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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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Tribute To Late Justice Ahmad Belgore

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By AbdurRaheem Sa’ad Dembo

Death is an inevitable
visitor. When it strikes its victims it’s usually the end of an era. It was in the morning of Eid-l-Fitri, which was 10th April, 2024 I read the news of the demise of Justice Ahmad Olanrewaju Belgore, who died the previous night. He was a star in the judiciary because of his piety, consistency and fairness.

Many prominent Nigerians have sent their condolences to his family, Ilorin Emirate and Nigeria judiciary. One significant thing about late Justice was the fact that his life as a judge was filled with face of humanity.

Emir of Ilorin Alhaji (Dr) Ibrahim Sulu-Gambari and Chairman of Kwara State Traditional Rulers Council in his condolence message described the demise of Justice Belgore as a big loss to the Ilorin Emirate and the Nation at large.

According to the Emir “Belgore was one of the finest justices that the Ilorin Emirate had ever produced, who contributed in no small measures to the growth and development of the judiciary in particular and humanity in general.He prayed that Almighty Allah accept his good deeds, forgive his shortcomings and admit
him into aljannah firdaus.

The Turaki of Ilorin Emirate, Senator Saliu Mustapha has also expressed grief over the death of the legal luminary, described him as a renowned jurist who lived and served the country with his knowledge of the law as an examplary member of the bench.

Senator Mustapha while commiserating with the Nigerian Bar Association on the death of Justice Ahmad Belgore noted that the late jurist contributed immensely to the development of his community and the state in general. Recalling his years of service in the judiciary where he worked with utmost dedication and bowed out in glory last year.

The Senate Committee Chairman on Agric production and Services condoled the Belgore family, The Emir of Ilorin, Ilorin Emirate Descendants Progressive Union, the people of Balogun Fulani Constituency, Associates and friends of the deceased over the demise of illustrious son of the Ilorin Emirate.He prayed Allah to overlook Justice Belgore misdeeds and grant him eternal rest.

Meanwhile, Kwara state Governor,AbdulRahman AbdulRazaq equally expressed sadness over the death of Justice Belgore who passed on Tuesday night.The Governor sent his heartfelt condolences to the entire Ilorin Emirate, and to the Belgores who have lost a rare gem.His Excellency prayed to Allah to forgive justice Belgore of his shortcomings, and admit him to aljannah firdaus.

The Nigerian Bar Association,The Lagos Lawyers and other prominent Nigerians have also mourned the late Ilorin born jurist, but mentioning all of them may not be necessary.

It is imperative to say that late Justice Ahmad Belgore was an incorruptible judge as he retired meritoriously last year.This was aptly captured by the words of Shehu Bashir,Esq “Justice Ahmad Belgore was a jurist with decency of conscience.He journeyed the delicate profession of adjudication with distinction and came out unblemished.

He was an incredibly tolerant, calm, generous, religious and extremely patient man.His propensity to generosity would almost make you think he had more than he was giving,yet he was undoubtedly incorruptible. And he would never make public his generosity to a third party.He was such a responsible gentleman.”

According to a retired judiciary staff who craved for anonymity, disclosed that in 2015 when his benefit has not been paid,he reached out to late Justice Ahmad Belgore and he gave him 120,000 naira as at that time.

Significantly,the late Justice has been described by many as an embodiment of humility, generosity and accessibility. In the words of Pharm Munirat Bello “He was a great icon of peace and beacon of hope to the less privileged, reliably a dependable pillar of support. His act of kindness could be likened to the scent of the natural musk, very calming yet so impactful. No life hardly gets in contact with him and fail to progress. He was gifted with a divine heart of generosity. An upright jurist to the core, an impeccable symbol of Islam. I have never for once seen him angry to the point of passing derogatory words, he could be stern but in a loving way”

Sheikh Saidu Ibrahim Maimasa is a close associate of late Justice Ahmad Belgore and he is also the Public Relations Officer of Markaz, recounted how helpful he was to him and other friends.He said describing his magnanimity and generosity would be inexhaustible.

He cited a case of a person whose house was forcefully taken and he approached Late Justice for possible redress at the Court of law.He explained that the justice told the man not to go to court, because there was no point going to court and win, and thereafter he lost his life.He later ensured that another house was erected for the man from his personal purse.

