For an efficient system, clear lines of authority and reporting have to be established and operationalized, removing all elements of ambiguity and overlap in the implementation of an organization’s day to day activities towards achieving set goals. Borne out of the need to achieve universal health coverage in Imo state, with a population whose vast majority makes out of pocket payments at the point of accessing healthcare, the Imo State Health Insurance Agency (IMSHIA) was established by law 4 of 2018 with the statutory role of providing health insurance for all residents of the state.
Through the Global Fund Resilient and Sustainable Systems for Health (GF-RSSH) project, HSCL, as a Technical Service Organization to MSH conducted a landscape assessment of the State’s health system to map out key stakeholders, understand the context, appreciate strides that have been made by the state and have a bird’s eye view of its gap. As a fall out from the landscape assessment, a purposefully developed plan tailored to meet the identified gaps in the State’s Health Insurance Agency was developed.
Development of top-level and detailed organizational structure
To strengthen the governance structure of the Agency, a benchmark study was conducted with the aim of drawing lessons from other established schemes. This was done by comparing various state and national health insurance schemes within Nigeria, and other African countries with similar contexts and a track-record of relative success. Working hand in hand with state actors, drawing lessons from other contexts with best practices and relying on extant laws (including the law establishing IMSHIA and the NSHIS law), HSCL led the development of a top level and detailed Organizational structure aimed at streamlining administrative processes and guaranteeing efficiency in the running of the scheme and the Agency. This has been validated and accepted as the standard by the State.
Development of Job Profiles and Process Manuals
To further strengthen the efficiency in the Agency’s administrative and operational processes, job profiles for all positions specified in the detailed organizational structure were developed and validated with the State. The Job profiles seek to reduce ambiguity about roles and minimum requirements for occupying any position within the organization. They clearly spell out these requirements, detailed job description showing what is expected of each officer and key performance indicators for gauging their performance.
Process manuals for all key functions within the Agency were developed providing laid down processes and procedures to be employed in managing IMSHIA’s daily operations. They include the guidelines and practices to be adopted for the smooth and efficient operation of the Agency. They manuals will; i) ensure uniformity, completeness and consistency in the performance of tasks within the Agency, ii) enable clear definition of job responsibilities in the Agency as well as their interrelationships, iii) prevent/minimize information gaps in the event of staff turnover; and v) avoid discretionary and inconsistent definition and application of guidelines and procedures
The support for IMSHIA’s Institutional architecture through the development of the detailed organizational structure, job descriptions and process manuals will propel the Agency towards efficient execution of its tasks in a seamless and replicable manner. This support is expected to translate to overall improvement in the administration of the State health Insurance Scheme towards the provision of quality healthcare to all Imo state residents.
