Skip to main content

BRIEF RESEARCH REPORT article

Front. Health Serv.
Sec. Health Policy and Management
Volume 4 - 2024 | doi: 10.3389/frhs.2024.1460580

Optimising availability and geographical accessibility to emergency obstetric care within a sub-national social health insurance scheme in Nigeria

Provisionally accepted
Aduragbemi Banke-Thomas Aduragbemi Banke-Thomas 1,2*Tope Olubodun Tope Olubodun 3Abimbola Olaniran Abimbola Olaniran 4Kerry Wong Kerry Wong 1Yash Shah Yash Shah 5Daniel C. Achugo Daniel C. Achugo 6Olakunmi Ogunyemi Olakunmi Ogunyemi 7
  • 1 London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
  • 2 University of Greenwich, London, London, United Kingdom
  • 3 Federal Medical Centre, Abeokuta, Abeokuta, Nigeria
  • 4 Royal Tropical Institute (KIT), Amsterdam, Netherlands
  • 5 Google (United States), Mountain View, California, United States
  • 6 Nnamdi Azikiwe University, Awka, Nigeria
  • 7 Lagos State Ministry of Health, Lagos, Nigeria

The final, formatted version of the article will be published soon.

    Introduction: Health insurance is a key instrument for a health system on its path to achieving universal health coverage (UHC) and protects individuals from catastrophic health expenditures, especially in health emergencies. However, there are other dimensions to care access beyond financial accessibility. In this study, we assess the geographical accessibility of comprehensive emergency obstetric care (CEmOC) within the Lagos State Health Insurance Scheme.Methods: We geocoded functional public and private CEmOC facilities, established facilities registered on the insurance panel as of December 2022, and assembled population distribution for women of childbearing age. We used Google Maps Platform's internal Directions Application Programming Interface to obtain driving times to facilities. State-and local government area (LGA)-level median travel time (MTT) and number of CEmOC facilities reachable within 30min were obtained for peak travel hours.Results: Across Lagos State, MTT to the nearest public CEmOC was 25min, reduced to 17min with private facilities added to the insurance panel. MTT to the nearest public facility in LGAs ranged from 9min (Lagos Island) to 51min (Ojo) (median=25min). With private facilities added, MTT ranged from 5min (Agege and Ajeromi-Ifelodun) to 36min (Ibeju-Lekki) (median=13min). On average, no public CEmOC facility was reachable within 30min of driving for women living in six of 20 LGAs. With private facilities included in the scheme, reachable facilities within 30min remained zero in one LGA (Ibeju-Lekki).Conclusions: Our innovative approach offers policy-relevant evidence to optimise insurance coverage, support efforts in advancing UHC, ensure coverage for CEmOC, and improve health system performance.

    Keywords: Universal Health Coverage, Maternal health, Emergency obstetric care, Geographical accessibility, health insurance

    Received: 06 Jul 2024; Accepted: 26 Sep 2024.

    Copyright: © 2024 Banke-Thomas, Olubodun, Olaniran, Wong, Shah, Achugo and Ogunyemi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Aduragbemi Banke-Thomas, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.