Health Reform in Nigeria: A Journey towards Universal Health Coverage
June 2020 —
A webinar on June 25 highlighted Nigeria’s successes in achieving health reform, advanced over two years with support from USAID through HP+. Presenters, including HP+ Project Director Suneeta Sharma, HP+ Nigeria Country Director Frances Ilika, and Osun State Health Insurance Scheme Executive Secretary Adeniyi Oginni, discussed domestic resource mobilization, capacity development of primary healthcare management, and health insurance coverage expansion in the Federal Capital Territory and Abia, Ebonyi, and Osun States. Advancements include the unlocking of US$58 million for health to aid advocacy and policy reform and the enrollment of 345,000 individuals in health insurance schemes in Osun State and the Federal Capital Territory.
Nigeria’s National Basic Health Care Provision Fund Makes Significant Strides
May 2020 —
In December, with support from the USAID-funded Health Policy Plus (HP+) project, two Nigerian states—Ebonyi and Osun—passed a series of state-level bills legalizing state health insurance schemes. The bills’ passage marks an important milestone for Nigeria’s national Basic Health Care Provision Fund (BHCPF) by establishing the necessary structures for the fund’s rollout at the state level. HP+ and other partners also secured government approval of the BHCPF’s previously stalled Operations Guidelines, unlocking US$150 million in appropriated funds. Once in place, the BHCPF will substantially improve Nigerians’ access to high-quality healthcare, especially among the poor. In addition, HP+ successfully advocated for the inclusion of Nigeria’s Federal Capital Territory (FCT) as one of the states to benefit from initial implementation of the fund, along with Abia, Edo, Katsina, Osun, and Yobe.
Nigeria’s Abia State Government Releases Funds for Technology Infrastructure to Support Health Insurance Rollout
March 2020 —
Nigeria’s Abia State government has formally approved the release of US$137,000 as take-off grant to be used for procuring technology infrastructure—a critical need that has delayed the rollout of the state insurance scheme since its official launch in September 2019. HP+ has supported Abia State Health Insurance Agency (ABSHIA) in multi-layered advocacy efforts that resulted in the release of the take-off grant. The release of the grant will enable an effective rollout of the ABSHIS toward providing health insurance for about 200,000 residents—a major leap forward in improving access to affordable and equitable quality healthcare in the state.
PEPFAR Minimum Requirements Webinar
February 2020 —
HP+ led a webinar on January 30th to discuss how countries -- with examples from Botswana, Nigeria, Tanzania, Kenya and Indonesia -- have met PEPFAR’s minimum program requirements for policies and practices essential for success. With special guest Sylvain Bowra of the State Department in Botswana, HP+ contributors shared a new resource illustrating the status of each of the minimum requirements across all PEFPAR countries.
USAID, through HP+, Recognized for Support of Sweeping Health System Reforms in Nigeria
January 2020 —
“No other organization supports [the National Health Insurance Scheme] like HP+.” That was the first reaction of Professor Muhammed Sambo, Executive Secretary of Nigeria’s National Health Insurance Scheme last week when reviewing recent results that come in part from technical and financial support given to establish state-level insurance agencies in four Nigerian states. The health reform goal is to reach women and children under five, and to date, Osun state has enrolled over 200,000 participants into their insurance scheme. In the Federal Capital Territory health insurance coverage has been extended to 85,000 formal sector workers and $2.19 million was released to pay for nine months of capitation and fee-for-service. Likewise, in November 2019, Nigeria’s National Primary Health Care Development Agency presented HP+ with an award in recognition of the project’s technical contribution to strengthening the country’s primary healthcare system, specifically for their work in helping states implement Nigeria’s Primary Health Care Under One Roof policy, aimed at improving the quality of and access to care at the community level. More information about efforts in Osun State
Project-supported States Achieve High Marks in Basic Health Care Provision Fund Performance Scorecard
December 2019 —
In Nigeria, HP+ has been working to support implementation of the Basic Health Care Provision Fund (BHCPF)—a critical health reform aimed at improving and expanding high-quality, affordable, accessible primary healthcare services to all Nigerians. This month, the first-ever BHCPF scorecard, intended to showcase state-level readiness and initial implementation of one of the key sources of federal-level funding for the BHCPF, was rolled out. The evaluation revealed that, of all 24 states assessed, only three (Abia, Osun, and the Federal Capital Territory)—all of which were supported by HP+—met all of the requirements. A fourth HP+-supported state (Ebonyi) met all but one requirement. The scorecard assessed whether proper structures were put in place to accept federal-level funds for implementation, facility baseline assessments were conducted, and a significant cascade of facility-level trainings on BHCPF implementation were completed. HP+ support to this effort is critical, as the project has worked to improve institutional capacity and facility-level readiness to implement a ground-breaking health reform, that if successful, could significantly move the needle towards achieving universal health coverage goals in Nigeria.
