In the end, what is most important within the Health Insurance Fund schemes is that the patients, the beneficiaries of the program, receive high quality treatment. After all, if they don’t, why would they want to pay for insurance? This is why a PharmAccess team conducts two Monitoring and Evaluation (M&E) visits a year to monitor the standards of care at clinics and hospitals in the program and to evaluate whether they are maintaining and improving standards. The goal of these visits is to support these healthcare providers to continually improve their services and facilities.
The M&E team from Hygeia and PharmAccess
In January a team of twelve visited all thirteen primary healthcare facilities within the Health Insurance Fund program in Lagos and Kwara State. On this visit the team scored the clinics on medical care, management, bio-safety, laboratory and pharmacy facilities and IT.
The scoring is conducted with a PharmAcces tool. Each of the above sections receives a score from 'one' to 'five', based on an extensive questionnaire. Over 500 questions are covered and responses are entered on a personal digital assistant (PDA). The scoring is a thorough way of identifying areas of improvement. If for example a facility gets rated a 'one' on the 'use of microscopes', it means that the equipment is not available. So it needs to be ordered. But, if it scores a 'two', then microscopes are available, but not properly used. A training session is therefore essential.
Overall, the primary clinics have significantly improved since the start of the program: equipment upgrading activities targeted in 2008 have all been realized, the number of enrollees increased significantly compared to 2007, to a total number of 50,000 at the end of 2008 and the training sessions organized by Hygeia and delivered in cooperation with PharmAccess were very well attended. Perhaps in correlation with the improvements, the clinics in the program saw an increasing number of patients: a total of 140,000 visits in 2007 and 2008.
In particular, May Hospital in Lagos stood out. Since 2007 the management structure has been professionalized, important measurements have been taken on bio-safety, making the hospital cleaner and safer and the hospital is starting to use computers to process patient data. Second, the Shonga Community Health Centre in Kwara is also worth mentioning. In one year time the clinic showed improvements on all aspects.
The entrance of the Resource Access Unit in Kwara State, one of the thirteen primary clinics in the program
Although the results of this latest M&E trip look promising, there is room for improvement. And in some areas not all planned improvements have been fully realized. Maintaining a regular power supply, for instance, remains a problem for quite some clinics. Power outages are frequent in Nigeria and although most clinics have back-up generators, these are not always powerful enough to deliver over a longer period. In the upgrading plans for 2009 attention will be paid to this power problem. In addition, future improvements will be less focused on assets/equipment but more on processes and skills. This will require the implementation of guidelines and better quality management in the clinics. Based on the M&E results, Hygeia will develop an updated quality improvement plan in cooperation with each clinic to further implement improvements. So that they help ensure that quality treatment remains the top priority for the program.