The NHIA in its endeavor to improve access to quality and affordable health services for all residents of The Gambia began a pilot of the National Health Insurance Scheme (NHIS) and the e-NHIS system, the digital platform that would be used to operationalize the scheme. The first health facility selected for the pilot of the NHIS was Bundung Maternal & Child Hospital (BMCH). The pilot began in July 2023 and was divided into two phases:
First phase – 11th July to 31st August 2023
Second phase – 1st September to 31st December 2023
Inclusion Criteria
The inclusion criteria for the pilot is to women with an NHIS card or electronic birth certificate presenting for labor and delivery and their newborns. The services covered are labor, delivery and post-partum services which include all required medicines and laboratory tests. For normal delivery coverage is up to 7 days and cesarean section coverage is up to 10 days after delivery.
Enrollment And Service Delivery
In total, five hundred and thirty-eight (538) women were enrolled, out of which three Hundred and ninety-nine (399) women were enrolled and registered for the NHIS pilot at BMCH in the second phase. Exit interviews were conducted to gauge the quality of experience of beneficiaries i.e. 99.1% or 330 respondents were highly satisfied with service delivery BMCH and the NHIS coverage during the second phase. Overall, most beneficiaries are satisfied with the services rendered.
Quality of Care
In our bid to ensure that contracting facilities provide quality of care, A Quality Assurance committee set up to ensure quality of service delivery to all beneficiaries. The committee’s objective is to provide technical guidance and support for the pilot. The Committee have standard operating procedures (SOPs) in placed, which were developed in a consultative process with health facilities, hospitals, and program units of the Ministry of Health for the use of e-NHIS. In the most recent quality of care assessment, BMCH continued to maintain a high score of 92.40% which is similar to the score they have been receiving throughout.