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Investigation:Poor Abuse , Communication,Others Bedevil Kwara Health Insurance Scheme

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Kwara Health Insurance Scheme

 

In 2020, the Kwara State Government, launched the Kwara Health Insurance Scheme (KHIS) to make access to basic healthcare by Kwara indigents seamless. The program however hasn’t been entirely flawless. In this report, Omolola Afolabi unravels some of the inadequacies bedeviling the scheme in the state.

For Sanni Amuda, a 46-year-old artisan in Awodi Gambari, Ilorin, the past few years have been akin to sprinting through the fog. His income has been irregular whilst also struggling with meeting his family’s needs.

He recalls a watershed moment when the government announced the commencement of the Kwara State Health Insurance Scheme (KHIS). He said he felt he could save funds and take care of his wife and four children’s medical needs by subscribing to the scheme but he soon met a brick wall of challenges.

“I was so excited about the scheme as I thought it would make access to quality healthcare for my family and I easy and affordable. I went with my wife and four children and after a long, stressful day of queuing up to register, we eventually got all our names and passport photographs captured. They promised to call me soon to pick up our cards but till this moment, they have not communicated that to me.”

Sanni Audu

Sanni Audu

Amuda who works as a carpenter has seen his enthusiasm give way to disbelief. He says the scheme is a scam. He was vehement.

The scheme allows for a maximum number of six persons to enroll from each family but it’s been six months since Amuda registered his family without any official proof.

A scheme blighted with challenges

The Kwara State Health Insurance Scheme was established by law in November 2017 to provide mandatory health insurance coverage to all residents of Kwara State, particularly the indigent people amongst its burgeoning population of 3.2 million people.

The insurance package provides coverage for consultations, diagnostic tests, and medication for all disease categories, including hypertension and diabetes, that can be managed at a primary health care level and limited coverage of secondary care services.

Secondary care services provided include radiological and more complex laboratory diagnostic tests and hospital admissions for different disease categories, minor and intermediate surgery, antenatal care and delivery care, neonatal care, immunizations, annual check-ups and HIV/AIDS treatment care support.

Excluded from the program are high technology investigations (computed tomography and magnetic resonance imaging), major surgeries and complex eye surgeries, family planning commodities, treatment for substance abuse/addiction, and cancer care requiring chemotherapy.

According to Governor Abdulrahman Abdulrazak in 2021, about 30,000 people have registered under the scheme with only 5 per cent benefiting from the scheme. The scheme, according to Kwara indigents and residents who spoke with Solacebase has been fraught with several problems right from its inception. The inadequacies are seen in the poor rate of adoption and utilization of the scheme by the people.

Amuda added that despite being an indigent in Kwara, he still spends a significant part of his meagre earnings on healthcare for his family. The scheme, touted by the Abdulrazak-led administration in different quarters as a novel initiative, has become a shadow of its projected promises.

A Kwara indigene, Falilat Ajoke, said she had enrolled for the scheme 3 months ago and has been left in the dark with no response to her enquiries.

“I have had some health challenges for a while now and it would have been better managed if I was able to get information from the designated quarters. Because of my state of pregnancy, I looked forward to accessing the services but when their contact number was not reachable, my only resort was to consult traditional and private facilities.”

Faliat Ajoke

Faliat Ajoke

Mrs Falilat Ajoke has dialed the number designated for calls severally by the KHIS without any response .

Ajoke reiterated that the contact numbers of the scheme were not reachable when she and her friends attempted to reach the agency for enquiries without success. Attempts by Solacebase to reach KHIS via its contact numbers on 08148831004, 09024770622 were futile. Calls placed to the numbers didn’t connect.

The Scheme doesn’t profit us: The private sector

Sitting on a sprawling chair in a private hospital in the centre of Ilorin, a young medical officer, Sekina Jimoh wears a defiant countenance. Dressed in a floral chiffon blouse with a pen in her hands, Jimoh was drafting a prescription during this reporter’s visit.