UHC Day: Blog Explores the Importance of Leadership and Management in Quest for Universal Health Coverage
December 2019 —
A blog published by Health Policy Plus in the lead up to Universal Health Coverage Day December 12th, considers a governance angle on Universal Health Coverage and identifies three areas that are particularly critical: 1) politically aware and savvy champions committed to inclusive processes; 2) leadership and management that fosters a culture of accountability; and 3) more data on the costs of effective management and administration of UHC programs. The authors, Jay Gribble, the deputy director for family planning and reproductive health and Alyson Lipsky, the project’s lead on governance and stewardship, draw on results from HP+ Nigeria and other case studies as they argue that these governance, stewardship, and accountability elements will be key to reaching UHC goals.
From Legislation to Implementation for UHC: Abia State Launches its Social Health Insurance Scheme
October 2019 —
Nigeria’s Abia State launched its social health insurance scheme on September 26, 2019, taking a major step forward in ensuring its citizens gain access to equitable, affordable, and quality health services. The launch comes after a year’s long engagement by Health Policy Plus (HP+), which provided technical support to the health insurance scheme that includes defining and costing of health benefit package, developing the mechanism for claims management and provider payments, and strengthening of the organizational capacity of the agency’s governing board, management, and staff. The launch event was attended by HP+ project director Suneeta Sharma and HP+ Nigeria deputy country director Gani Alabi and several high-level government officials, including the deputy Governor of Abia state, Dr Udeh Oko Chukwu and representative of Senator Orji Uzor Kalu, former governor of Abia state, who committed to enrolling vulnerable populations from his constituency through his eponymous foundation. The chairman of the House of Assembly’s committee on health also demonstrated political will reinforcing the legislatures’ commitment to policies and frameworks for universal access. The governor’s representative announced that disbursement of funds through the Basic Health Care Provision Fund would begin on October 1, flowing to the 292 accredited ward-level primary health centers. The event demonstrated community leadership and the importance of traditional leaders in overseeing the success of the health scheme at the local level. Moving forward, payroll deductions of formal sector employees will begin in October.
Read additional background from local reporting
Legislatures Day Agenda Features UHC Strategies to Extend Health Care to All
October 2019 —
Abia State hosted a Legislatures Day Event on September 26, 2019, which featured a special session in the general chamber of the House of Assembly, an orientation focused on state health systems strengthening, and a launch among legislatures and HP+ visitors. The first-time special parliamentary session on universal health coverage at the House of Assembly coincided with the launch of the State Social Health Insurance Scheme and was designed to advance state government understanding and commitment for financing and oversight of the primary health care system. HP+ project director Suneeta Sharma addressed the legislature, where members of the Health & Women, Appropriations, and Public Private Partnership (PPP) committees as well as the speaker of the House expressed their commitment to universal health coverage and the strengthening of the state’s primary health service delivery. The PPP Committee chairman said: “The House will support the primary health care initiative, which will improve the economy of the State because when people are healthy, they can work.” The Abia Legislatures Day Event was an innovative way for HP+ to engage collectively with the House of Assembly on this important topic and to set a model approach for engagement with government leaders in other priority States. Get more background details.
HP+ Supports Reactivation of Domestic Resource Mobilization Committee for Tuberculosis
October 2019 —
Across two USAID priority states—Lagos and Kano—and at the national level, HP+ is supporting the implementation of a series of activities aimed at achieving sustainable financing for HIV and tuberculosis (TB) programs in Nigeria. At a workshop on September 3, organized by the Kano State Ministry of Health in collaboration with HP+, the Kano State TB Domestic resource mobilization (Domestic resource mobilization) Committee was reactivated following a gap in donor funding and HIV/AIDS programming integrated into the committee’s mandate. The Domestic resource mobilization Committee’s aim is to improve local domestic resource funding for TB and HIV/AIDS control programs in the state, promote public-private partnerships, and ensure effective and efficient appropriation, release, utilization, and management of funds for TB and HIV. The workshop was attended by members of the Kano State Domestic resource mobilization Committee for TB/HIV, including representatives of development partners such as USAID’s Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project, KNCV Tuberculosis Foundation, and FHI360. The workshop resulted in commitments made to develop a roadmap for integration of TB/HIV into national programs, advocacy kits for stakeholder engagement, and improved awareness efforts.
