Vulnerable Groups SHIP in Nigeria





Vulnerable Groups Social Health Insurance Program in Nigeria

Despite large investments in expanding coverage of health in Nigeria, barriers still exist that prevent adequate utilization of these services by the poor. Consequently, direct interventions are required to reach the socially and economically excluded.  Ensuring a healthy population is one of the social welfare responsibilities of government particularly the provision of welfare support for these identified vulnerable sub-population groups.  Therefore, strengthening social protection systems through policies targeted towards designing of appropriate social protection instruments, that are most suitable for reducing disparities in accessing health services is increasingly becoming a priority area of work for governments at all levels.

With the realization that urgent and explicit changes are required to organize, integrate, and improve the delivery system, Federal government held a Presidential summit on Universal Health Coverage (UHC) committed all levels of government to place a high priority on establishing mandatory health insurance in Nigeria with special funds to expand financial risk protection mechanisms for the poor and vulnerable groups.  Hence the need for this study to generate evidence for NHIS and other stakeholders to develop financial protection strategies to target these disadvantaged population sub-groups against catastrophic medical spending.

But who are the vulnerable?  >>>Click here to download VGSHIP Executive Summary<<<


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Lead Consultancy Report on the Final Reports of Consultants from the Zones on the Feasibility Study for Community Based Health Insurance Scheme in Nigeria


Introduction: As part of preparation for the field work, a national technical workshop was organized for the development and harmonization of the tools, methodology, work plan and reporting format for the studies. During the workshop, each consulting firm made presentation on the methodology, data
collection tools, reporting format, etc. To ensure quality in the process, a consultant from the National Bureau of Statistics (NBS) was invited to make a presentation on the standard methodology for sampling and to advice on the source and use of Enumeration Areas (EA) for the study. An interactive and plenary format was adopted for the workshop process with the participants breaking into groups with specific topics assigned to them to develop and subsequently present at plenary. Each group’s presentation at the plenary, were extensively discussed and the agreed outcomes were harmonized and adopted as the appropriate tools for the survey and reporting format for all zonal consulting firms.

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Papers & ArticlesReports

Cost of Routine Immunization in Nigeria


Background: With the active collaboration of development partners and governments, there have been progressive increases in immunization coverage in Nigeria, but the challenges of sustaining these gains is yet to addressed.   It is within this context that EU-PRIME[1] assisted to facilitate the establishment of an enduring and sustainable immunization financing system in Nigeria, with particular reference to the EU-PRIME focal States.  At the Local Government Area level, effective resource mobilization is constrained by lack of detailed cost estimate of immunization services in Nigeria.  This study was therefore, commissioned by the EU-PRIME in collaboration with the National Primary Health Care Development Agency (NPHCDA) to determine the cost of a fully immunized child in Nigeria. The outcome of the study would provide evidence on resource needs, availability and gaps; which are required for planning an appropriate and sustainable immunization financing strategy beyond the lifespan of the EU-PRIME Project.  The objectives of the study are to:

  1. Determine the total cost per fully immunized child in Nigeria.
  2. Develop cost projections for routine immunization at federal, EU-PRIME focal states[2] and LGAs from 2007 to 2010.
  3. Analyse the current and anticipated financing of routine immunization at all levels against projected costs, determining funding gaps and their implications for routine immunization at national, EU-PRIME focal states and the LGAs.

 >> Click here to download article <<

 Kenneth Ojo, Centre for Health Economics and Development, Abuja, Nigeria
Ibrahim Yisa, Partnership for Transforming Health System II, Abuja, Nigeria
 Adedoyin Soyibo, Health Policy Training And Research Programme Department of Economics, University of Ibadan, Ibadan, Nigeria
 Lekan Olubajo, National Primary Health Care Development Agency (NPHCDA)
Paul Schoen,  Economic Development Group, Hubconsult Ltd, UK


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Economics of Health Insurance: Issues for Research in Nigeria


Abstract: Despite the growth and the key role of health in the economic development of a country, financing quality universal health care is still a major challenge in Nigeria. The dysfunctional state of public sector health facilities and low levels of consumer satisfaction with publicly financed health care have resulted in the loss of a form of social protection for a large portion of the population especially rural households and those working in the informal sector. This paper aims to explore the economics of health insurance in Nigeria. Within the broad framework, it attempts to identify the key issues for research, review what is known about them, and identify the major challenges for proper assessment of the economic impact of health insurance. Nigeria operates public-private mix of health insurance system. Although private health insurance coverage is still low, the market is expanding across the country. Therefore, policy goals for the health insurance sector in Nigeria may require reassessment in light of recent evolutions in the system and evidence of its performance. While NHIS has made progress in extending coverage, the issues of functioning regulatory framework and effective institutional arrangements still requires further improvement. Presently, there are various community-based health financing schemes in Nigeria today, but the long term impact will depend on the level of social capital in the community. Other issues on the research agenda are how to make the best possible use of parallel public and private health insurance in Nigerian settings where health systems are weak and how to design alternative health insurance strategies to improve financial protection and access to care in such settings. However, this paper has highlighted a range of empirical questions that need to be answered if the economics of the current public–private mix
in health care, health insurance and health financing are to be properly assessed.