According to her, the hospital has been running at a loss since the commencement of the scheme. She explained that:

“Challenges on our part are more of finances because of the capitation which is still not sufficient for the type of treatment we offer. There are a lot of old patients with hypertension and diabetes and other illnesses that patronize us every 10 days or two weeks and sometimes we have to run tests and dispense the required medications without charging them.”

Capitation is the payments agreed upon by a health insurance company and a medical service provider. They are fixed, pre-arranged monthly payments received by a physician, clinic, or hospital per patient enrolled in a health plan, or per capita.

According to the medical officer, the hospital ensures the capitation on every of their patient is judiciously expended and when it is exhausted, we ensure the treatment is completed or it gets to a safe stage before a referral, in case a need for that arises.

She explained that Kwara State wouldn’t reimburse for vital extra services rendered by the medical facility to members of the scheme. The capitation given is not enough, she stressed.

Asked how the hospital makes up for this loss, she said, “As per humanitarian service, well we can’t deny the patient his or her drugs. It will eventually be a burden on the hospital when the registered patient develops complications. So we attend to them and make up for it in other places when the possibility comes.”

She explained that primary and secondary treatments, primary and maternal care, child care, and malaria are the treatments her hospital offer. She, however, clarified that this is a general problem and that private hospitals are not discriminated against by the state government.

About the hospital’s referral policy under the scheme, she said: “We only refer patients when it is absolutely necessary. To do that, we reach out to the Kwara Health Insurance Agency with the patient’s details to release a code.”

“The “genuinely poor” are cheated out of the system”

Partnering with the Islamic Development Bank and a group of non-profit organizations dedicated to improving access to quality healthcare in Africa, PharmAccess, Kwara Health Insurance Scheme (KHIS) was designed to improve access to medical care by rural, and low-income communities who often struggle with high out-of-pocket expenses when seeking healthcare.

Touted as a unique initiative, government officials often claim this objective has not been derailed since the launch of the project. However, findings by Solacebase proved otherwise as high-income earners are gaming the system, thereby reducing the chances of poor people benefiting from the scheme.

The nurse and Officer-in-charge of Zango Ward Clinic and Maternity, Ilorin East Local Government Area (LGA) who simply identified herself as Khadijah recalls an incident when a wealthy car dealer came with his large family and several other employees to register as indigents.

“He would not agree to register otherwise and officials were left with no choice than to capture them as such,” she said.

Another nurse, Muslimah Adetoun lamented that wealthy indigenes come under the guise of not being able to afford the paid scheme. This invariably limits the chances of those who are genuinely poor.

She added that several registered members of the scheme have stopped patronizing hospitals due to  lack of confidence and poor access to the scheme adding that many people do not have official proof of enrollment. She lamented that many residents who enrolled have relocated from the communities where they initially registered and find it difficult to transfer their subscription to another clinic.

 

 

 

She explained that communicating with KHIS office is often challenging which makes giving them feedback discouraging.

“We tried to create a feedback channel so we can communicate some of the issues we encounter but that has been neglected as we are never able to reach them”

Kulende Primary Health Centre, Ilorin Eaast LGA, looks

deserted with old and rustic-looking equipment. Mariam Abdulkareem, a nurse, heads the PHC. Although she acknowledged that her PHC has 201 enrollees, a great number of people who require the service offered by the scheme are yet to benefit.

“There is a service offered by the scheme for civil servants but they haven’t added maternity fee for now. Up to 50 per cent of the capitation is given to the health centre and an extra is added during emergencies.”

“Some have registered and for long their names are yet to be officially captured and sent to the health centre. They have come up to complain several times about it, but I always tell them I’m not the one in charge so they always have to go home gloomy,” she lamented.

Primary Health Care is dead in Kwara, expert

Dr. Adekunle Salau is a medical professional who has been working in Kwara State for over ten years. He said the state is poor and struggles to pay the national minimum wage adding that poor remuneration eventually affects the health-seeking behaviour of the people.