Nigerian State First to Launch Enrollment into Basic Health Care Provision Fund
June 2019 —
On May 3, Osun State—one of three states supported by HP+ in Nigeria—became the first state in the country to begin enrollment of clients into the national Basic Health Care Provision Fund (BHCPF), the federal government’s initiative to provide the rural poor with a basic package of health services. Along with the achievement of this milestone, the state will receive approximately US$2.5 million over the next nine months—delivered directly to selected primary healthcare facilities to support the delivery of high-quality health services. HP+ has supported Osun State to pilot the BHCPF for the last three months in preparation for the scheme’s statewide roll-out. “The learning from the pilot program will influence what will happen moving forward,” said HP+ Nigeria Country Director Onoriode Ezire to government officials at the launch. “We hope that, beyond the launch, access will be improved, and we will continue to address maternal and infant mortality in the state,” he added.
Nigeria’s Sweeping Health Reform Gains Momentum
May 2019 —
On May 22, 2019, two key health reform bills secured concurrence by Nigeria’s House of Representatives, the final step before the bills move forward for presidential authorization. The Federal Capital Territory’s (FCT’s) State Health Insurance and Primary Health Care Board bills, which were passed last month by Nigeria’s Senate, promise to improve access to primary healthcare and relieve financial barriers, particularly among the poor. Once signed into law, the bills will allow the FCT to access the country’s Basic Health Care Provision Fund—a national- and state-level mechanism that aims to extend health insurance coverage and provide a range of free services to the country’s most vulnerable groups.
Nigeria’s Senate Passes Health Insurance and Primary Health Care Board Bills – Leap Forward for Health Coverage for all
May 2019 —
Nigeria’s Federal Capitol Territory (FCT) is a major step closer to accessing resources for primary health care with the passage of a previously stymied law. Bolstered with evidence gathered with support from USAID through the Health Policy Plus project and capacity development of advocates and FCT leadership, the FCT secured sponsorship of the health insurance and primary health care board bills at the National Assembly and have been able to advance the bills through the stages of the legislative process. Concurrence and presidential assent, the final stages of the process, will open the door for the FCT to access the Basic Health Care Provision Fund (BHCPF), a national and state-level mechanism that will extend health insurance coverage, and a range of free services, not only to those in the public and formal private sector, but also to the vulnerable – pregnant women, children under 5-years old, persons with disabilities, and the elderly – and those in the informal sector, for whom access and the ability to pay for primary health care was a barrier. State-by-state health reform has been advancing to secure the systems and legal backing needed to access the BHCPF, while the FCT had been delayed until now. With this advancement, access to the fund is expected to reduce maternal and under-5 mortality rates and reduce financial hardship resulting from medical costs. Momentum around the BHCPF in Nigeria increased significantly last year with approved funding under the 2018 national budget. HP+ supported FCT leadership through each step of the legislative process, which it will continue to provide as the bill moves forward for concurrence and authorization by the President of Nigeria.
Two States Inaugurate Governing Boards of State Health Insurance Agency in Nigeria
March 2019 —
On January 17, two Nigerian states, Ebonyi and Abia, inaugurated the governing boards of their respective state health insurance agencies—an important step in making quality healthcare available and accessible to all Nigerians. This milestone follows an advocacy visit paid the previous day to the State Commissioner of Health, Hon. Dr. Daniel Umezurike, by HP+ Nigeria Country Director Onoriode Ezire, alongside officials from the country’s National Health Insurance Scheme (NHIS). The group discussed the need to establish state health insurance agencies and comply with the requirements of the Primary Health Care Under One Roof policy, prerequisites for accessing the Basic Health Care Provision Fund meant to improve access to quality and affordable healthcare for the poor. Moving forward, HP+ will continue to support efforts to increase quality and reduce the cost of healthcare services throughout the country.
