1️⃣ Problem Statement

In Ekiti State the major barriers to Universal Health Coverage include:

    High rates of Out-of-pocket payment for healthcare

    Low awareness and low uptake of health insurance

    Lack of leverage of cultural practices to advance UHC

    Low doctors to population density and lack of timetabling of doctors     availability at primary health centres

    Low involvement of people, especially retired health workers in health     volunteerism and community governance of primary health centres

    Lack of integration of health care delivery, health financing and health     reforms to achieve UHC.

    Health financing is skewed toward vertical programmes, like Ulerawa.

    Private provider participation is constrained, limiting service capacity.

    The need for policy reform toward full Universal Health Coverage (UHC) is     acnowledge but its pace slow, leading to continuing catastrophic health     expenditures and a huge undetected chronic preventable diseases.

We will solve this problem by enrolling people into a Mutual Benefits Health Organisation and using the membership fees to provide primary health services for them. The drive is to ensurethat a critical mass is enrolled at each neighbourhood  Mutual Health Organisation.

2️⃣ Impact Statement (Long-Term Goal – 5–10 Years)

This Model will significantly impact these problem areas, ensuring that vulnerable populations in Ekiti State are made visible through our open, walk-in registration. They will be engaged in equitable access to quality healthcare without financial hardship.  Many Members may have skills and or time to contribute to the management of the organisation and to service delivery because their participation is crucial. They will be encouraged to imbibe the philosophy of : Health of the people. By the people. For the people.

Our Cooperative Model has been founded on the philosophy of self-help, aimed at impacting the attitudes of the people to health care. 

We present health care as something done by the people for themselves not something done to the people by the government, important though government support is.

Our overarching goal is to improve the health conditions of vulnerable members of the communities by providing easy access to on-demand evidence based primary health care services, including health education, preventive services as well as rehabilitative health care, all of which require active participation of the people. 

For example, preventive health care will focus on water, sanitation, and hygiene (WASH) in  neighburhoods where The Cooperative Clinics are located and this will require active participation of the people.

Our approach is to adopt the Rochdale Values and educate people to look after themselves and their communities for mutual benefits.

This implies a degree of cooperativism in which members are involved in making contributions and providing services for mutual benefits, for example, volunteering to transport the ill to the hospital, social support, construction of communal latrines.

In the short term, we wish to change people's attitude from low involment to high involvement in health service delivery.  This phase will require a significant support from other organisations and agencies.

In the medium term, and as a result of the success of receiving treatment on demand, a critical mass of fee paying members have been enrolled. The Mutual Health Association is in bouyant financial state and can carry out local health initiatives like purchasing equipment for the Cooperative Clinic to expand their services.

In the long term, a thriving community owed and financed MHA is responsible for primary health services of a large number of neighbourhoods in Ekiti State. Primary Health Care based Universal Health Coverage is thus achieved neigbourhood by neigbourhood.

3️⃣ Core Assumptions

HAC assumes that financial barriers are a major driver of poor health access in Eiti State and resolving this will engerder attainment of UHC in the State. Anedotes exist where families and friends campaign for well wishers to contribute to a health fund to care of ill patients and accident victims. Patients are not discharged from hospital in good time because they have not paid their medical bill. Pregnant women attending untrained birth attendants, because they cannot afford hospital bill, etc.

HAC assumes that evidence of improved health indices in our target population can influence policy over time.  Our demonstration pilots may be able to shift state-level reform posture.

We assume that constructive engagement with policy makers will be more effective than confrontation and their support will be forthcoming when HAC begins to realise its goals.

With this, policy makers will be persuaded of the desirability of our strategic model to achieve universal health coverage.

Our hybrid model of combining a financing mechanism and health service delivery provides a realistic strategy to achieve UHC and a powerful advocacy lever.