“When the standard of living of a people is low, they won’t have a lot to spend on health and medical emergencies. Therefore, health insurance is supposed to step in to take care of that. Even the ones that are not emergencies, health insurance should be able to cover for it,” Salau said.

However, Salau opined that the availability of a health insurance scheme is not as important as the availability of quality health facilities to deliver the provisions of the scheme.

“If people are enrolled in the health insurance and are not able to access good healthcare, the purpose is defeated. They move away from PHCs to the general hospitals. The general hospitals are doing well but the issue is that they have a very high patient load and they are seriously understaffed. This, therefore, discourages a lot of people from visiting the general hospitals,” he added.

“But when the hospital close to you, can’t give you what you want then you would have no choice but to look elsewhere.”

He explained that it is difficult for people to fully benefit from the insurance scheme if there are no commensurate healthcare services, especially at the primary healthcare level which is usually the closest to them.

 

He stressed that PHCs are as good as dead in Kwara state. “Our PHCs are understaffed. It is one of the factors limiting people’s access to healthcare and rather fuels the bad habit of health seekers who rely on self-medication, patent medicine sellers and quacks.”

On efforts needed to create a linkage between health insurance and access to quality healthcare at PHC level, Salau said there is more work to be done as current realities don’t augur well for the country, predominantly the rural populace.

He explained that PHCs should be able to manage diseases such as malaria, and tuberculosis. But with the unavailability of drugs and necessary equipment, patients readily turn to alternative care.

“I understand it’s not the job of the insurance agencies to equip and staff health facilities but when these facilities don’t have the necessary working tools, the goal of the insurance scheme will be defeated. Equipping healthcare facilities should be where the real insurance should start from because that is where people who live in rural areas first turn to.”

The KHIS refused to comment on the issue. Initial multiple attempts to reach the executive director, KHIS, Dr Olubunmi Jetawo-Winter had proved abortive.

Later in a separate phone conversation with this reporter, Jetawo-Winter, promised to respond to the questions and asked that the email be resent.  When the questions were sent to her, Jetawo-Winter became evasive requesting the reporter to resend the email using an official email address. As of the time of filing this report, she still hasn’t replied the questions posed to her. Some of the questions contained in the email sent to her bothered on equitable utilization of the scheme, poor communication and feedback channel between the agency and other stakeholders amongst others.

Meanwhile, on May 27, the information desk of KHIS eventually replied to emails asking for comments. The desk promised to grant an interview with Solacebase on the issue soon.  As at the time of filing this report, the agency is yet to get back to this newspaper despite repeated reminders.

Efforts to reach out to the Country Directors of PharmAccess Foundation, Mrs Njide Ndili, and Regional Head, Islamic Development Bank, Mayaro were also unsuccessful. They are yet to respond to calls, emails and text messages sent to them at the time of filing this report.

This publication is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the Collaborative Media Engagement for Development, Inclusion and Accountability project (CMEDIA) funded by the MacArthur Foundation.

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Kano’s murder: How the mother hurried her daughter’s end

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Ummuklusum

 

By Abdullahi Haruna Haruspice

A beautiful promising young lady was gruesomely murdered by a Chinese national in kano- in what is obviously a love turn sour story. The lady painted in beauty never imagined her life would end so cruel like it did today. Her man who is no doubt a hand tool of the devil perforated her pretty body with a pocket knife. He butchered her and soiled the floor with her blood. She bled of blood and got choked of no air before she got to the hospital. By evening, her body was lowered six feet down where the earth covered her in eternity. People lived for love but Ummita died from a complicated love pang.

Her mother should be blamed for the painful end of her daughter, she lowered the bar and collapsed the fence of motherhood. She set her daughter for her early death. She was a mother consumed by the exigencies of time. She didn’t protect her daughter the way her own mother protected her. She failed her daughter.

