The Political Economy of the Design of the Basic Health Care Provision Fund (BHCPF) in Nigeria: A Retrospective Analysis for Prospective Action

Alawode, Gafar; Adewoyin, Ayomide B; Abdulsalam, Abdulmajeed O; Ilika, Frances; Chukwu, Chidera; Mohammed, Zakariya; Kurfi, Abubakar

doi:10.1080/23288604.2022.2124601

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…First, it mandated that at least 1% of Nigeria’s CRF be allocated to the BHCPF (in 2019, 1% of the CRF was $130–140 million). Second, this amount must be divided between health insurance (50%), direct support to facilities (45%) and emergency care (5%) ( Alawode et al. , 2022 ).…”

Section: Resultsmentioning

confidence: 99%

“…Some legislators saw this auditability—and the presence of donors in the Secretariat—as an infringement on sovereignty. More generally, they opposed the role of the BHCPF Secretariat, which was donor-funded and located in the Minister’s office ( Alawode et al. , 2022 ).…”

Section: Resultsmentioning

confidence: 99%

“…To inform this analysis, we examined multiple sources, including first-person accounts of Nigerian leaders over this period ( Lambo, 2014 ; Jonathan, 2018 ; Okonjo-Iweala, 2018 ), case studies of health programmes ( Tulloch et al. , 2017 ; Alawode et al. , 2022 ), national health policy documents and reports, and 23 interviews with stakeholders from Nigeria’s health sector, including senior policymakers ( Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

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Health reform in Nigeria: the politics of primary health care and universal health coverage

Croke,

Ogbuoji

2023

Health Policy and Planning

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Over the past decade, Nigeria has seen major attempts to strengthen primary health care, through the Saving One Million Lives (SOML) initiative, and to move towards universal health care, through the National Health Act. Both initiatives were successfully adopted, but faced political and institutional challenges in implementation and sustainability. We analyse these programmes from a political economy perspective, examining barriers to and facilitators of adoption and implementation throughout the policy cycle, and drawing on political settlement analysis (PSA) to identify structural challenges which both programmes faced. The SOML began in 2012 and was expanded in 2015. However, the programme’s champion left government in 2013, a key funding source was eliminated in 2015, and the programme did not continue after external funding elapsed in 2021. The National Health Act passed in 2014 after over a decade of advocacy by proponents. However, the Act’s governance reforms led to conflict between health sector agencies, about both reform content and process. Nine years after the Act’s passage, disbursements have been sporadic, and implementation remains incomplete. Both programmes show the promise of major health reforms in Nigeria, but also the political and institutional challenges they face. In both cases, health leaders crafted evidence-based policies and managed stakeholders to achieve policy adoption. Yet political and institutional challenges hindered implementation. Institutionally, horizontal and vertical fragmentation of authority within the sector impeded coordination. Politically, electoral cycles led to frequent turnover of sectoral leadership, while senior politicians did not intervene to support fundamental institutional reforms. Using PSA, we identify these as features of a ‘competitive clientelist’ political settlement, in which attempts to shift from clientelist to programmatic policies generate powerful opposition. Nonetheless, we highlight that some policymakers sought to use health reforms to change institutions at the margin, suggesting future avenues for governance-oriented health reforms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Health reform in Nigeria: the politics of primary health care and universal health coverage

Croke,

Ogbuoji

2023

Health Policy and Planning

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“…4,5 According to the WHO, the fastest route for achieving equitable universal care and improving the population's health outcomes is through adequate PHC funding. 1,6,7 However, recent WHO data indicates that most African governments spend less than 40% of their healthcare expenditure on primary healthcare. 3 Different countries' depending on their development status and health care system have different funding model for their PHCs.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Implementation of the National Primary Health Care Development Agency (NPHCDA) Gateway for the Basic Healthcare Provision Fund (BHCPF) Across Six Northern States in Nigeria

Igbokwe,

Ibrahim,

Aina

et al. 2024

Preprint

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Background: This evaluation research utilized both qualitative and quantitative methods to assess the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway of the Basic Health Care Provision Fund (BHCPF) across six states in Northern Nigeria: Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe. Methods: This was a mixed-method research that utilized longitudinal surveys and Key informant interviews to gather information about the implementation status of the BHCPF-NPHCDA gateway. Checklists were developed based on the BHCPF’s national guidelines to gather quantitative data, while simple open-ended questionnaires were used to collect qualitative data from the state BHCPF Program Implementation Unit (PIU) focal persons as key informants. Results: The result revealed that the NPHCDA had accredited these six states to use one Primary Health Care (PHC) facility in each political ward to implement the BHCPF. Factors that contributed to the success achieved in some states included the early completion of contingent start-up activities, well-established coordination structures, strong support from partners, and availability of established financial management systems. However, the delays in the submission of quarterly business plans by the BHCPF facilities affected timely approval and fund disbursement. Other challenges included staff capacity gaps, inadequate human resources, and poor management and supervision from the state health agency teams. Conclusion: There was suboptimal implementation of the BHCPF in at least one thematic area across all states. Therefore, actions such as government commitment for improved coordination, continuous capacity building, effective monitoring and evaluation, and targeted supportive supervision using innovative approaches should be undertaken to improve the program’s implementation. In a broader setting, the insights from BHCPF implementation are valuable for LMICs, offering guidance on overcoming implementation challenges associated with PHC financing. This research provides a resource for enhancing healthcare financing strategies in similar contexts.

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“…Out-of-pocket (OOP) expenses dominate health financing, accounting for 75% of health spending ( 11 ), with 16% of Nigerians incurring catastrophic health expenses, consuming over 10% of their household income ( 5 ). Established by the National Health Act of 2014, the Basic Health Care Provision Fund (BHCPF) is a critical initiative by Nigeria that aims to address the country’s health financing gaps ( 12 , 13 ). This fund aims to improve PHC delivery by channeling investments directly into PHC infrastructure, human resources, medicines, and commodities, and ensuring free PHC services for the poor.…”

Section: Introductionmentioning

confidence: 99%

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Ogundeji,

Abubakar,

Ezeh

et al. 2023

Front. Public Health

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IntroductionThe availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.MethodsWe collected primary data from 50 health facilities (25 per state), including PHC facilities—health posts, health clinics, health centers—and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider’s perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.ResultsWe found that average actual PHC costs per capita at PHC facilities—where most PHC services should be provided according to government guidelines—ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals—where approximately a third of PHC services are delivered in both states—the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.DiscussionBridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

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The Political Economy of the Design of the Basic Health Care Provision Fund (BHCPF) in Nigeria: A Retrospective Analysis for Prospective Action

Cited by 5 publications

References 17 publications

Health reform in Nigeria: the politics of primary health care and universal health coverage

Health reform in Nigeria: the politics of primary health care and universal health coverage

Evaluating the Implementation of the National Primary Health Care Development Agency (NPHCDA) Gateway for the Basic Healthcare Provision Fund (BHCPF) Across Six Northern States in Nigeria

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

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