MAKING COMMUNITY AND CLINIC-BASED PMTCT SERVICES MORE ACCESSIBLE: THE ROLE OF A COMMUNITY HEALTH INSURANCE SCHEME:A NIGERIAN COTTAGE HOSPITAL EXPERIENCE

In 2010, Shell Nigeria working in collaboration with River State Government of Nigeria, a CBO, (Shell Industrial Area Community Development Foundation), and an HMO, Health Care International, launched the first Community Health Insurance Scheme (CHIS) in the Niger Delta. The preferred provider, Obio Cottage Hospital (OCH) located in Port Harcourt and owned by the government, had earlier been rehabilitated by SPDC in preparation for the scheme take off. The annual premium payable is about $46.25. Indigenes of the community, who are the primary target of the initiative, pay 50% of that - subsidy funds provided by SPDC to the community. CHIS is a Health Systems Strengthening (HSS) programme which objective is to increase community access to affordable quality assured health care. The focus is on maternal and child health. Prior to CHIS, the Obstetric service in the facility was rudimentary, with few deliveries, supervised by Community Midwives and a part-time Medical Officer. Within a few months of the commencement of the scheme, service utilization quadrupled with average deliveries jumping from below 20 to about 180 per month. PMTCT, Family Planning services, Immunization and Cervical and Breast Cancer Screening programmes are all included in the scheme benefit package. We present the results of the evaluation of the PMTCT program between Jan 1, 2011 and Dec.31, 2011. The laboratory and obstetric data of the clients who registered for the PMTCT programme during the period under review were collated and analyzed. All the 2839 Clients accepted the VCT at the first ANC visit and were tested. 88 (3.1%) were HIV positive. The nulliparous ladies (about 36% percentage of the study population) constituted over 60% (55/89) of the HIV positive group. The 25-29yr age group had the highest number (39.3%), followed by the 30-34 age group (29.2%). 37 babies have been delivered and of these, only one baby (2.7%) tested positive to the virus.The role of the CHIS in encouraging pregnant women to book early for ANC, exposing them to VCT opportunities, enhancing compliance and the utilization of the PMTCT program is discussed. A sustainable health financing scheme like Obio CHIS, established all over the Nigerian Communities will benefit more urban and rural dwellers that are presently left out of the massive Federal Govt. PMTCT initiatives, which tend to be concentrated at the big tertiary hospitals in the urban cities.