Ekiti State Health Insurance Scheme

Overview

Ekiti State Government signed into law the bill establishing the Ekiti State Health Insurance Scheme (EKHIS) in 2016, with the objective of providing equitable access to basic healthcare needs and risk protection for the residents regardless of income levels or social status. This objective aligns with the United Nation Sustainable Development Goal on healthcare (SDG3) of ensuring healthy lives and promoting well-being for all while strengthening the health systems.

Introductions

BRIEF INTRODUCTION

The Ekiti State Government established the Ekiti State Health Insurance Scheme (EKHIS) in 2016 to provide equitable access to essential healthcare services and financial risk protection for all residents, regardless of income levels or social status.

Mandates

Establish and enforce quality assurance standards for all stakeholders.
Implement the minimum benefit package as defined by the National Health Act.
Determine capitation, fee-for-service, and other payment mechanisms for healthcare providers.
Advise on integrating the scheme with other social security services.
Classify healthcare facilities to improve health outcomes in line with the National Health Act.

Health Plans

Ekiti State Equity Health Plan (EKEHP): Targets vulnerable residents with essential healthcare services.
Community-Based Health Plan (CBHP): Offers a standardized contributory healthcare plan for all residents.
Ekiti State Private Health Plan (PHP): Provides a comprehensive set of benefits for individuals.
Formal Health Plan (FHP): Designed for private and public sector employees.

Eligibility and Scope of Coverage

All residents of Ekiti State are covered under the EKHIS.

Benefit Package

EKHIS covers preventive and curative healthcare services provided by registered PHCs and SHCPs in Ekiti State.

Implementation Status

EKHIS was officially launched on July 10, 2020, beginning with the Equity Health Plan. The scheme currently operates two major intervention programs:

Basic Health Care Provision Fund (BHCPF): Launched in 2021 to strengthen primary healthcare services, provide a Basic Minimum Package of Health Services (BMPHS), and ensure emergency medical treatment for all residents.
Ulerawa Program: A ‘case-bundled system’ aimed at achieving universal health coverage, particularly for vulnerable populations. It focuses on expanding access to high-impact primary care services.

Ulerawa Program

The Ulerawa Program focuses on increasing coverage of cost-effective maternal and child health services, strengthening PHC service delivery, and ensuring high-impact interventions to address 73% of the state’s disease burden.

Objectives
☛ Expand coverage of essential maternal and child health services.
☛ Improve service delivery capacity at PHCs.
☛ Enhance productivity of healthcare facilities.
☛ Improve the quality of care at PHCs.

Service Package (56 services in core areas):
♦ Antenatal care
♦ Delivery services
♦ Postnatal care
♦ Childcare
♦ Family planning
♦ Malaria treatment for all

Target Population
♦ Pregnant women
♦ Children under five years old
♦ General population for malaria treatment

Achievements

1. Expansion of Healthcare Coverage

Ulerawa has successfully increased health insurance coverage, focusing on maternal and child health services.
The program scaled up from 25 facilities to 50 facilities, and now to 177 facilities across all 16 LGAs in Ekiti State in 2023, ensuring access to essential healthcare services for underserved communities.

2. Strengthened Health System Infrastructure

ICT infrastructure was established and operationalized to improve data collection, management, and reporting processes.
Development of a comprehensive operational manual ensured standardized service delivery across participating facilities.

3. Capacity Building and Workforce Development

Operational training was conducted for Officers-in-Charge (OICs) and frontline healthcare workers to ensure the efficient delivery of services under the Ulerawa program.
The workforce benefited from specialized training in service delivery protocols to strengthen healthcare delivery at PHC levels.

4. Increased Community Awareness and Engagement

Community sensitization and engagement activities were carried out to improve public understanding of health insurance benefits and encourage enrollment.
The program contributed to behavioral change regarding healthcare utilization, with more families accessing health services through insured coverage.

5. Improved Access to Maternal and Child Health Services

The program prioritized maternal and child health, offering a range of cost-effective services such as antenatal care (ANC), safe delivery, postnatal care (PNC), and immunization for children.
The focus on case-bundled services has helped streamline care delivery for mothers and children in participating facilities.

6. Service Delivery:

Over 536,000 total services were provided across core healthcare areas as of March 2025, including antenatal care, malaria treatment, immunization, and family planning.

Improvement in Skilled Birth Attendance:

Facility-based deliveries attended by skilled birth workers increased:: – From 71.8% to 81.7%.; – From 87.1% to 93.5%.

