Piloting mutual health association establishment in Enugu State, Southeast Nigeria: Lessons learned

Background: Predominant out-of-pocket financing of health expenditures in low- and -middle-income countries (LMICs) remains a major setback to achieving universal health coverage (UHC). Nigeria has been attempting to bridge the gap through health insurance schemes targeting both the formal and informal sectors of the population. Objective: This paper aimed to provide a roadmap to assist in establishing community-based health insurance (CBHI) in any religious Nigerian Community. Materials and Methods: A cross-sectional descriptive design using qualitative methods was used for the study. The study areas were local government areas (LGAs) that make up the Catholic Diocese of Enugu. Extensive advocacies were used at various levels of the organizational structure of the Diocese to ensure buy-in. Organizational structure of the scheme was set up with nine major stakeholders who played active roles in the advocacies and the design of operational guidelines. Training of the stakeholders was conducted and two types of benefit package were adopted. A mutual health association (MHA), called Ndubuisi MHA, was approved and incorporated based on the NHIS model called intermediary method. Results: Nigeria’s first faith-based CBHI-Ndubuisi MHA with over 3000 enrollees was set up, approved, and registered with Enugu North LGA, Enugu State Ministry of Health and Corporate Affairs Commission. The scheme is running conveniently with a purpose-built administrative structure, monitoring and evaluation plan, and benefit packages. Conclusion: Establishing CBHI through faith-based organizations is possible and sustainable with underlying equity principles. The model used in this study can be implemented in any organization that has an element of mutual solidarity and existing administrative structures that can be used as a platform.