Nigeria Releases Stalled Funds and Further Commits to Improving Health Insurance Programming
January 2019 —
In late 2018, Nigeria’s Federal Capital Territory (FCT) Health Insurance Scheme broke new ground, holding its first ever stakeholders’ meeting—a move which led to the eventual release of nearly US$1.4 million in stalled funds and new political commitments by some of the FCT’s top leaders. In November 2018, the USAID-funded Health Policy Plus project and Nigeria’s FCT Health Insurance Scheme co-convened a stakeholder’s meeting to examine the implementation of the FCT Health Insurance Scheme since its roll-out in 2011 and generate lessons learned to improve the scheme’s implementation and expand access to high-quality healthcare. The meeting concluded with a list of recommendations, including a call for the government to ensure the prompt release of funds. Three days after the meeting, the FCT Director of Treasury released 350 million Naira (US$972,000) for payment of outstanding capitation to healthcare providers; the original request had been made six months prior. Additionally, 150 million Naira (US$417,000) was approved by the FCT Minister for payment of fee-for-service payments owed to providers since 2017. The government also committed to settling all remaining overdue payments by the end of 2018 and paying all first quarter 2019 payments in advance. HP+ Nigeria and partners are hard at work monitoring the progress of these commitments. Read the full news article.
USAID Convenes Plenary on Family Planning Financing in Nigeria
January 2019 —
In December, USAID, through the Health Policy Plus (HP+) project convened a special plenary at the 5th Nigeria Family Planning Conference in Abuja. The session, “Financing Family Planning in Nigeria within the Context of the Basic Health Care Provision Fund and State Health Insurance,” featured panelists from USAID and Palladium—the prime implementer of the HP+ project—and discussants from the private sector and government. Dr. Kolade Oluwatosin, director of the private-sector firm Health Systems Consult Ltd., said during the meeting, “Best practices from countries like Kenya [another HP+-supported country] have shown that insurance can be used to address issues in family planning, but stakeholders—from donors, insurance bodies, civil society organizations, and government—must come together to agree on robust benefit packages.” From the meeting, a list of recommendations was generated for how Nigeria’s government could improve access to family planning while strengthening standards of care.
Results from State-level Applications of the RAPID Model are Leading to New Commitments in Nigeria
December 2017 —
Three recent launches of results from HP+ led state-level applications of the RAPID (Resources for the Awareness of Population Impacts on Development) model in Nigeria are raising awareness of the potential impact that family planning and child spacing can have on the country’s development, and leading to pledges of new resources and support in Bauchi, Ebonyi, and Sokoto states. Factsheets for each state, as well as national-level, results are available.
Ebonyi State Governor Calls for FP Investment at RAPID Launch in Nigeria
November 2017 —
The Governor of Nigeria’s Ebonyi State, David Umahi, pledged new resources and called for traditional leaders to promote family planning in their communities on November 1, 2017, at the launch of the Ebonyi State RAPID (Resources for the Awareness of Population Impacts on Development), which was developed with support by the USAID-funded Health Policy Plus (HP+). The Ebonyi State RAPID provides easy-to-use facts and figures that support the case for investment in family planning in Ebonyi based on a model application projecting the impact of rapid population growth on various sectors. The RAPID estimates that a total fertility rate reduced to three births per woman by 2037 and then reduced to about two births per woman by 2050 could save approximately $107 million (Naira 38 billion) in primary education costs between now and 2050. Governor Umahi pledge a bus to be used for community mobilization and outreach services in rural parts of the state. The event was broadcast live on state TV and included the HP+ country director, Onoriode Ezire, members of the state executive council and traditional leaders.
Nigeria’s Bauchi State Launches its First RAPID, Attempts to Curb the Impact of Rapid Population Growth
October 2017 —
On September 13th 2017, His Excellency Governor Mohammed Abdullahi Abubakar, the Executive Governor of Bauchi State announced the launch of the first Bauchi RAPID. The launch represents the first RAPID among the three states HP+ is currently supporting. In his remarks, Abubakar noted that, “Bauchi state has consistently allocated 16 percent of its annual budget to health since 2016 according to the 2001 Abuja Declaration.” Yet, while meeting the Abuja spending targets is a positive step, the RAPID application highlighted additional steps the state could take to lessen the impacts of rapid population growth. HP+ country director Onoriode Ezire highlighted the high growth rate of the Bauchi State populace as a result of high fertility rates, noting that the state government will have to implement adequate policies related to health, education, and employment to support a growing population with already high numbers of unemployed youth and dependents. At the launch event, Abubakr insisted that Bauchi state “will implement the recommendations of the Bauchi RAPID for the good of the people of Bauchi State.”
