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Healthcare Financing

Health financing indicators are generally weak in the African continent especially among the low income countries. Available estimates from Health Accounts show that out-of-pocket (OOP) spending in fee-for-service (FFS) delivery represents the dominant source of healthcare financing. In low income settings, this portends a potentially vicious cycle of poor-health due to the disastrous consequences of catastrophic events. To alleviate this burden and protect population health, many countries have launched national health insurance schemes as a step toward universal health coverage. Insurance coverage rates remain low especially in the larger countries, including Nigeria, and health insurance schemes are being launched at subnational levels to grow coverage. This research pillar focuses on the healthcare financing strategies and reforms being undertaken in African countries and assesses the sustainability of those reforms. Research topics include:

Estimation of health accounts and sub-accounts both at the federal and state levels
Assessment of health financing pathways to fiscal sustainability at subnational levels
Fiscal space and sustainability of public coverage of vulnerable population groups
Factors shaping fiscal sustainability of state health insurance schemes
Correlations between benefits packages and equity in healthcare consumption
Affordable options for the informal, indigent and vulnerable population groups

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National Health Account 2010 – 2016 (CHECOD, FMoH and NBS)

IMG-20171025-WA0026

Policy Objectives Of The 2010-2016 NHA

The main goal of the 2010-2016 NHA is to demonstrate how Nigeria’s health resources are spent, on what services, which providers, who pays for them and through which schemes. NHA is used for monitoring health expenditure patterns and to provide requisite information to improve the capacity of decision-makers to identify health system problems and improve health system performance.

Key Findings

nha

Specifically, the NHA is expected to answer the following policy questions:

  1. How are resources mobilized and managed for the national health system?
  2. Who pays and how much is paid for health care?
  3. Who provides goods and services, and what resources do they use?
  4. How are health care funds distributed across the different services, interventions and activities that the health system produces?
  5. Which health providers benefit from health care expenditure?
  6. What is the comparison between funds released to and funds received by benefiting entities within the national health system?
  7. What is the level of resources mobilized for health within the country by development partners?
  8. What is the Total Health Expenditure (THE) for the country?
  9. What is the level of expenditure for preventive and curative health care?

In addition, the NHA sub-accounts for priority health interventions will be estimated. These include reproductive health, HIV/AIDS, Tuberculosis, Malaria, Non-Communicable Diseases and Neglected Tropical Diseases.

nha 2

National Health Accounts Core Team

  1. Federal Ministry of Health (FMoH)
  2. National Bureau of Statistics (NBS)
  3. Centre for Health Economics and Development (CHECOD)
  4. World Health Organization (WHO)

<<Contact us @ info@checod.org for the full report>>

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KENNETH OJO ANNUAL SYMPOSIUM (CHECOD and FMoH) – Maiden Edition

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DSC_0071Centre for Health Economics Development (CHECOD) in collaboration with Federal Ministry of Health hosted the maiden edition of Kenneth Ojo’s memorial symposium titled “Financing Universal Health Coverage in Highly Informal setting: Economic Imperatives of State Health Insurance and PHC Revitalization”. The symposium moderated by Dr. Francis Ukwuije of W.H.O had in attendance Professor Eyitayo Lambo, the former minister of health and participants from National Health Insurance Scheme, W.H.O, World Bank, USAID, National Primary Healthcare Development Agency (NPHCDA), EU-SIGN, Health Reform Foundation of Nigeria and other organizations. Through the keynotes address, panel discussions and audience discussions by way of questions and answers provided takeaway points in the symposium.

The Executive Director of CHECOD, Dr. Olumide Taiwo delivered the talk: “Why we are here, who will pay for health?” The presentation based on 2010-2014 National Health Account data, showed the need for State Health Insurance Scheme to reduce out-of-pocket spending for the vulnerable group. DSC_0043The trends in NHA, indicates increase in health spending, however taking into account population growth, per capita health spending is reducing. Feasibility study on Community Based Health Insurance Scheme carried out by CHECOD and National Health Insurance Scheme across the country shows that households are willing to pay for health insurance as a step towards Universal Health Coverage. The symposium also featured the presentation of the CHECOD Vision by the Director of Programs, Oluwole Smile. He enthusiastically rekindled the passion and vision of the founding chairman of CHECOD, Dr. Kenneth Ojo, to go beyond health financing to health informatics and actuaries science.

Highlight of the symposium was the keynote address presented by Professor Eyitayo Lambo, the former minister of health. In his presentation, Prof Lambo stressed the three objectives of UHC- equity in access, quality in healthcare service and protection from financial risk- universal health coverage is a destination, no country has 100% coverage. The path to UHC in Nigeria must be home grown, there must be political commitment, subsidies and compulsion to engage the informal sector, though that may be challenging. UHC cannot be achieved without revitalizing PHC. DSC_0057 (2)

The first panel discussion titled “UHC financing: what have we learnt and what is the way forward? gave answers to key questions on the challenges of NHIS and empowering the states to set up health insurance scheme. To involve the informal, they can take advantage of existing structure like the Trade Union to increase coverage. The second panel discussions- “Achieving UHC through PHC revitalization: Challenges and prospect”- brought to the fore that pooling funds is not the critical issues, but health facilities and human resource to improve the supply side of healthcare. In the years to come, the Centre will continue to have the symposium to provide a fertile ground for participants to share ideas on improving the health system. We look forward to our next gathering and are eager to hear success stories from those taking the lead in improving the health system in Nigeria.

symposium

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CHECOD, FMoH and NBS on National Health Accounts 2010 – 2014, Nigeria

CHECOD NHA

Policy Objectives of the 2010-2014 NHA

The main goal of the 2010-2014 NHA is to demonstrate how Nigeria’s health resources are spent, on what services, which providers, who pays for them and through which schemes. NHA is used for monitoring health expenditure patterns and to provide requisite information to improve the capacity of decision-makers to identify health system problems and improve health system performance.

Specifically, the NHA is expected to answer the following policy questions:

  1. How are resources mobilized and managed for the national health system?
  2. Who pays and how much is paid for health care?
  3. Who provides goods and services, and what resources do they use?
  4. How are health care funds distributed across the different services, interventions and activities that the health system produces?
  5. Which health providers benefit from health care expenditure?
  6. What is the comparison between funds released to and funds received by benefiting entities within the national health system?
  7. What is the level of resources mobilized for health within the country by development partners?
  8. What is the Total Health Expenditure (THE) for the country?
  9. What is the level of expenditure for preventive and curative health care?

In addition, the NHA sub-accounts for priority health interventions will be estimated. These include reproductive health, HIV/AIDS, Tuberculosis, Malaria, Non-Communicable Diseases and Neglected Tropical Diseases.

 

National Health Accounts Core Team

  1. Federal Ministry of Health (FMoH)
  2. National Bureau of Statistics (NBS)
  3. Centre for Health Economics and Development (CHECOD)
  4. World Health Organization (WHO)

<<Contact us @ info@checod.org for the full report>>

 

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FeaturedHealthcare Financing

Development of State Health Accounts for Sokoto and Bauchi States

State Health Accounts

Over the past two decades, macro-economic forces, mismanagement, political instability and corruption have led to inadequate financial resource flows to the Nigerian health sector.  Inefficient use of available resources, lack of financial management at all levels, the rise in poverty levels and an increase in the burden of disease such as AIDS/HIV/TB have also aggravated the problems.  In order to accelerate the process and progress of health sector reform, with ultimate aim of ensuring significant improvement in the health status of the Nigerian population, it will be extremely important to understand the broad financial dimensions of the health sector. There would be a need to generate and use relevant evidences, which are currently lacking. For example, the data available cannot adequately provide answers to the following basic questions: What is the total spending in the health sector? Who is spending? What is being spent on?  What are the sources of this expenditure?  In this regard, the health accounts would be an appropriate and consistent framework for modeling reforms and monitoring the impact of health care financing. Furthermore, it would be a vital instrument for describing and measuring the flow of health expenditures outlining total spending, the contribution to spending by different sources and claims on spending by different uses of fund.

Sokoto and Bauchi State require better planning to improve the efficiency, management, and distribution of health services, particularly for the poor and vulnerable populations such as women and children. But they lack the crucial information to coherently analyze the level of social protection and measure the extent to which people are protected against illnesses and have access to health services in state.  On routine and regular basis, they need to collect and analyze data on actual allocations and expenditure of resources and link them to health performance and system reforms.

 

Both states have indicated as priorities in their Strategic health development plans, the development of State health accounts SHA to measure the “financial pulse” of the health sector so that they can answer the questions: who is financing health, how much do they spend, how are the funds distributed, what is the financial burden on private households in the form of out-of-pocket expenditure, what kind of services are being purchased, and who benefits from these services.  By linking healthcare financing expenditures[1] with allocations, the SHA will provide information to state policy-makers to enable them discern system-wide inequities and identify areas that require changes in policy leading to improve access, utilization and better health outcomes.

[1] From central, state and local governments, international and indigenous donors, private contributors and households

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