Accelerated Reforms in Healthcare Financing: The Need to Scale up Private Sector Participation in Nigeria

Document Type : Review Article

Author

Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria

Abstract

The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

Keywords


  1. American Public Health Association. Strengthening health systems in developing countries [internet]. 2008. [cited 2013 Oct 19]. Available from: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1375
  2. Central Intelligence Agency (CIA). World Facts Book [internet]. 2013. [cited 2013 Sep 16]. Available from: https://www.cia.gov/library/publications/the-world-factbook/fields/2119.html
  3. Adetokunbo L. Primary Health Care in Nigeria, Health Reform Foundation in Nigeria (HEFRON). Nigerian Health Review, 2007. p. 24.
  4. Das Gupta M, Gauri V, Khemani S. Primary Health Care Service Delivery in Nigeria. Survey Evidence from Lagos and Kogi. Development Research Group. Washington, DC: World Bank; 2003.
  5. World Health Organization (WHO). World Health Report 2000. Health Systems, Improving health performance. Geneva: WHO; 2000. doi: 10.1016/s0033-3549(04)50043-2
  6. Adegoke AA, Campbell M, Ogundeji MO, Lawoyin TO, Thomson AM. Community Study of maternal mortality in South West Nigeria: how applicable is the sisterhood method. Matern Child Health J 2013; 17: 319–29. doi: 10.1007/s10995-012-0977-z
  7. Guerrier G, Oluyide B, Keramarou M, Grais R. High maternal and neonatal mortality rates in northern Nigeria: an 8-month observational study. Int J Womens Health 2013; 5: 495–9. doi: 10.2147/ijwh.s48179
  8. CIA Facts Book [internet]. 2012. [cited 2013 Oct 8]. Available from: http://www.indexmundi.com/g/r.aspx?v=29
  9. World Bank. Health expenditure per capita [internet]. 2013. [cited 2013 Oct 10]. Available From: http://data.worldbank.org/indicator/SH.XPD.PCAP
  10. Schoen C, Doty MM, Robertson RH, Collins SR. Affordable Care Act Reforms Could Reduce the Number of Underinsured U.S. Adults by 70 Percent. Health Affairs 2011; 30: 1762–71. doi: 10.1377/hlthaff.2011.0335
  11. Anderson GF, Markovich P. Multinational Comparisons of Health Systems Data, 2010. New York: The Commonwealth Fund; 2011.
  12. IFC. The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives. Washington, DC: International Finance Corporation; 2007.
  13. World Health Organization (WHO). Strengthening the Capacity of Governments to Constructively Engage the Private Sector in Providing Essential Health-Care Services [internet]. 2010. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_25-en.pdf
  14. Health Reform Foundation in Nigeria (HERFON) [internet]. Available from: http://www.herfon.org/home.html
  15. Consultative Group of Nigeria. Nigeria, economic strategy and policy: The Way Forward. Federal Government of Nigeria Abuja, 2000.
  16. Central Bank of Nigeria (CBN). Annual Report and Statement of account, 2000.
  17. Health Reform Foundation in Nigeria (HERFON). Nigeria Health Review. 2006. [cited 2013 Oct 8] . Available from: http://www.herfon.org/home.html
  18. Appropriation Bill [internet]. 2013. [cited 2013 Oct 8]. Available from: http://www.nassnig.org/nass2/legislation.php?id=1583
  19. World Health Organization (WHO). Africa Public Health Alliance & 15%+ Campaign [internet]. 2010. [cited 2012 May 19]. Available from: http://www.who.int/workforcealliance/members_partners/member_list/aphra/en/index.html
  20. Central Bank of Nigeria (CBN). Annual Reports and Statement of Accounts. World Bank Country Report for Nigeria, 2005.
  21. World Bank. African Development Indicators. Washington, DC: World Bank; 2000. doi: 10.1596/0-8213-5720-4
  22. World Bank Health Expenditure per capita [internet]. [cited 2013 Sep 16]. Available from: http://data.worldbank.org/indicator/SH.XPD.PCAP
  23. Trading economic index [internet]. 2013. [cited 2013 Aug 17].Available from: http://www.tradingeconomics.com/nigeria/gdp
  24. David A, Squires DA. Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality. New York: The Commonwealth Fund; 2011.
  25. Soyibo A, Coordinator P. National Health Accounts of Nigeria, 1998–2002. Geneva: World Health Organization; 2005.
  26. Nigeria Health Expenditure. Total versus Private [internet]. 2013. [cited 2013 Oct 11]. Available from: http://nigeria.opendataforafrica.org/msqivrf/nigeria-health-expenditure-total-vs-private
  27. Obansa SAJ. Health Care Financing in Nigeria: Prospects and Challenges. Mediterranean Journal of Social Sciences 2013; 4: 231.
  28. Adinma ED, Adinnma BJ. Community based healthcare financing: An untapped option to a more effective healthcare funding in Nigeria. Niger Med 2010; 50: 95–9.