The woman was not unaware when the storyline between the Chinese man and her daughter reigned, she was in the picture and gave her nod. The reason the man could find refuge in her house for years, she joined to enjoy the largesse that came from the man. The night Ummita died, the mother was around. Contrary to the new story of break in, the Chinese man walked unhindered to the house, after all, the house has always been his refuge. Have it that indeed there was no knocking, she raised alarm after the murder had taken place. The man had always been a welcomed guest to the house, the story of pushing his way into the house is an afterthought. The mother hurried her daughter’s end. She cooked up that story to appear helpless, the woman had been fleecing the Chinese man for long.

47 Year Old Chinese Murderer Kills Kano Woman

There is a limit to how stupid love could hold a man captive, the man couldn’t take it anymore, so he took the foolish and cowardly path by snuffing life out of the poor vulnerable girl. She was a lamentable victim of societal burden, she needed to live to the dictates of what the society wanted, so she abandoned her real self by going all hogs to be like the girl next door- forgetting that not everyone is greeted with same luck. While others escape with theirs, she got dimmed by her hubris. Today, she lay buried beneath the earth.

Love is not a soccer game, it is an instinct contract, while it lingers, all senses are lost in it. While she saw the Chinese man as a conduit balm, he saw the world in her, he went all hogs to make her his world, he planned his world around her. He was planning for blissful existence with her, even while she got hitched to another man, he still hoped for her. They maintained same line of communication, he could call her and even do video calls with her because polyphonic phones have bridged the gulf of privacy. She was married to her man but still in romantic link with the Chinese man. Her marriage ended and the Chinese man heaved in triumph for the love of his dream is back to him. And that was when the story changed, she no longer saw him worthy of attention, perhaps there are more finer or richer guys that appealed to her consciousness. For the second time, the Chinese man felt threatened and he was not ready to lose his investments again. That was when he struck and Ummita fell to his cruelty and today she is no more.

Dear mothers, not all that glitter is gold, when your daughter begins to live beyond your family means, query her – she may not be using her head , her innocence is being exploited. Speak sense to her, tell her, men don’t act nice to women for free, it comes with a price. Men invest in women with the undeniable expectation to reap. Mothers, hold tight to your daughters, men are out there to ruin them, like sister Ummita who got consumed by the treacherous pang of men.
@haruspice

Sadly musing

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Hon Mahmud Celebrates First Son, Adnan Marriage in Kano

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Honourable Gaya right flank by the chief Imam of Alfurqan Dr Bashir Aliyu Umar

 

Abu Ahmad

The son of a Federal Lawmaker, Hon. Abdullahi Mahmoud Gaya representing Gaya, Ajingi and Albasu Constituency tied the knot with Aisha Mukhtat Idris in Zamfara State on Saturday.

The marriage was officially tied up at Gusau the capital of Zamfara state with an undisclosed dowry amount while family members in Kano joined live zoom to attend the ceremony.

In Kano, notable politicians stormed the state to rejoice with the family of Hon. Abdullahi Mahmoud Gaya, Chairman House Committee on Petroleum downstream.

Dignified Nigerians, national and states lawmakers and and fellow citizens across the country witnessed the colourful event at the residence of the lawmaker in the state.

Speaking during the ceremony Senator Bayero Nafada Counselled the couple to exercise forbearance in their union and congratulate his colleague for seeing his first son married in good health.

“There should be patience between the two of them, more especially the husband; wife and husband when it comes to patience, the husband must be more patient than wife and wife must be obedient to the husband, if she is very much obedient to the husband then I believe the husband will not contemplate adding another one. So I want to advise all of them to take their responsibilities and I am using this opportunity to thank their parents for the good upbringing of their children” Bayero Nafada said.

 

 

Abdurrahman Umar, uncle of the groom said “the marriage of our son Adnan today is a great day, we are much grateful to all those who attended the wedding today, My cousin Abdullah Mahmoud showed that he is a great leader in our society by hosting notable dignitaries to witnessed the marital ceremony of our son.