Nigeria Demonstrates its Commitment to Sustainable Development
July 2017 —
Nigeria launched the country’s fourth National RAPID on July 6, emphasizing the nation’s commitment to implementing policies to address future population growth and sustainable development. Nigeria’s total fertility rate is 5.5 percent. The RAPID was launched at a summit – "Investing in Youth to Reap the Demographic Dividend in Nigeria" – where Minister of Budget and National Planning, Senator Udoma Udo Udoma said, "Young people and not oil are the most valuable resource we have as a nation." The RAPID model, an evidence-based advocacy tool the projects the impact of high fertility across sectors, was developed in collaboration with the USAID-funded Health Policy Plus project. Read local press coverage
World Population Day 2017 – Investing in Family Planning to Meet the SDGs
July 2017 —
This World Population Day, the USAID-funded Health Policy Plus project produced an online slideshow featuring responses to the question, "How can family planning investments help your country achieve the Sustainable Development Goals?" Olive Mtema, HP+ Malawi, responds: “Results from HP+’s DemDiv model estimate that Malawi’s per capita gross domestic product could increase from US$397 (2014) to US$2,148 by 2054 when family planning is included, turning Malawi into a middle-income country around the year 2040.” Responses from Ms. Olive and others are captured in a photo show, and in a blog by HP+ country directors from Malawi, Nigeria, and Pakistan.
New HP+ Model to Advance Sayana Press Scale Up
June 2017 —
In June, the USAID-funded Health Policy Plus (HP+) project collaborated with the Bill and Melinda Gates Foundation’s TSU Nigeria project to test a new model that projects the potential public health impact, costs and benefits of introducing and scaling up DMPA-SC (or “Sayana Press”). Nigeria is in the process of developing its strategy for Sayana Press scale up, with the BMGF TSU project providing technical assistance. This served as an ideal opportunity to apply the model with these stakeholders and the results will inform and be included their strategy, expected final in late July. The model was developed by Palladium and Avenir staff. PATH, one of the lead organizations spearheading Sayana Press research and scale up in several countries, was at the model application workshop in Nigeria. PATH had contributed data to the model development over the past year, but this was their first time seeing the model in action. Soon after the meeting, PATH staff requested a call with HP+ to go over the model in more detail and discuss how it could potentially be applied in other countries where PATH is working on scale up. This initial meeting is tentatively scheduled for July 12th or 13th. HP+ is also in discussions with UNFPA Cameroon to apply this model there in August or September.
Family planning advocates in Nigeria identify investment and advocacy priorities
May 2017 —
Full implementation of the Task Sharing Policy and Funding for Family Planning Costed Implementation Plan (CIP) in all States were among the key issues Family Planning Advocates identified as priorities that need urgent attention to scale up access to voluntary safe and quality Family Planning services in Nigeria. These issues were addressed earlier this month when the Federal Ministry of Health (FMoH) and the USAID-funded Health Policy Plus (HP+) project hosted a high-level Family Planning (FP) Advocates’ workshop in Abuja that highlighted the urgency and importance of Nigeria’s investment in expanding coverage and uptake of FP services. The event brought together prominent Nigerians from a wide variety of backgrounds to explore the challenges facing Family Planning and to commit to specific actions advocating for increased resources for FP intervention. Participants included religious leaders, elected officials, journalists, and leaders of business associations. Budget allocation; donor dependence; state-level service delivery; and data generation and management were identified as key advocacy issues to prioritize moving forward.
HP+ Represented on Nigeria’s National RAPID Steering Committee
March 2017 —
Two key members of the HP+ Nigeria team, country activity manager Ed Abel and program director Onoriode Ezire, have been selected as members of Nigeria’s National RAPID Steering Committee. This high-level committee was created by the National Population Commission to guide the strategic direction for application of the RAPID model in Nigeria. RAPID is a computer model that projects the social and economic consequences of rapid population growth on a variety of sectors, and can be a powerful advocacy tool used to persuade policymakers and stakeholders to invest in family planning. Members have set their sights on a revision of Nigeria’s National Population Policy and the possible creation of a new set of RAPID projections. Once the new projections have been finalized, RAPID will be applied at the national level and in three states in Nigeria to raise awareness of the impacts of population growth and to advocate for additional national/state financial resources to support family planning programs.