BEPHA stands for the Bamenda Ecclesiastical Province Health Assistance. This is a Mutual Health Organization, set up by the four Bishops of the Ecclesiastical Province of Bamenda, as a response and contribution of the Church towards alleviating misery caused by poverty, in the domain of health. BEPHA has the status of a Common Initiative Group (CIG). The principles on which BEPHA operates are: Insurance, Participation and Solidarity.
In insurance, risk is pooled, members pay contributions to cover the risks period, and when a risk materialises the member receives a specified indemnity from the group, related to the risk. This is what BEPHA will also do, but in the domain of health.
The difference here is that, while with insurance, the members undergo a long process to receive their benefits (some end up never having); with BEPHA the benefits are received immediately. That is, the health service covered is received before the part payment due from the member (25 percent cost of treatment) is demanded.
All members contribute but only those affected benefit from the financial support.
This is also in accordance with the teaching of Christ in Mtt.25:31 – 45 which says, “What ever you do to the least of my brethren, that you do unto me”.
Membership is voluntary. All members have the right to participate, directly or indirectly in various decision making bodies and to control the operation of the scheme.
II. THE PROBLEM
The four Bishops of the Ecclesiastical Province of Bamenda observed with dismay that:
- The children of God are living in misery brought about by poverty and because of this; they are unable to afford quality health care.
- Some of those who seek health centre or hospital care are unable to pay their medical expenses.
- Some are exposed to usury or exploitation (cheating) for example borrowing at exorbitant interest rates.
- Some simply do not seek medical care when sick.
- Some try to treat themselves (auto-medication).
- Some delay at home hoping to have an improvement and most often report for treatment when they feel their lives threatened because the health condition has aggravated or deteriorated.
- Some go to traditional practitioners, prayer groups, etc, hoping to have cheaper health care or a miracle.
For over five years now, the Bishops have been reflecting on this project. They felt it was taking too long for it to materialise. Hence, in their Provincial Council of August 23, 2007, they took the decision for BEPHA to start.
The objectives of BEPHA in the Diocese of Buea include the following:
- To ensure quality health care to all at affordable rates.
- Members to live in solidarity and offer mutual assistance to each other.
- To alleviate misery by promoting good health.
- Sustainable health care to the entire population.
- Holistic health for its members and beneficiaries.
IV. THE ORGANISATION OF BEPHA
The organs constituting BEPHA are:
- The General Assembly
- The Board of Directors
- The Finance Committee
- The Executive Committee
- The Health Committee
- The Management Staff
a. The General Assembly is made up of some elected members of BEPHA who will deliberate on issues concerning BEPHA, the service offered and the service providers. It shall meet annually and by convocation of the Bishop of the Diocese (Chairman of the Board of Directors).
b. The Board of Directors is made up of the Bishop or his delegate, Vicar General, Financial Secretary, Diocesan Health Coordinator, 2 elected members of the Diocesan Health Commission, the Chairman, Secretary and 2 elected people from the General Assembly, an Auditor/Accountant, and Medical Adviser. The Board of Directors defines the mission of BEPHA and formulates her general policy. The Board shall meet quarterly and by convocation of the Bishop (President of the Board)
c. The Finance Committee is made up of the Financial Secretary, Auditor and the Chairman of the General Assembly. These are members who are competent in the field of accounting and management. The Finance Committee shall be charged with monitoring the duties of the officials of BEPHA. This shall be in conformity with the Constitution and Manual of Procedures.
d. The Executive Committee is made up of the President, Secretary and the 2 elected members from the General Assembly. The Executive Committee shall oversee the day-to-day functioning of the Management and Staff of BEPHA.
e. The Health Committee is made up of the Diocesan Health Coordinator, 2 elected members of the Diocesan Health Commission and a Medical Adviser. The Health Committee gives advice on the services to be covered and their prices. It examines the reports and comments on the performance of the Medical Adviser.
f. The Management Staff is made up of the Manager, Secretary, Accountant, Marketing Officer(s), Medical Adviser and BEPHA representatives at Partner Health Care Providers. The Medical/Health Adviser has the task of going through the prescriptions as appropriate to the diagnosis of the beneficiary before payment is carried out to the Service Providers. This is to ensure quality care by avoiding over-prescription and also to ensure that the doctors be faithful to the contracts made between them and BEPHA.
V. DESIGN OF THE BEPHA SCHEME IN THE DIOCESE OF BUEA:
1. TARGET POPULATION
The target population intended to be covered by December 2008 was 2.5 percent of the population in the Diocese of Buea that is willing to join, which is 12,946 inhabitants from the feasibility study carried out.
2. DEMOGRAPHIC DATA
- The actual population of the Diocese of Buea is 777.042 inhabitants.
- From the results of the feasibility studies carried out:
- The average family size is 6 people
- The percentage of people in Social groups is 75.2 percent
- About 54.15 percent of the prospective clients have difficulties to pay for their health cost when the total cost reaches FCFA 25,000 and above.
- 71.59 percent of the prospective clients were between the ages of 18 and 45 years..
- 82.06 percent of the prospective clients are literate.
