Table 3 Participants’ perceptions of performance of major health financing mechanisms in Nigeria
| Â | Government budget | OOP | FSSHIP | CBHI | Donor funding |
|---|---|---|---|---|---|
Efficiency | Highly inefficient. Funds are inadequate and disproportionately allocated b/w personnel and service delivery. Allocation is not based on epidemiologic or demographic evidence. Hence, no value for money. | Regressive and highly inefficient. Pool is fragmented. Running cost is high. | NHIS has made efficiency gains but FSSHIP is inefficient because employees have not started contributing. Use of HMOs ↑s admin cost and ↓s what is available for service delivery. Difficult to ascertain value for money. | Efficiency is low because size of pool is too small | Opinions varied. Efficient because it employs cost-saving mechanisms to achieve high impact, and fiduciary and accountability requirements are strict. Inefficient because resources are sometimes wasted due to weak coordination of donor funds. |
Equity | Inequitable. Mainly funds tertiary hospitals at the expense of needed primary care. No fairness in geographic distribution of resources. | Inequitable. Access to healthcare is determined by ability to pay. | Limited to FG employees and beneficiaries. Majority of Nigerians are not covered | Inequitable. Coverage is low | Donor funds are earmarked for specific services that do not benefit everyone. |
Quality of care | Generally suboptimal but varies across facilities – quality of care is better in tertiary hospitals | Directly linked to affordability and availability of services | Benefit package is not comprehensive and quality of care is suboptimal | Depends on the scheme and process of implementation | Perceived to be relatively high. |
Effect on household health expenditure | Has not reduced OOP or catastrophic health expenditure | High tendency for catastrophic health expenditure | Reduces direct OOP for enrollees for services covered | Risk protection for basic health services | Tendency to reduce direct OOP for services covered |
Sustainability | As predictability (in time and amount) of funds. Perceived to be predictable in time but unpredictable in amount due to economic and political contexts | Not sustainable. Depends on ability of users to pay for health services | Current practice (FG statutory transfers) is unsustainable. HMOs are paid based on enrollees allocated rather than productivity | Not sustainable without cross-subsidization | Not sustainable. Lack of or delay in payment of counterpart funds by some State governments. Apparent donor fatigue |