  29. Heller P. Back to Basics -- Fiscal Space: What it is and how to get it. Finance and Development 2005; 42(2). Available from: http://www.imf.org/external/pubs/ft/fandd/2005/06/basics.htm
  30. Trading economic index [internet]. [cited 2013 Aug 17]. Available from: http://www.tradingeconomics.com/nigeria/gdp
  31. African Union. Fourth Session of The African Union Conference Of Ministers of Health Addis Ababa, Ethiopia, 2009. p. 16–7.
  32. The Vanguard. Nigerian economy on a debt cliff [internet]. 2013. [cited 2013 Sep 17]. Available from: http://www.vanguardngr.com/2013/06/nigerian-economy-on-a-debt-cliff/
  33. The Post. SURE-P Targets More Investment in Health Sector [internet]. 2013. [cited 2013 Oct 10]. Available from: http://thepost-ng.com/sure-p-targets-more-investment-in-health-sector/#.UleA7VBwocc
  34. Uzochukwu BSC. Health Care Financing, A review of the Nigerian Situation. Health Reform Foundation Scientific Meeting, 2012. p. 5–10.
  35. Vicente R, Castillejo J. The role of Public Private Partnership. The Brazilian experience in modernizing hospitals in Sao Paoulo Prefecture Health Secretariat. World Hosp Health Serv 2012; 48: 20–3.
  36. Purohit BC. Private initiatives and policy options: recent health system experience in India. Health Policy Plan 2001; 16: 87–97. doi: 10.1093/heapol/16.1.87
  37. Bryan L, Conway M, Keesmat T, McKeena S, Richardson B. A practical guide to Health System Strengthening in sub-Saharan Africa. Health International 2009; 1–3. Available from: http://www.africa.com/mckinsey-on-africa/strengthening_sub-saharan_africa8217s_health_systems_a_practical_approach
  38. La Forgia G, Mintz P, Cerezo C. Is the Perfect the Enemy of the Good: A Case Study on Large Scale Contracting for Basic Health Services in Rural Guatemala. In: Gerard M. La Forgia, editors. Health Systems Innovations in Central America: Lessons and Impacts from New Approaches. Washington, DC: World Bank; 2005.
  39. La Forgia GM, Harding A. Public-private partnerships and public hospital performance in São Paulo, Brazil. Health Aff (Millwood) 2009; 28: 1114–26. doi: 10.1377/hlthaff.28.4.1114
  40. Meessen B, Soucat A, Sekabaraga C. Performance-based financing: just a donor fad or a catalyst towards comprehensive health-care reform? Bull World Health Organ 2011; 89: 153–6. doi: 10.2471/blt.10.077339
  41. Meessen B, Musango L, Kashala JP, Lemlin J. Reviewing institutions of rural health centres: the Performance Initiative in Butare, Rwanda. Trop Med Int Health 2006; 11: 1303–17. doi: 10.2471/blt.10.077339
  42. Federal Ministry of Health. Report of the special committee on national health care financing. Lagos: Federal Ministry of Health:1985.
  43. Ogunbekun I, Ogunbekun A, Orobaton N. Private health care in Nigeria, walking a tightrope. Health Policy Plan 1999; 14: 174–81. doi: 10.1093/heapol/14.2.174
  44. Wonderling D, Gruen R, Black N. Introduction to Health Economics. 5th Edition. Maidenhead : Open University Press; 2010.
  45. Schoen C, Osborn R, Squires D, Doty MM, Pierson R, Applebaum S. How health insurance design affects access to care and costs, by income, in eleven countries. Health Aff (Millwood) 2010; 29: 2323–34. doi: 10.1377/hlthaff.2010.0862
  46. Weisbrod BA. The health care quadrilemma: an essay on tech­nological change, insurance, quality of care, and cost contain­ment. J Econ Lit 1991; 29: 523–52.
  47. Keehan SP, Cuckler GA, Sisko AM, Madison AJ, Smith SD, Lizonitz JM, et al. National Health Expenditure Projections: Modest Annual Growth Until Coverage Expands And Economic Growth Accelerates. Health Affairs 2012; 31: 1600–12. doi: 10.1377/hlthaff.2012.0404
  48. World Health Organization (WHO). Report of the Commission on Macroeconomics and Health. Geneva: WHO; 2001. doi: 10.1016/s0968-8080(02)00085-x
  49. Criel B, Kegels G. A health insurance scheme for hospital care in Bwamanda District, Zaire: lessons and questions after 10 years of functioning. Trop Med Int Health 1997; 2: 654–72. doi: 10.1046/j.1365-3156.1997.d01-349.x
  50. Carrin G, Waelkens MP, Criel B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop Med Int Health 2005; 10: 799–81. doi: 10.1111/j.1365-3156.2005.01455.x
  51. International Labour Organization, ILO/STEP. Methodological guide for undertaking case studies: health micro insurance schemes. Geneva: ILO; 2000.
  52. Rao P, Gabre-Kidan T, Mubangizi DB, Sulzbach S. Leveraging the private health sector to enhance HIV service delivery in lower-income countries. J Acquir Immune Defic Syndr 2011; 57: S116–9. doi: 10.1097/qai.0b013e31821ed719
  53. Novignon J, Olakojo SA, Nonvignon J. The effects of public and private health care expenditure on health status in sub-Saharan Africa: new evidence from panel data analysis. Health Econ Rev 2012; 2: 22. doi: 10.1186/2191-1991-2-22