Furthermore,A family source disclosed that anything that has to do with Belgore’s family, the late Justice Ahmad Belgore was always at the forefront.Meaning he had imbibed the sunnah of Prophet Muhammad (SAW) in uniting the family.

In unraveling his unwavering support for the less privileged, a young man was said to have gone to his GRA residence and appealed to him that he wanted to go to school but he had no sponsor.The late Justice embraced him and sponsored his education throughout.

Parts of the traits of great men are humility and accessibility. If you are the type that cannot render help to people until an influential person in the society recommends them, then you may be far from circle of great men.Your door should be open for help , that is when you would be able to identify those whole truly need succour .

Justice Ahmad Belgore was never a religious bigot,According to Sheikh Saidu Ibrahim Maimasa “He had an open door policy, because he was very accessible.His security orderly was a Christian from Oyo State and he did not only sponsored his wedding but he was also there in person.He did not discriminate”

He was born on April 18,1953, Belgore studied Law at the prestigious Ahmadu Bello university (ABU),Zaria, where he bagged LL.B (Hons.) with specialisation in Islamic Law 1975 to 1978.He attended the Nigerian Law School, Victoria Island,Lagos between 1978/1979 session.

He was the presiding Justice of the Ilorin Division of the Court of Appeal before his retirement in April,2023.He was also former Chief Justice of the Gambia.Justice Ahmad was younger brother to former Chief Justice of Nigeria (CJN) Alfa Belgore.

There is no doubt about the fact that late Justice Ahmad Belgore had lived a life worthy of emulation.He was a regular reciter of holy Quran and a great scholar in his own class.He was the president of Darul-Uloom Alumni Association.

Perfection, they say, belongs to God. I pray Allah forgive his shortcomings and grant him aljannah firdaus.

abdurraheemsaaddembo@gmail.com

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A Tribute to Barrister Sulaiman Ahmed Assayouty

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Late Barrister Suleiman Ahmad Assayouty

 

By AbdurRaheem Sa’ad Dembo

Death is a reminder that this world is fleeting and interim. It has yet corroborated the assertion that we are strangers on this planet called, earth just as Barrister Assayouty has left us unannounced through the inevitable shackles of death

I was shocked because he was a brother that I knew very well as an undergraduate in Bayero University, Kano.He wasn’t a regular student as he was preoccupied with hustling in photography business.He usually stationed at the old site of Bayero University Kano where he carried out his business activities

I was at the new site and we had our regular photographer in person of Hope Photo there but whenever we were at the old site we patronised him.In fact his business point was a regular station for Ilorin Emirate students and other customers whenever they did not have lectures.

Since I left the University I have not heard or seeing him until the day he graduated from Law School and the same was posted on the BUK Alumni WhatsApp Group, Ilorin Emirate chapter.I knew within me that day that he struggled to attain the feat and I rejoiced with him through my comments.

We were all in BUK but Assayouty was an hustler and we patronized him not just because he was one of us but he’s very humble. He had a dream and he pursued it with tenacity, hardwork and prayers so he became a certified lawyer eventually. I was not even aware that he later had a Sayuti Cafe on campus,i got to know through BUK Chat zone on Facebook; an online medium for BUK students and others. I’m sure it was after we have left the school he operated the cafe business

From the Account of my friends and brothers that are resident in Kano, they said he was going to a Police Station in Tofa with his wife and his child yesterday 8th April,2024 before they had an accident that claimed his life and injured his wife and his child who are still in the hospital. I pray to Allah for their speedy recovery.

When a promising young man died it is usually tremendously painful because a dream has been shattered and retrogressed.The demise of Assayouty was one too many as it reinvigorated and rejuvenated the futility of this world.He laboured so hard to become a lawyer. He was studying Law in pari passu with hustling. How great would it have been if He had lived long to enjoy the fruit of his struggle?

According to Mallam Zakariya Bayero “we were staying in an uncompleted building together in 1998, he was running a diploma programme then”.

Barrister Yakubu Abdullahi reacted to my Facebook post about his demise thus “May Allah admit him to Jannat, his death is shocking, I know him as a struggling lawyer, despite his commitment to law practice,he has other struggles he did around Janguza axis. May Allah forgive his shortcomings”.

