ISQUA18-2642Leveraging on Digital Technology to Promote Quality, Efficiency and Transparency in Accessing Health Care: Proof of Concept in Lagos, Nigeria

Abstract

Objectives: In Sub-Saharan Africa, there are challenges of quality, efficiency and transparency in the healthcare space. Processes are generally slow hindered by non-automation, resource restriction and resistance to change; eventually resulting in delays in decisionmaking further exacerbating problems in the healthcare sector. In 2017, PharmAccess Foundation supported the Lagos State Government in South-West Nigeria in preparatory plans for a Statewide Health Insurance Scheme. A major step was the proof of concept to demonstrate the applicability of an innovative digital platform for enrollment on the upcoming scheme. The main objective of the pilot was to demonstrate how digital mobile solutions can be utilized to improve decision-making and transparency, reduce transaction costs, and increase access especially for poor households. The implementation enabled the State refine her approach towards the launch of the Lagos State Health Insurance Scheme. Method(s): PharmAccess implemented a six-month pilot (proof of concept) of the CarePay platform with 150 low-income families and two hospitals Subol Hospital at Idimu (private healthcare facility) and Igando General Hospital (public healthcare facility). The pilot mirrored the Lagos State Health Insurance Scheme benefit package, provider payment and interactions between the patients and the provider (quality delivery of services). Recruitment was based on defined set of eligibility criteria. Geographical mapping was done to identify slums with a high concentration of very low-income households within 1 kilometer of Subol Hospital in Idimu axis of Lagos. A paper based Progress out of Poverty Index tool (PPI tool) was also applied by the recruitment agents for the identification of very low- income households to participate in the proof of concept pilot. The target for Subol Hospital was to enroll 75 families. Independent field agents were trained on how to deploy the CarePay registration module using an App on an android device and administer a paper based PPI tool. Recruitment for the 75 families to access care at Subol Hospital was completed within 2 months (August to September 2017). Result(s): The proof of concept intervention showed clarity in the processes involved from the point of registration to the point where patients were able to access care seamlessly and efficiently. Utilization data recorded at Subol Hospital enabled the facility to improve on decision-making processes efficiently. Each step of the processes involved earned the trust of the patients (hence patient-centered care as they identified as being part of decisionmaking for them) due to the transparent nature of implementing the steps of each process; and hence utilization increased and access to care increased. The decision-making also assisted the facility in prioritizing foci of quality improvement to reduce costs. Conclusion(s): The proof of concept on leveraging on digital technology, implemented in the health care space in Lagos State showed how processes can be efficiently managed which will in turn allow for efficient decision-making. The transparency in the system, reduction in transaction costs, increase access and financing care are innovative ways of improving processes in the health care system in low-income countries such as Nigeria.