The results and learnings from the past ten years in Kwara State have well-positioned PharmAccess to advise other states on introducing health insurance for their population. About eight states (including Lagos, Delta, Ekiti, and Cross River) are following the example of Kwara State of promoting financial inclusion for health by enacting a state health insurance law.

As a component of its technical support to Lagos, PharmAccess is currently implementing a six-month proof of concept of the CarePay platform with 150 low-income families and two hospitals (one private and one public). The digital infrastructure for this pilot is based on the M-TIBA digital health exchange platform that PharmAccess, with support of the Dutch Ministry of Foreign Affairs, has developed in Kenya,in collaboration with Safaricom (the largest telecommunications operator in Kenya) and CarePay (a social enterprise based in Nairobi). This digital health exchange includes a mobile health wallet to facilitate the financing and delivery of healthcare.

In Lagos, the pilot will provide the Lagos State Health Insurance Scheme (LSHIS) benefit package to 150 low-income families. To commence, a clearly defined set of eligibility criteria was developed for the recruitment process. Geographical mapping was done to identify slums with a high concentration of very low- income households within 1 kilometre of the health facilities. A (progress out of) Poverty Index tool (PPI tool) was applied by the recruitment agents for the identification of very low-income households to participate in the proof-of-concept pilot. The enrollees have now started accessing care through their health wallet on their mobile phone. In the backend, CarePay facilitates claim-handling with the providers and the company captures financial and medical utilisation data. The objective of the pilot is to deliver proof of concept of how mobile technology can increase reach, transparency and efficiency. The feedback is used to improve the processes towards the launch of the Lagos State health insurance scheme.

Looking for efficient ways to make healthcare inclusive using digital technologies has become an even higher priority, now that the Lagos State Government enacted the Lagos State Health Management Law. This makes health insurance compulsory for all residents of the state. It is an ambitious, yet highly urgent Law. A megacity like Lagos, with 22 million residents, has over 60% of its population within the low-income informal sector, living below $2 a day, i.e. below the poverty level. Around 72% of their medical cost are paid out-of-pocket, which is often the beginning of a downward spiral of poverty and ill health.

The objectives of the Lagos State Health Scheme Law include fostering the development of equitable, efficient and sustainable healthcare financing. This should ultimately translate into improved State healthcare indices, the elimination of financial impoverishment when citizens access healthcare services as well as the entrenchment of a positive perception and confidence in the Lagos State healthcare delivery system.

Lagos State is planning to launch its mandatory Health Insurance Scheme before the end of this year covering all 22 million residents. The Lagos State Government has committed to subsidizing or paying the premium of all indigents identified using the Poverty index tool. It is expected that contributions from the formal sector will result in cross-subsidisation and sustainability of the scheme.