Shortly after the religious rite in Gusau, Dr Bashir Umar chief imam of Alfurqan Jumaat mosque prayed to Allah to bless the marriage and grant the couple pious children. Also Dr. Abu Bakar Lawan chief imam of Triumph Jumaat mosque prayed for the couple and advised them to live in peace and harmony..

The joyous groom, Adnan Abdullahi Mahmud thanked Almighty Allah for sparing his life to witness this historic moment of his wedding day. “I thanked Allah for allowing me to witness this historic moment in my life, I also thanked my father Alhaji Mahmud Abdullahi Mahmud Gaya who trained me and supported me at all levels, words cannot express my appreciation to him, my mom, members of immediate family, friends, well-wishers and all those who have come from far and near to rejoice with our family on this great and historic occasion, May Allah in his infinite mercy reward everybody”

In his goodwill message Hon. Abdullahi Mahmoud Gaya expressed his happiness and appreciated the dignitaries and well-wishers who came from far and near to rejoice with his family. He later urges the couples to be patient and embrace the Sunna of Prophet Muhammad (S.A.W) with the fear of Allah SWT in all their activities.

Among the dignitaries who attended the marriage ceremony in Kano were NNPC Boss, Mele Kyari, Honourable Alhassan Ado Doguwa, Malam Abdurrahman Umar, Former Chief of Air Staff Air Mashall Muhammad Umar,State APC Chairman Abdullahi Abbas, Alh. Manniru Babba-Dan Agundi, Sanetor Bayero Nafada, Honourable Sha’ban Sharada, Hon Hafiz Kawu, Dr Kabiru Said Sufi, Captains of industries and government agencies, technocrats, members of state and Federal Assemblies, friends and supporters of Gaya’s family, politicians and other stakeholders.

in Zamfara state capital, the wedding was also attended by Zamfara State Deputy Governor, Sen.Hassan Muhammad Gusau, Former Governor Zamfara State ,Hon.(Dr.)A.A.Yari., Former Sokoto state Governor, Distinguished Senator.Dr.Aliyu Magatakarda Wamako (Sarkin Yamman Sokoto) His Excellency, Alhaji Mahmud Aliyu Shinkafi.(Dallatun Zamfara), Distinguished Senator,Tijjani Yahaya Kaura(Tafidan Kaura), Hon.Lawal M.Liman,(Gabdon Kaura), HRH.Alhaji Hassan Attahiru, (Emir of Bungudu). HRH.Alhaji Dr.Bello Muhammad Barmo, (Emir of Mafara),, HRH.Mejor Sunusi Ahmad Muhammad Asha (Emir of Kauran Namoda),HRH.Alhaji Bashar Isma’il Ari III.(Emir of Moriki), Mai martaba Sarkin Tambuwal. HRH Emir Gobir na Isa.Rt.Hon.Bature Umar Sambo,(Sarkin Sudan Gusau),Alhaji Lawali Muhammad,(Makaman. Kaura), Engr.Abdullahi Abdulkareem,
(Katukan Tsafe) Professor Abdullah Shinkafi,(Walin Shinkafi). Alhaji Yahaya Abubakar Yari, Alhaji Jafar Abubakar Yari, Hon.Sha’ayya S.Pawa (Dan-malikin Mafara), Hon.Bashir Muhammad Yusif Dala, Malam Kabiru Sokoto, Hon.Sani Musa Talata Mafara. The nuptial knot was tied after a bride price of was paid to the bride parant in Gusau Zamfara state.

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Online Universities: The dawn of a new era

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Rayyan Tilde

 

By Rayyan Tilde

Since the start of the internet era, our civilization has been experiencing a great change in the way we do almost everything. From the way we communicate, to what we eat, down to how we entertain ourselves. Every sector has changed drastically since the advent of technology. Educational sector is one of the few sectors that is yet to be seriously disrupted by technology. I believe technology will continue to disrupt the way we do and see things even to the extent of fully actualizing what Huxley portrayed in his book (Brave New World).