This contributed to a reduction in maternal mortality rates (NDHS, 2019 & 2024).

Improved Vaccination Coverage:

Percentage of fully vaccinated children increased by 38%, providing protection against life-threatening diseases.

Reduction in Early Childhood Mortality:

Neonatal mortality reduced by 57%.
Infant mortality reduced by 53%.
Child mortality reduced by 55%.
Under-5 mortality reduced by 54%

(NDHS, 2019 & 2024).

7. Financial Protection for Vulnerable Populations

The Ulerawa program extended health coverage to vulnerable groups, reducing out-of-pocket expenses and providing financial risk protection for low-income households.

8. Data-Driven Decision-Making

Ulerawa facilitated improved data collection, monitoring, and reporting at the primary healthcare level, enabling evidence-based decision-making for program expansion and future interventions.

Financing Model

The Ulerawa program adopts a bundled fee-for-service payment model, ensuring reimbursement is aligned with clinical guidelines to improve service quality and efficiency.

Summary

EKHIS operates in 177 PHCs, 21 SHFs, 3 THFs, and 4 private facilities.

BHCPF enrolled 53,830 beneficiaries and has delivered over 230,271 services as of March 2025

Ulerawa treated 496,770 persons with over 536,000 claims processed as of March 2025

The program aims to eliminate financial barriers to healthcare and provide equal access to quality services.

Ekiti State Health insurance Scheme Ulerawa programme is a key intervention ensuring equitable healthcare for all residents of Ekiti State, safeguarding them from financial hardship while enhancing healthcare accessibility and service quality.

Vision and Mission

VISION
Accessible healthcare for Ekiti State Residents

MISSION
To put in place appropriate health plans and programs that will ensure access of all Ekiti residents to qualitative and affordable health care services through collective pooling and redistribution of financial resources.

Objectives

The scheme objectives are to:
★ Ensure access to quality healthcare services for every resident of Ekiti State
★ Ensure residents have financial Protection and access to affordable healthcare services.
★ Protect families from the financial hardship of huge medical bills.
★ Limit the cost inflation of healthcare services
★ Promote efficiency in healthcare service delivery.
★ Ensure adequate distribution of healthcare costs across income groups.
★ Promote private sector participation in the provision of healthcare services.
★ Ensure the Basic Minimum Package of Health Services (BMPHS) as stipulated by the National Health Act is delivered to the poor and vulnerable residents of Ekiti State.
★ Take appropriate measures to plan, organize and develop medical and other health services commensurate with the needs of the residents, especially in areas with limited access to health facilities.
★ Take necessary measures to facilitate access and delivery of quality health services for all residents of Ekiti State.

Our Mandate

Our mandate are:
♣ To establishing quality assurance for all stakeholders.
♣ Implementation of the minimum benefit package as defined under the National Health Act.
♣ Determining, after due consideration, capitation, fees- for service and other payment mechanisms due to health care providers, by the HMOs in line with similar scheme.
♣ Advising the relevant bodies on inter-relationship of the scheme with other social security services.
♣ Classifying healthcare facilities and provides in a manner that shall help improve health outcomes in the state as required under the National Health Act.

Stakeholders

♥ Ekiti State Health Insurance Scheme Committees.
♥ Ekiti State Ministry of Health.
♥ National Health Insurance Scheme.
♥ Third Party Administrators.
♥ EKSHIS Accredited Private Healthcare Providers.
♥ Primary Healthcare Development Agency.
♥ Ekiti State Ministry of Finance.
♥ Ekiti State Ministry of Justice.
♥ Registered Enrollees.
♥ Public and private sector Employers, trade unions, community leaders and tradesmen/market groups.
♥ Ministry of information.

♥ Any other body that maybe considered by the scheme from time to time.

Principal Officers

EKHIS MANAGEMENT

S/No	FULL NAME	DESIGNATION
1	Dr. Charles Olusegun Doherty	General Manager.
2	Mrs. G.T Adeyemo	Director Admin & Supplies.
3	Mr. Olaoye Samuel	Director Finance & Account.
4	Mls. Ogundero Oluwabunmi	Director of Programme.
5	Mr. Ogunyemi Oyeyemi	Director Planning Research & Statistics.
6	Mrs. Priscilla Oyediran	Director Quality Assurance.
7	Mr. Akinola Ilesanmi	Chief Internal Auditor.

Government of Ekiti State, Nigeria.