Table 4 Needed change and future prospects of major health financing mechanisms in Nigeria

Government budget

Efficiency in health spending needs to be boosted. Wastages need to be reduced

• Use evidence to advocate for more budget for health.

• Health spending should be results-driven and performance-based using relevant evidence (learn from private sector and donors)

Need to improve transparency and strengthen accountability mechanisms

• Institutionalize Health Accounts to publicly disclose budget performance and make information accessible to citizens

• CSOs to do more budget tracking and advocacy and promote citizens’ demand for government accountability

Enhance sustainability

• Expand revenue streams (Tax administration and tax policies should focus on areas that need to be taxed e.g. informal and private sectors as has been done with success in Lagos state

OOP

Quality of care needs to improve, and users’ need to be unhindered in their choice of providers

• Establish systems that deliver quality and

• promote consumerism (users should have a choice of where to purchase services without price discrimination)

NHIS

NHIS needs to be strengthened to perform its regulatory and quality assurance roles.

HMOs need better regulation

• Capacity building of NHIS staff on implementation of regulatory frameworks.

• NHIS should perform its oversight roles – enable them identify loopholes in the system and institute measures to block them

Coverage of NHIS needs to improve and be expanded to the informal sector

• Amendment of the legislation that established the NHIS which made health insurance voluntary rather than mandatory. Engage States in the process.

• CSOs should be engaged in sensitizing the informal sector

Premium contribution by enrollees of FSSHIP

NHIS and government need to develop a proper advocacy tool to reach the end users (negotiations with labor unions)

Lack of evidence of impact of NHIS

NHIS should commission a study to assess the program and produce evidence on impact

Quality of care needs to improve

Revision of NHIS benefit package and essential drugs formulary to be more comprehensive

CBHI

Larger pools are needed to ensure risk equalization

Pooling should be done more centrally (e.g. at the LGA levels)

Need for cross-subsidization to improve efficiency

Government should provide funds for subsidization. These could be earmarked for the poorest and most vulnerable groups

Purchasing should be more strategic

Technical facilitators (such as NHIS, HMOs, trained MHAs) should be engaged to assist with purchasing

Donor funding

Public finance management needs to be strengthened for better coordination of donor funds

Review and revise the PFM system to enable donors bring their money into the system

Sustainability of donor funds need to be improved through counterpart funding

State governments need to meet their responsibilities by paying counterpart funds

Depend less on donor funding for delivery of certain health services

Explore other internal sources of funding for health care such as corporate social responsibility of private companies