The way things are taught today is [in some areas] the same as they were taught 200 years back or even the way Fatima bint Muhammad Al-Fihriya founded the world’s first university in 895 CE in Fez. That is about to change with online universities — the platforms that are ushering a new era of learning.

What’s an Online University?

An Online University, like any other conventional university, is an authorized place where you can study and earn your First, Masters and even Doctorate degrees. The major difference is that it is done remotely by using the internet as a medium that connects you with the university.

Challenge

The Online University like any other new thing before it, is still yet to be fully accepted by people especially in Africa. It’s clearly written in many traditions that humans tend to stick to what they are used to. They tend to perceive it as being safe while portraying the new one as being unpromising. Calestous Juma in his book “Innovation and its Enemies”, mentioned 10 innovations that were heavily criticized when they came into existence. He explained how coffee was rejected, Tractors, Electricity, printing of the Quran and other innovations.

Zulum is Coming-Dr Aliyu Tilde

A more recent example is how many scholars rejected the idea of listening to the Quran on a radio, regarding those that did that as apostates. Great Imams like Sheikh Ibrahim Niass had to go through a lot to convince the ummah that it is absolutely fine to listen to the Quran on a radio.

In 1892, John Froelich introduced the first tractor to replace the animals that were used on the farm, there was a great resistance from those that were using the incumbent source of farm power that had reached its biological capability, especially those that were fixated in the business of selling oxen and mules that work on the farm.

Today, it will totally be funny to find someone that’s against the above mentioned innovations as far as he is in a civilized society. An Austrian economist, Joseph Schumpeter, concluded in one of his researches that “Resistance to new technologies is often frowned upon as a temporary phenomenon that is inevitably overcome by technological progress”. I believe online universities will become more accepted as the technology used in the platform improves. With the progress that’s being made in fields like Augmented Reality and Virtual Reality, it is now possible for a university to teach its students basic practicals with Augmented Reality and a more complex one with a VR headset — from their homes. Though VR headsets are expensive now, I believe they’ll soon be available at a more affordable rate.

Advantages

According to BioHistory, new things emerge when humans reach a limit, thus being stressed which will then force them into finding a better solution, they considered it to be the building block of civilization — according to a research they did about the roman civilization and the modern-day western civilization.
I consider it to be a miracle from our Lord (SWT). For instance: With Farm mechanization, He saw how our population was increasing, if it were to increase without a creative way of producing farm produce for us to eat, there would have been a great hunger globally. Same with the way we study. If you look at the number of students that are trying to have a degree, there’s no way they can fit into our conventional university system without a compromise in the standard of learning. Online universities will be able to solve this since the platforms are tailored to appeal to every student in an individualistic manner.

Elon Musk’s Starlink is a device that uses satellite technology to deliver internet connectivity to anyone that’s using it at any point on this planet. This type of technology will help in allowing people in remote areas to still benefit from this system of learning.

Advantage – Finance

With Online Universities, you don’t have to worry about the cost of accommodation, feeding, transportation and other expenses that you may incur if you were to study away from home. This means one can study in a university that’s in the United Kingdom while he lives in an environment where life is extremely cheap.

Many online universities now allow students to enroll for a single course at a time. This makes it easier for students who can’t afford to pay for a complete program, by allowing them to take their courses as funds become available to them.

Advantage – Morality

I believe it is the fear of every right-thinking parent that their child will leave their home and go to a place where his upbringing will be challenged by the influence of other people — if they are to enroll in a conventional university.

Online Universities in Nigeria

There are a few number of accredited online universities in Nigeria, the one I can attest to, after researching both online and offline is the one from ABU Zaria. They offer a variety of courses and the best part is, they offer the same certificate as that of the students in-campus.

Conclusion

In the next 20 years, I believe online universities are going to dominate the educational system. The fact that someone from my village at Tilde or any other place on earth — as far as he is connected to the internet, can be able to enroll in a university anywhere on this planet and graduate will make life easier for everyone.

Rayyan Tilde
17.07.2022

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