NIGERIA

Country presentation:State of Health Care Financing

by

Chima A. Onoka and Chijioke I. OkoliHealth Policy Research GroupUniversity of Nigeria, Enugu

1. HOW IS REVENUE COLLECTED IN YOUR COUNTRY?

Who are health care funding contributions collected from:

– Individuals – Government– Private employer/Company– Donor funds and NGOs World Bank WHO UNICEF

How are these contributions structured?

Individuals OOPS insurance (national health insurance

5%, CBHI contributions)

Government – taxes direct taxes (10% income taxes from

the formal sector) indirect taxes (VAT 10%, etc) Revenue (especially from the oil

industry)

How are these contributions structured?(contd)

Private employer/Company

Prepaid insurance Waivers

Donor funds and NGOs GRANTS LOANS TECHNICAL ASSISTANCE DONATIONS

Who collects them?

Government finance agencies (taxes deducted at source from employees in the formal sector)

Health facilities – public and private (OOPs)

Community Health Committees (CBHI for the informal sector)

Private organization/Corporate bodies (deducted at source from employees’ salaries)

2. How are funds pooled in your country?

What is the size of the population?

140 million (70% rural, 30% urban)

Which groups are covered by each financing mechanism?

Pool Groups covered % covered

OOPs General public 75%

NHI (formal sector) Formal sector (federal Govt employees) [Mandatory]

5%

CBHI (informal sector)

Informal sector (Pilot rural communities) [Voluntary]

5%

Private/Corporate bodies insurance

Employees (families and dependants) [Mandatory]

10%

Private voluntary health insurance

Individuals 5%

What are the allocation mechanisms for

distributing pooled resources?

0

10

20

30

40

50

60

70

80

90

100

%

OOPs NHI (formal sector) CBHI (informalsector)

Private/Corporatebodies insurance

Private voluntaryhealth insurance

POOL

URBAN

RURAL

3. How are services purchased in your country?

What services are included in the benefit package

OOPs All health care services

NHI (formal sector) Common infectious and non infectious diseases, maternal and child health services

CBHI (informal sector)

Private voluntary health insurance

Private/Corporate body employee insurance

All health care services except high cost-demanding chronic illnesses e.g. cancers

What provider’s payment mechanisms are used?

Fee for serviceCapitationsSalariesBudget allocation

How equitable is health care financing (both in terms of who bears the burden of health care financing and who benefits

from health care)

Based on Socioeconomic groups

0

5

10

15

20

25

30

35

40

45

50

%

HIGH MIDDLE LOW

SE CLASS

BURDEN

BENEFIT

Percentage of income spent on healthcare

Based on rural – urban groups

30%

70%

RURAL

URBAN

Based on public spending per capita for health ($)

2

8

RURALURBAN

What factors contribute to equity or inequity in financing in your country?

Low budget allocation ( 5% of per capita GDP)

Low income per capitaPoor solidarityMal-distribution of Health workersPower (political)

To what extent are households provided with financial protection in your country?

Exists only amongst the private organization employee insurance schemes though limited

to the very rich ones like oil companies

3 out of 36 states and FCT (Abuja) of the country offer free emergency care for

accident victims for the 1st 24hrs, but only in the tertiary hospital in the states

EVERYONE IS ON HIS OWN

Way forward

• incentives ( rural allowance) for medical personnel (doctors, nurses etc) working in rural areas

• basic infrastructure like power supply, paved road network and water supply

• transparency and accountability in the management of CBHI funds

• expansion of national health insurance (NHI) to state and local government employees

• Beneficiaries of NHI: who really are employees’ dependents?

Way forward (contd)• In PHC centres YOUTH Corps doctors (post-

interns) are often used, it relegates usage to low income category and trivializes the set up

• ensuring that PHCs are consistently manned by qualified medical personnel (in order to increase utilization)

• commitment on the part of government (policy consistency)

• consistency in drug supplies• De-emphasize political appointments in health

ministry (how?)

Thank you