Dr. Francis Ukwuije

Head, Healthcare Financing Equity & Investment, HSS, DHPR&S FMOH

27 June , 2016

Federal Ministry of Health

Central Coordination for Financing UHC in Nigeria: Progress & Next Steps

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Background

Need for Strong Govt Leadership

Central National Coordination for UHC

Opportunities

The National Health Act 2014

President’s Pledge on Health

What We’ve Started Doing

Summary/Conclusion 2

Presentation Outline

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BACKGROUND

Federal Ministry of Health 4

NIGERIA

• Population Over 180M

• Federal system of government • Federal, States, LGAs

• 36 states & Federal Capital Territory (FCT) • 774 LGAs

• 3 levels of health care delivery

• tertiary, secondary and primary

• About 70% of Nigerians live in rural areas (LGAs) and there are over 20, 000 PHCs in Nigeria

Federal Ministry of Health 5

NSHDP 2010-2015 Goal » UHC

Source: NDHS 2003, 2008 & 2014

Indicator (%) 2003 2008 2013 Modern Contraceptive Prevalence Rates

8.2 9.7 9.8

Total Fertility Rate 5.7 5.7 5.5 Antenatal Care Coverage 60.1 58 61 Delivery in a Health Facility 32.6 35 36 Skilled Birth Attendance 41.8 39 38.1 DPT3 Coverage 20.1 35.4 38 Measles Coverage 31.4 41.4 42

• Maternal deaths 576 per 100,000 live births

• U-5 child mortality 128 per 1,000 live births (2013)

• Poverty: 61% < $1/day • 5-7% Insurance Coverage • Over 60% OOPS

What Was the Situation?

Federal Ministry of Health 6

Total health expenditure (THE)

was 6.7% of GDP in 2009

(>4-5% Benchmark)

5-7% population covered by pre-

payment and risk pooling schemes

(< 90% Benchmark )

< 2% coverage of population with social

assistance and safety-net progs

(< !00% Benchmark)

Out-of-pocket spending >60% of

total health expenditure

(>30-40% Benchmark)

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Nigeria Was Not on Track Towards UHC

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Need for Clear & Strong Government Leadership &

Commitment

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Presidential Declaration on UHC; March 10,

2014

Federal Ministry of Health 9 9

Central National Coordination for UHC

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HEALTHCARE FINANCING EQUITY & INVESTMENT (HCFE&I) BRANCH,

LOCATION: Health Systems Support (HSS) Division,

DHPRS, FMOH

MANDATE: Provide overall policy and strategic

direction towards achieving the Presidential mandate and deliver Nigeria’s UHC

targets in line with the NHAct 2014 and SDGs

through leveraging existing resources and building

appropriate partnerships

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UHC

Quality of Care NAFDAC,

Regulatory Bodies, Other

MDAs & Partners

Physical Access

NPHCDA, MSS, SURE-P, GF, GAVI, Others

Risk Protection

NHIS, CBHIS, PHI, Free

Health Schemes,

Others

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OPPORTUNITIES

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THE NHAct 2014: VEHICLE FOR ACHIEVING UHC

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3 Main Sources

FG Grant at Least 1% of CRF

Donor Funding

Other Sources including Private

Sector

BHCPF

Distribution

50% for BMHCP through

Insurance 45% for Primary

Healthcare

5% for Emergency

Care

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Basic Healthcare Provision Fund (BHCPF)

Federal Ministry of Health 15

review policy to ensure efficient and effective management of our health system with focus on

prevention

Ensure that no Nigerian will have any reason to go outside the country for medical treatment

Guarantee financial sustainability to the health sector and minimum basic healthcare for all

Review occupational health laws and immediately commence enforcement of the provisions to reduce hazards in the work

place

Partner with state Governments and development partners to ensure all round implementation of our primary health plans by

expanding access to health insurance for rural communities

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The President’s Pledge for Health

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WHAT WE’VE STARTED DOING

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Wide Strategic

Stakeholder Engagement UHC/HCF&E

Roadmap

Domestic Resource

Mobilization (DRM);

Global Financing Facility (GFF); Joint Learning

Networks (JLN);

National & State Coordination

Platforms-HCFE&I Units,

TWG, JLN Priority Setting;

UHC Impact

Analysis & Investment

case

National HCFE&I Policy &

Implementation Strategy

Operationalization of the National

Health Act 2014; SHIS & SPHCDAs

National Health Policy Review & Review of NSHDP1 for

NSHDP2

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SUMMARY

Federal Ministry of Health 19

• Even though Nigeria was not on track towards UHC

• Presidential Declaration of UHC March 10 2014, and the NHAct 2014 became the game-changers within the context of NSHDP to establish strong political commitment and leadership

• Institutional Structures in place at the HCFE&I FMOH for central coordination of UHC

• Process of Review/Development of Policies and Guidelines on-going

• Urgent need to accelerate establishment of State Health financing Units, TWG, SHIS, and SPHCDA towards strong coordination and implementation of UHC at sub-national levels.

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THANK YOU

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