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Willingness to pay for voluntary contributor social health Insurance (VCSHI) in Nigeria


Nigeria is currently facing severe budgetary constraint to provide adequate health for the majority of its citizens. The declining budgetary trends are generating serious concern about the equity,
efficiency and sustainability of public subsides as a mechanism in health sector financing. The NHA 2003-2005 estimates for Nigeria shows that about 70 percent of the total expenditure on health is through out-of-pocket payments by households. The catastrophic consequences of this have pushed
some households into poverty. It then becomes necessary for the governments of Nigeria and other stakeholders to aggressively embark on policies and programs that will reduce the burden of household health expenditure and guarantees equitable access to health services, regardless of
individual income or social status. These necessitated the establishment of Voluntary Contributors Social Health Insurance Programme (VCSHIP) for those who are not currently covered by any existing NHIS programme. But with declining economy and rising level of poverty, there is the possibility that the lower income groups may not have the ability to pay. Moreover, experience has shown that households in the low income brackets are more sensitive to price changes in health care services. Consequently, policy should be directed on how to price health services that will take account of
demand or people’s willingness and ability to pay. It is important to know whether the households are willing to pay for health insurance and if so, how much? What factors determine their willingness to pay? Does the average households’ willingness to pay match or exceed the cost of their health care?
This informed the decision of NHIS to conduct a study on willingness to pay for VCSHI. The broad aim of conducting this study was to explore the factors that are responsible for willingness to pay for VCSHI in Nigeria. The idea was to generate evidence to help guide policy on financial protection for
millions of Nigerians. We also aimed to gain insight into the options available for equitable implementation of the VCSHI program.

The results from this current study have shown that people are very enthusiastic about joining in the voluntary contributor social health insurance scheme. Indeed, Nigerians are willing to make some financial sacrifice to pool resources against catastrophic cost of illness. With high degree of acceptability, willingness to enroll and contribute, there is a high interest in VCSHI. The result from the survey shows that19.29 million or 97.3% out of the total households of 20 million support its establishment. This is also the case for employers and their employees where approximately 74% of the sampled enterprise accepted the scheme. It is therefore, obvious that there is potential demand for health insurance in Nigeria which will require further research. While there is such high enthusiasm in joining, this is not always carried through to the decision to pay for the scheme. Cautiously, the amounts indicated by the respondents should be viewed as only evidence to support the hypothesis that the Nigerians are willing to pay and not as the exact amounts, they will be able to pay at time of implementation.One of the major barriers to paying for the scheme is access to financial means of payment. Only a few proportions of employers and individuals are willing to pay at least N1200 per individual per month to join the scheme. Majority of the sample were willing to pay less than N400 per individual per month to join in the scheme. This raises a lot of policy questions that need to be looked at.

The first issue relates to income generating capacities of households and businesses. The informal sector makes up a large proportion of the labour force in Nigeria. With the exception of a few, this category of people earns relatively meagre incomes. This is one of the reasons why they have indicated that they are only willing to pay an amount that is less than that prescribed by the
government. Another issue is that people react to past outcomes in making present decisions. This relates to the level of trust in the management of the funds. For sustainability and good governance, there is an overriding need to guarantee Nigerians that their contributions in the insurance fund will be
secured and a minimal level of quality care will be available on demand.Such trust issues are relevant and needs to be addressed in order for the scheme to be able to raise sufficient funds.

Because the amounts households and informal sector workers are willing to pay are small, there will be a need for the government to guarantee some transfers to the scheme in order for it to operate efficiently and effectively. This is even reinforced by the result that shows that financial consideration
was one of the most important reasons for not willing to contribute to the VCSHIS across the zones. The government can decide to cover the cost of care for those that are unable to pay for the scheme. Because the mean amounts that households and employers are willing to pay vary by geopolitical
zones, such transfers should reflect the deficiencies that exist in each geopolitical zone. At the minimum, subsidy should be given to the very poor who may not be able to access health care services given their low level of income, vulnerability to diseases and poor health seeking behaviors.
But over the last three decades there has been growing concern on the effectiveness and performance of government interventions in financing health care in Nigeria. In response, the overwhelming suggestion has been on reducing the role of government and on reforming public management by
adopting aspects of private sector practice. This position is predicated on the possibility that private sector expansion may be able to correct current imbalances and government failures and mobilize additional resources for health sector investment. But with the introduction of VCSHIP, what should
be the role of government? In particular, the role of NHIS needs to be carefully defined in terms of policy objectives and the limits of its capacity as a regulator and a provider. With the demand for increasing role of the private sector in health insurance in Nigeria, government will have to improve its capacity to take on a new responsibility to regulate and develop incentive mechanisms to promote cost control, quality assurance, equity and access for the poor. As an
outcome of this study, it is recommended that government should take on the role of coordinator, facilitator, supervisor and regulator of private sector health insurance activities. This will enable government to address potential problems of over-provision, moral hazard and adverse selection. The
involvement may also include the creation of incentives for cost-sensitive provider/consumer behavior (for example, capitation payments, co-insurance), tax relief for private providers located in rural areas
as well as training programs for HMOs and other stakeholders in Nigerian health insurance sector. Notwithstanding, many outstanding policy questions still need to be carefully addressed in order to ensure effective implementation of the VCSHIP.

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