In Quran 62 Verse 8, Allah says “Say, indeed, the death from which you flee.Indeed it will meet you”. Today it has met our brother but our solace is that Barrister Sulaiman Assayouty died as a Muslim in the holy month of Ramadan, he never tarnished the image of his family and lived a dignified life.May Allah grant him aljannah firdaus and give his immediate family, the Ilorin Emirate BUK Alumni and friends the fortitude to bear the huge loss.

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Kano Water Scarcity: How Long is Governor Abba’s ‘State of Emergency’?

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_By Misbahu El-Hamza_

Kano State makes headlines almost every year, and coincidentally, during Ramadan for water scarcity. The frequent headlines are often attributed to electricity system failures, which disrupt water pumping, or equipment faults at water treatment plants, exacerbating the situation.

About ten months ago, upon taking office, Kano State Governor Alhaji Abba Kabir Yusuf declared a State of Emergency to address water scarcity across the state, urging for patience and maximum cooperation from residents. Although I haven’t seen or reviewed the governor’s plan during this emergency, I recall that resolving Kano’s water issues was one of his campaign promises.

I remember when the governor inspected the Challawa Water Treatment Plant in May 2023 and expressed dissatisfaction with its condition. It was said that only two of the six pumping machines of the facility were functioning at the time.

Following that, the governor give a one-week ultimatum to the Kano State Water Board to submit its demands in order to end the water shortage in the state. There was a sigh of relief by the public. Personally, I had hoped that we’re finally getting over this hardship.

Unfortunately, nearly a year now, the situation is not only prevalent in urban areas but is even worse in rural communities. We are not only seeing those trending headlines of water scarcity in Kano, we’re experiencing the brunt of it.

Recently, the price of a 25-liter jerrican of borehole water in Kano surged by ₦50 to ₦150. Someone told me that he bought one at ₦200 around Kurmi market. In areas like Hotoro, Nassarawa LGA, where I reside near Kumbotso LGA housing the Challawa water plant, prices rose from ₦40 to ₦70 or higher. The Chalawa water plant is believed to have the capacity of supply the whole of Kano with water, but we rely heavily on individual boreholes for water, with little to no infrastructure connecting us to the water plant.

While I resides in a suburb and can afford buying a jerrican of what seems to be clean water, in the rural areas where I often visit for work, the situation is dire. Many communities lack access to clean water sources, with broken or dried-up boreholes and wells being common. Residents, including young children, often resort to fetching water from stagnant ponds shared with cows, donkeys, camels, and even dogs. This water is what they use for all daily activities, posing serious health risks. It’s evident that both state and local governments have neglected these communities, offering little to no solutions for their water woes. Where you see boreholes or wells in these communities, they are either constructed by individual donors or (charity) organizations and a handful ones by politicians.

Governor Alhaji Abba Kabir Yusuf must be aware of the current water crisis in both rural and urban Kano. However, the pressing question remains: how long will his State of Emergency address the suffering caused by the persistent water scarcity or total lack of it across the state?

Three days ago, I heard a jingle apologizing for the water scarcity in Kano metropolitant, blaming the repair works at Challawa and Tamburawa treatment plants. It’s said to have been sponsored by Kano State Water Board. To me, the jingle suggests the governor partly fulfilled his pledge, now it’s the board’s turn to restore water supply. Or at least that’s my assumption.

I know this isn’t the first time the the board apologises. In 2022, the then Managing Director of the board was quoted apologizing to Kano residents for failing to supply water during Ramadan. At that time, 25-liters jerrican of borehole water cost between ₦30 – ₦100.

I remain hopeful that before his remaining three years expire, Alhaji Abba Kabir Yusuf will emerge as Kano’s hero by addressing the water scarcity issue, providing relief to the growing population, including those in rural areas.

As the governor continues to address our water problem within this emergency period, I hope the demands the water board submitted to him as requested include: establishing new plants and resaviors or enhancing existing ones, extending mainline pipes to suburbs and rural areas, ensuring independent power supply for the plants, and securing permanent employment for existing and additional staff. If the board manages its expenses independently, perhaps shifting it to the state payroll would improve also efficiency.

With reliable service and effective system in place, the board and the state government should be rest assured that Kano people will be more willing to pay for water, and the board does not need to heavily depend for its revenue from the industries it diverts our little water to.

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