3. SERVICES TO BE COVERED
- Para clinical Examinations (Laboratory, X-Ray, Echography and others)
- Pharmacy (Drugs and Consumables)
- Minor and Major Surgical operations
- Out Patient Consultation
- Maternity Services
4. PARTNER HEALTH CARE PROVIDERS IDENTIFIED BY THE PROSPECTIVE CLIENTS IN THE FEASIBILITY STUDY:
(i) Kumba Health District (visit regularly)
District Hospital Kumba, Hope Clinic Kosala, Catholic Health Centre Fiango, Government Health Centre Kumba, Presbyterian Health Centre, Baptist Health Centre.
(ii) Buea Health District
Provincial Hospital Annex, Mount Mary Health Centre, Khawa Clinic, Buea Town Health Centre.
(iii) Tiko Health District
Regina Pacis Mutengene, Mbingo Annex Mutengene, District Hospital Tiko, CDC Cottage Hospital.
(iv) Muyuka Health District
District Hospital Muyuka, Manyemen Annex (Presbyterian), Banga Bakundu Health Centre (Apostolic), Calvary Hospital, Holy Trinity Hospital Ekona.
(v) Limbe Health District
Provincial Hospital Limbe, Limbe Maternity, Government Health Centre Batoke, Ndifor’s Clinic, Government Health Centre Bonjongo, CDC Hospital Limbe.
(vi) Mundemba Health District
District Hospital Mundemba, PAMOL, Mundemba Integrated Health Centre.
(vii) Ekondo Titi Health District
PAMOL Hospital Lobe, Ekondo Titi Health Centre, District Hospital Ekondo Titi, Christ the King Health Centre, District Hospital Mbonge.
(viii) Tombel and Bangem Health Districts
Nyassosso PCC Hospital, District Hospital Tombel, Catholic Health Centre Baseng, Ndum Health Centre, Muambong Health Centre, Ndibenjock Health Centre, District Hospital Bangem.
5. THE ANNUAL CONTRIBUTIONS
- The Annual Premium shall be FCFA 5,600 per member and per beneficiary.
- If the group or household pays in one instalment, the premium per member and per beneficiary shall be FCFA 5,000.
- If the group or household pays in two instalments, the premium per member and per beneficiary shall be FCFA 5,600.
- Annual Premiums and Registration Fees are non refundable.
- Household or groups who want to register less than 4 members shall pay an annual premium of FCFA 7,000 per member or beneficiary.
6. REGISTRATION OF MEMBERS AND BENEFICIARIES:
- Registration into BEPHA is FCFA 1,000 per member.
- A member must register with at least 4 beneficiaries of his/her household.
- The maximum number of beneficiaries shall be 10 people per household or group (1 member + 9 beneficiaries).
THE WAITING PERIOD: This is the period of maturity for a benefit. It starts from when the entire premium is paid to the 60th day (2 months). But in the special situations below, it varies as follows:
• 10 months for delivery service, and
• 6 months for planned surgery.
7. BENEFIT PLAN (COVERAGE FORMULA)
- The maximum number of times in a year a member /beneficiary is entitled to benefit are three (3).
- MINOR RISKS: These are health problems having a health cost of equal or below FCFA 25,000. BEPHA shall cover 75 percent of the cost.
-MAJOR RISKS: These are health conditions having health cost of above FCFA 25,000 (e.g. surgical operations, fractures, accident cases and others).
- For all major surgical cases, BEPHA will pay 75 percent of the bill where such bill is equal or below FCFA 70.000; and a maximum coverage of FCFA 70 .000, where the bill is above FCFA 70,000.
- PLANNED SURGERY: The waiting period is 6 months. BEPHA will pay 75 percent of the cost up to the ceiling of FCFA 70.000.
- UNPLANNED SURGERY: BEPHA will pay 75 percent up to FCFA 70,000.
- TYPE OF SURGERIES: All surgeries, except those contrary to the doctrine of the Catholic Church, e.g. elective abortion.
- Laboratory Tests: All except Echography for sex determination.
- CONSULTATION COST.
- PHARMACY AND DRUGS: Essential and generic drugs provided in the health institutions. Branded name drugs shall not be covered. GNLD and unnecessary vitamins shall not be covered by BEPHA.
- Hospitalisation in General Ward. Members admitted in the Private wards shall pay the balance of the daily cost, while BEPHA pays the amount equivalent to the daily rate in the General Ward.
8. THE ANNUAL CONTRIBUTION FOR SCHOOLS:
Nursery School FCFA 1,000
Primary School FCFA 1,500
Secondary and High School FCFA 2,500
9. INCLUDED IN THE BENEFIT PLAN OF SCHOOLS ONLY:
In addition to all the services offered already described, they are also entitled to:
1. Public Transport rates to and from the nearest BEPHA Partner Health Care Provider at 75 percent.
2. The number of times to benefit from the health care services offered by BEPHA is not restricted.
BEPHA shall not cover the following: Tooth and eye problems; chronic conditions like diabetes, hypertension, Rheumatism, Arthritis, Epilepsy, AIDS; Heart Transplant, etc, until a decision is taken in favour of this in the General Assembly of BEPHA.
- For a delivery case to benefit, the pregnant woman must have attended at least 3 antenatal clinics.
- BEPHA will not cover any cost resulting from health care services motivated by non-medically indicated (personal) reasons such as bed rest, routine check-ups, medical examinations for employment, aesthetic surgery, and other similar and or related situations.
11. EPIDEMICS: In the event of an epidemic, the government will have to intervene through the Ministry of Public health.