blocks containing roughly 5,000 enrollees and managed by a medical practitioner or where it is not available, a community health extension worker should be used. With this, the target of the community health insurance would be achieved," President of the Nigeria Medical Association (NMA) Dr. Kayode Obembe said.