Beti Baiye (Guest Writer)
The first thing that catches the attention of first-time visitors entering the spacious, airy reception and waiting area of the Model Primary Healthcare Centre (PHC), Ozuboko, Port Harcourt, is the walls. Every inch is covered with sheet after sheet of A4 paper, each one listing hundreds of names and numbers.
According to Dr. Flag Amachree, Head of the PHC, the names listed are of individuals enrolled in the BHCPF Equity Health Plan. The plan is part of the Rivers State Contributory Health Protection Programme (RIVCHPP), a state social health insurance initiative designed to provide quality healthcare services to the people of Rivers State.
#Health4AllRivers
Some initiatives take time to gain momentum, while others quickly develop a life of their own and take off like a rocket, RIVCHPP falls into the latter category. Sir Siminalayi Fubara, Rivers State Governor, approved the programme’s implementation in January 2024, and by December of the same year, nearly 100,000 participants had been enrolled.
The journey to implementation, however, was not as swift as the programme’s launch. Although the Rivers State Health Insurance Law was signed in 2021, it remained inactive until 2024, making Rivers State the last to implement state health insurance.
Dr. Adaeze Oreh, the state’s Commissioner for Health, noted that geographical and financial access to healthcare is the first pillar of Governor Fubara’s ‘Health4AllRivers’ agenda. She emphasised that “ensuring the implementation of the legislation mandating the establishment of RIVCHPP was a priority of his administration.” She further explained that #Health4AllRivers is a strategy aimed at guiding Rivers State toward achieving Universal Health Coverage (UHC) and ensuring health and well-being for all, leaving no one behind.
The advantage of being last
Being the last to implement the programme has clearly not hindered the state’s progress. Dr Vetty Agala, Acting Executive Secretary of RIVCHPP, explained that it allowed Rivers State to learn from the experiences of other states, gaining invaluable insights that helped refine RIVCHPP’s implementation strategies. “That has helped us in more ways than one because now we have experience from all the other states,” she added.
The insights gained led to the decision to adopt the IT already in use by other states. This was a practical choice, as it reduced the time, cost, and risks associated with developing a new platform. This IT system connects healthcare facilities directly to a central dashboard. Once fully operational, it is expected to enhance transparency and efficiency in areas such as enrolment, monitoring, and service delivery.
RIVCHPP made the strategic decision, supported by legislation, to operate without Health Maintenance Organisations (HMOs) as fund holders. Instead, as enrolment grows, HMOs will be engaged selectively for specific tasks such as enrolment, claims management and capacity building.
From community to facility-based enrolment
A major shift in the programme’s enrolment strategy was driven by lessons learned. Initially, RIVCHPP focused on community-based enrolment, but utilisation remained low. This led to the adoption of facility-based enrolment. Explaining this change, Dr. Agala said, “some people may not know where the facility in their ward is, or because they have never interacted with the health workers, they may feel hesitant to visit. However, when enrolment happens within the facility, clients meet the head of the facility, become familiar with the environment, and feel more comfortable seeking care when needed.”
How effective was this change in strategy? Mrs. Carol Tekena, a beneficiary at Ozuboko PHC said, “I heard a town crier in my community — Ozuboko — they asked us to come to the facility that there was free registration. I came here the next day to see for myself and they registered me, opened a folder for me, I saw the doctor, went for tests, had an eye exam, received glasses, got drugs — all for free. I called my husband shouting, ‘It’s real o, it’s real!’ Infact, I called my yard people [neighbours] — more than 10 of them — they all came here and got registered.”
With RIVCHPP evangelists like Mrs Tekena, it’s no wonder Model PHC, Ozuboko, recorded the highest number of enrolees, 1,420 within a 3-month period.
Justina Bestman, a 30-year-old mother of four, was five months pregnant with twins when she visited the PHC in her community for a routine checkup. During this visit, she registered for the BHCPF Equity Health Plan, a decision she believes ultimately saved her life.
Four months later, Justina experienced complications during labour. Thanks to her BHCPF enrolment, she was promptly transported to the Rivers State University Teaching Hospital where she received immediate medical attention at no cost.
Reflecting on her experience, Justina said: “Looking at the situation I found myself in, if not for RIVCHPP, I don’t think I would have survived this experience.”
The plans and people
Enrolment in RIVCHPP depends on the specific plan chosen. The BHCPF Equity Health Plan, which covers pregnant women, persons living with disability, children under 5, widows and the elderly over 60, is funded by BHCPF, an innovative funding model. The Commissioner for Health described it as “a significant enabler of the strides that RIVCHPP was able to achieve in such a short timeframe.”
Dr Agala stated that the flagship informal sector plan for small business owners, petty traders, and others, nicknamed the ‘Sim-Jara plan’, was launched in December 2024, with over 1,000 individuals already enrolled. She added that the enrolments for the formal sector are expected to begin by the first quarter of 2025.
Leveraging technology and community ownership
To address initial scepticism and build trust, the team engaged with key stakeholders, including community and traditional leaders, and raised awareness through mainstream and traditional media.
“To bring about the steady penetration of RIVCHPP in our communities, we rely on a whole of government approach which requires consistent advocacy — relationship building, stakeholder sensitisation, and forging linkages have been instrumental to creating a supportive policy environment for RIVCHPP, from traditional and community leadership, community-based organisations, trade and labour unions, Local Government authorities and even the legislative arm of government,” Dr Oreh explained.
According to Dr Ireju Ajie, Head of Health Services at RIVCHPP, a WhatsApp group which started with 400 women was created for enrolled pregnant women to monitor experiences, enrol newborns, and address challenges in real time. Babies born under the programme are celebrated as ‘RIVCHPP babies’ and are automatically enrolled for care until age five. The mother exits the programme three months after childbirth.
There is a separate WhatsApp group for Ward Development Committee (WDC) Chairmen to ensure community ownership and accountability.
The team also conducts regular follow-ups with patients. If a beneficiary has not accessed any healthcare services within six months of enrolment, they send reminders to encourage utilisation by highlighting available services.
Work in progress
While the programme has achieved significant progress, several challenges remain. Although 205 Primary Healthcare Centres (PHCs) have been accredited, some remain underutilised due to security concerns in certain areas. The high cost of healthcare means not all services can be covered. In addition, National Identification Numbers (NIN) are mandatory for BHCPF Equity Plan enrolment, but not everyone has one. Some areas have limited internet connectivity, and some healthcare workers have limited digital literacy. Also, despite efforts to curb the practice, some health workers continue to charge enrolees.
Despite these challenges, the programme is thriving, as there is strong support from the Commissioner for Health and a political commitment to its success as stated by Dr Agala.
A bigger, stronger RIVCHPP
Tuesday, January 21, 2025, marked one year since Governor Fubara approved the implementation of RIVCHPP. The state is better for it, as any initiative aimed at achieving UHC, ensuring affordable, equitable and accessible healthcare for all — is commendable.
RIVCHPP boldly aspires to become the leading State Social Health Insurance provider in Nigeria and Africa. Building on the significant progress achieved in its first year, Dr. Oreh envisions a dramatic reduction in out-of-pocket payments, which were over 90% at the start of the current administration. With Governor Fubara’s unwavering commitment to improving healthcare access, she anticipates “a bigger, stronger RIVCHPP with over 1 million lives enrolled and receiving quality healthcare services without needing to make payment at point of care”