Establishing state national health insurance schemes.
Nigeria adopted the Bamako Initiative to improve service equity, quality, and community participation through decentralization.
Nigeria has long put UHC at the center of its health agenda, and new reforms at the federal and state levels have the potential to advance Nigeria’s progress. These reforms will need to overcome significant challenges, includinghigh out-of-pocket expenses, low budget allocations and expenditures at all levels of government, and limited coverage through health insurance and other demand-side financing mechanisms. The Government of Nigeria is working with local and international partners to overcome these challenges and improve health financing and expand coverage of basic primary care services for the poor and most vulnerable.
The launch of Nigeria’s National Health Insurance Scheme (NHIS) in 1999 marked the first milestone toward UHC in Nigeria. The NHIS covers government and private sector employees, students in tertiary institutions, and individuals who wish to contribute voluntarily into the insurance pool. The 2006 National Health Policy redesigned the NHIS, aiming to protect families from medicallytriggered financial hardship; limit rising healthcare costs; equitably distribute healthcare costs and health facilities among income groups; ensure quality and efficiency; and harness private sector participation.However, extending coverage of health insurance to non-federal government employees through the NHIS has been a persistent challenge.
In March 2014, stakeholders attending the Presidential Summit on UHC in Abuja adopted the UHC Declaration,affirming that health is a fundamental human right and that the government is responsible for guaranteeing healthcare for all Nigerians.The Declaration was further supported by the establishment of the National Health Act of 2014 (NHA).The NHA earmarks a portion of federal revenues for a Basic Health Care Provision Fundto make supply and demand-side investments for primary health care, helping to implement more equitable and efficient health care financing on the path to UHC and provide essential services to the most vulnerable members of the population.
These federal policies have also translated to reform efforts at the state level. Multiple state governments have passed or are in the final stages of passing state-sponsored health insurance bills to provide financial risk protection and access to quality care for their residents. States have also started implementing the Primary Health Care Under One Roof policy, which aims to integrate all primary health care (PHC) structures and programs at sub-national levels, under one state level body, and in the process, improve the implementation of PHC. Finally, the National Primary Health Care Revitalization Initiative aims to make at least one PHC center per ward fully functional, ensuring that all Nigerians have access to the essential package of basic health services at the PHC level.
Impact: Cross-Country Knowledge Sharing
Practitioners and policymakers from Nigeria participated in their first JLNworkshop in Mombasa, Kenya in June 2011.After the workshop, Nigeria became the 8th member of the JLN. Since joining the network six years ago, Nigeria has actively participated in several key collaboratives, including:
• Domestic Resource Mobilization
• Expanding Coverage Collaborative on Reaching the Poor
• HFG Governing for Quality
• HFG Stakeholder Communications for UHC
• IT Core Business Requirements
• IT-Provider Payment Data Analytics
• Leveraging Existing Resources for Efficiency
• Medical Audits
• PHC Measurement for Improvement
Nigeria was also a major contributor to the Data Analytics for Monitoring Provider Payment Toolkit.
Subnational JLN for UHC in Nigeria
The Government of Nigeria, including the Federal Ministry of Health (FMOH), National Primary Health Care Development Agency (NPHCDA), and National Health Insurance Scheme (NHIS), with support from a consortium of development partners, is launching a Nigeria Subnational Joint Learning Network for Universal Health Coverage.
This state-to-state network will connect practitioners and policymakers to enable learning exchange and knowledge co-production in support of health care financing reform, both across states and between the state and federal levels. The subnational network will build on Nigeria’s participation in the global JLN since 2011, leveraging the global JLN’s joint learning model for practitioner-to-practitioner knowledge exchange and co-production of new products and tools that can be adapted and implemented to support country’s UHC reforms.
Stewardship of the subnational network is provided by the JLN Nigeria’s country core group. The network is co-funded by the Bill and Melinda Gates Foundation and USAID through the Health Finance and Governance Project, in partnership with the World Bank. Results for Development Institute and Solina Health are providing network coordination.
A start-up workshop to support network design and learning prioritization was held in July 2017 in Abuja, with an initial group of 10 Nigerian states, including Abia, Bauchi, Cross River, Osun, Niger, Kaduna, Sokoto, Lagos, Rivers, Kwara, and federal government representation from the FMOH, NPHCDAand NHIS. Technical collaboratives for the subnational network will be inaugurated in fall 2017.
Nigeria Country Core Group Members
• Dr. Nneka Orji, Federal Ministry of Health
• Mr. Mshelia Christopher, National Health Insurance Scheme
• Dr. Lekan Olubajo,National Primary Health Care Development Agency
• Modupe Ogundimu, Nigerian Representative and Co-Convener of the Steering Group of the JLN
• Chioma Ogbozor, Learning Coordinator (supported by the World Bank)
Country Core Group Members
National Health Insurance Scheme, Nigeria
Dr. Nneka Orji
Ministry of Health
Christopher Samba Mshelia
National Health Insurance Scheme, Nigeria
Ministry of Health
by Rakiya A. Muhammad, allAfrica
by Stefan Nachuk, Amanda Folsom, and Nathaniel Otoo, PLOS
Expanding access to health insurance is an important part of an overall strategy to achieve universal health coverage (UHC). Nigeria will need to make crucial decisions if access and financial protection in the context of health are to be expanded to cover the majority of the population. The Health Policy
The review indicates that UHC interventions in low- and middle-income countries improve access to health care. It also shows, though less convincingly, that UHC often has a positive effect on financial protection, and that, in some cases it seems to have a positive impact on health status. The review also
This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured