Nigeria’s health crisis does not get as much attention as it deserves.
The data is troubling: Up to 58,000 mothers die annually on account of pregnancy or childbirth in Nigeria. In 2017, infant mortality rate for Nigeria was 65 deaths for every 1000 live births. The under-five mortality rate in Nigeria is 201 per 1000 live births meaning that one in five Nigerian children never reach the age of five.
The spending is paltry: What our government spends on health is one of the lowest in the world. In 2017, the health budget of all the 36 states was a little over N332 billion, which was about 4.9% of total budget size. This is a far cry from the Abuja declaration of April 2001, where African Union countries met and pledged to allocate at least 15% of their annual budgets to improve the health sector.
- The meagre resources are mostly allocated to secondary and tertiary care, resulting in a neglected Primary Health Care (PHC) system.
The BHCPF: In 2014, the Federal Government enacted the National Health Act (NHAct), a component of which is the Basic Healthcare Provision Fund (BHCPF). The Fund is supposed to mobilize 1% of the consolidated revenue in new funds per year to strengthening Primary Health Care (PHC). In 2018, N51.15 billion was earmarked for the BHCPF, with additional $20 million grant to support the BHCPF made available by the World bank and $2 million from the Bill and Melinda Gates Foundation.
Why it matters: Primary Health Care (PHC) centres are the first and – often – the only point of care for poor and vulnerable Nigerians especially in rural and hard-to-reach communities. Most receive no funding to meet even basic operational needs.
- The BHCPF will provide funding through the State Primary Healthcare Board to eligible public PHCs for operational costs including essential drugs and consumables, transportation for retrieval of vaccines, provision and maintenance of facilities, equipment and medical transport vehicles, community outreaches and development of human resources.
It will reduce out-of-pocket spending due to lack of insurance. The Basic Minimum Package of Health Services of the BHCPF consists broadly of maternal health interventions for pregnant women (ANC, labor and delivery, emergency obstetric and newborn care and caesarean section), children focused interventions (curative care and immunization), routine screening and checks for non-communicable diseases (blood pressure check and Blood sugar checks) for adults, treatment of malaria for all Nigerians, nutrition and family planning.
- All of these will be offered free to all Nigerians regardless of health insurance and will be paid by the National Health Insurance Agency (NHIS) through claims that will be submitted by State Social Health Insurance Agencies (SSHIA).
- The establishment of state insurance schemes as a result of the BHCPF will increase the spread of insurance for a lot of Nigerians especially in the informal sector who are currently not covered by the NHIS
The BHCPF will use two approaches to improve service delivery in at least one Primary Health Care clinic per ward in Nigeria.
- An initial lump sum payment to public PHC facilities to meet their operating expense and;
- A delivery of 9 high impact interventions known as the Basic Minimum Package of Health Services (BMPHS) as mentioned earlier will be paid to accredited private and public health facilities after the service has been provided free to beneficiaries.
How accountability will be ensured: Community members will hold the facilities accountable through the formation of ward development committees (WDC) comprising members of the community.
- They will collaborate with PHCs to identify health and social needs of the ward and prioritize identified health needs in annual quality improvement plans and quarterly business plans to be developed by the PHCs.
- They will also be co-signatories to the facility account. Funds will be only be disbursed through bank transfers to ensure that facilities which are the end users get the funds.
- PHCs will be tracked through a quality improvement scorecard, where quality of care and service utilization will be measured by a series of indicators through the National Health Facility Survey.
- The BHCPF will have clearly established lines of accountability and a robust data and performance frameworks for continuous evaluation.
Next Steps: The National Health Act was passed in 2014 but implementation of the BHCPF suffered delays. In fact, it was only in December 2018 that an operation manual to guide the implementation of the fund was finally signed by the implementing entities (Federal Ministry of Health, National Health Insurance Scheme (NHIS) and the National Primary Health Care Development Agency).
- So far, the Federal Government has released N13.775 billion from the N51.15 billion that was earmarked for the BHCPF in 2018. The funds from the World bank and Bill and Melinda Gates foundation are also available.
- Baseline assessments of facilities to benefit from the BHCPF have been completed in some states and is ongoing in others.
- The capacity building of health workers to handle funds at the facility level is also ongoing and funds will be disbursed to facilities once they meet certain criteria and capacity of health workers have been built.
- Facilities in about 18 States and the FCT will benefit from the first phase while more States will be covered once they meet the take-off criteria.
No delays needed: We must remember what is at stake here. Women and children continue to die due to nonfunctional PHCs. There is need to intensify efforts in ensuring that the funds are disbursed to the end users as soon as possible.
Bottom Line: The BHCPH is expected to reach over 7 million Nigerians in rural and hard to reach areas, especially women and children under-five who will receive care through the Basic Minimum Package. Primary healthcare is key to the attainment of the goal of Health for All Nigerians, and the BHCPF will help Nigeria inch closer to the target.