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The Importance Of Full Implementation Of Basic Health Care Provision Fund (BHCPF) To The Health Sector In Nigeria

 Introduction

The World Health Organisation (WHO) Report of year 2000 rated Nigeria’s health system as one of the worst among member countries having placed 187th position among 191 countries. This provoked diverse responses from stakeholders over a decade that culminated in the enactment of the National Health Act, 2014 which provides a legal framework for the provision of health care services to all Nigerians and signifies Nigeria’s commitment to Universal Health Coverage (UHC). 

Basic Health Care Provision Fund (BHCPF) was established under Section 11 of the National Health Act 2014 as the principal funding vehicle for a Basic Minimum Package of Health Services (BMPHS) whilst also serving to increase the fiscal space and overall financing to the health sector. It is expected that the attendant service upscale arising from application of this funding would assist Nigeria achieve Universal Health Coverage (UHC).  

Funding of the BHCPF would be derived, as stipulated in the Act from contributions including


(a) an annual grant from the Federal Government of Nigeria of not less than one per cent       (1%) of its Consolidated Revenue Fund (CRF);                                                                                 


(b) grants by international donor partners; and  

                                                                                              (c) funds from any other source.  

        

*Purpose of BHCPF:*

50% of the fund shall be managed by the National Health Insurance Scheme (NHIS) through the State Social Health Insurance Agencies (SSHIAs) and used to purchase the BMPHS for beneficiaries who shall be confirmed as vulnerable and enrolled by the NHIS/SSHIAs. 

45% shall be disbursed by the National Primary Health Care Development Agency (NPHCDA) through State Primary Health Care Development Agencies (SPHCDAs) for strengthening the Primary Health Care (PHC) system as shown in Figure 1 below. 


5% to be administered by the National Emergency Medical Treatment Committee (NEMTC) shall be used for providing Emergency Medical Treatment. 


*Figure 1. Flow of funds for health services.*

Implementation of BHCPF


Implementation of the BHCPF as stated in the NHA, 2014 requires the definition of a BMPHS for Nigerians by the National Council on Health (NCH), the establishment of functional State Primary Health Care Development Agency (SPHCDA) and State Social Health Insurance Agency (SSHIA) in each state of the federation and FCT; and the identification of one Focal Primary Health Centre (PHC) per political ward to be accredited for provision of primary care and referral services for all Nigerians especially the vulnerable. The guiding principles of implementation of the fund as stated in the September, 2020 guidelines approved by the Emergency National Council on Health on 6th August, 2020 are as follows:

*Population Coverage:* The BHCPF shall focus on provision of a BMPHS in line with the NHAct 2014 for all Nigerians especially the vulnerable population.


*Service Provision:* Provision of health care services within the BHCPF shall be by public and private Primary and Secondary Health Care facilities duly registered by the State Ministries of Health (SMoHs) or the FCT Health Secretariat and granted a Certificate of Standards.


*Scope of Services:* This is based on the Basic Minimum Package of Healthcare Services (BMPHS) as defined by the Honourable Minister of Health in line with the NHAct 2014.


*Governance Structure:* In line with the NHAct 2014, the 3 payment gateways shall be responsible for management of the funds, under the supervision of the Honourable Minister of Health and Honourable Commissioners for Health at federal and state levels, respectively.

*Flow of Funds:* Funds will be transferred from the Consolidated Revenue Fund account by the Federal Ministry of Finance (FMoF) to the 3 gateways (NHIS, NPHCDA, and NEMTC). The NHIS and NPHCDA gateways will in turn allocate the funds to the corresponding state gateways (SHIA and SHIS, SPHCDA and SPHCB) which shall disburse directly to health facilities. For the NHIS gateway, the SHIA shall pay health facilities according to the number of persons enrolled and services rendered for referred cases while NEMTC shall pay emergency service providers directly.   


*On-boarding of States:* On-boarding to each gateway by state level organs can be achieved by fulfilling the eligibility criteria for each gateway through release of 25% of the total cost of projects as counterpart funding as stipulated in the NHAct. 2014. State governments may wish to set aside 25% of the cost of the project from their annual budgetary provision as first line charge.

*Enrolment (NHIS Gateway only):* Enrolment activities will be carried out by NHIS/SSHIAs 

Monitoring and Evaluation: There shall be routine monitoring and periodic evaluation of activities related to the Fund by the respective gateways and their state counterparts..


*Benefits of BHCPF Implementation*

Equitable access to health care services across population groups.

Improved quality of services provided in the healthcare system.

Financial risk protection through reduced out of pocket expenditure. 

Transparency and accountability in management of funds in the health sector.

Improved infrastructure. 

Increased availability of medicines and consumables.

Increased job opportunity and improved human resources for health. 

Improved health outcomes and indices. 


*Challenges in Implementing BHCPF*

Despite the yearly appropriation of the Fund since 2018 to date, the gateways at states level, especially the health insurance gateways, are still having diverse challenges in accessing the first tranche of the funds occasioned by the technicalities in operating the BHCPF TSA accounts on remita platform.   

Most of the SSHIAs that are to conduct accreditation, enrollment and management of medical costs are at rudimentary stages of their set-up and so lack the personnel and competences for implementation of the Fund. 

States governments’ unwillingness to release the 25% counterpart fund which is a prerequisite for accessing the Fund.

Disparity between the interest of development partners and indigenous stakeholders in determination of coverage, benefit package and provider payment mechanism.


*Conclusion.*

The importance of full implementation of BHCPF to Nigerian health sector cannot be over emphasized in the face of global economic recession.  It is therefore desirable for all stakeholders to be resolute in playing their roles in ensuring it happens. 


 _Dr. Adeniyi Oginni, MBChB; MPH; Ph.D. 

Executive Secretary, Osun Health Insurance Agency &

Chairman, Forum of CEOs of SSHIAs in Nigeria._

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