An accountability framework for the implementation of the Basic Health Care Provision Fund (BHCPF) in Nigeria Benjamin SC Uzochukwu, Chinyere Mbachu, Lucy Gilson, Obinna Onwujekwe, Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus Fourth Global Symposium on Health Systems Research HSR2016, 14 -18 November 2016, Vancouver, Canada Background In October 2014, following a decade of planning, the National Health Act (NHAct) was signed into law. The Act provides a legal framework for the provision of health care services to all Nigerians NHAct–key features Guarantees every citizen the right to a minimum package of health services Mandatory provision of emergency services Framework for identifying people eligible for free basic services -pregnant women, children under 5, senior citizens Establishes Basic Health Care Provision Fund (BHCPF) Financing the BHCPF An annual grant from the Federal Government of not less 1% of the Consolidated Revenue Fund (total Federal Revenue before it is shared to all tiers of government) Additional sources of funding: Grants by international donors Funds generated from innovative sources (e.g. taxes on cigarettes and alcohol). 25% counterpart fund donations from States and Local government areas For states to benefit from the funds, they are required to establish a state PHC development agency/board in addition to the 25% counterpart funding Fig 4: Monitoring and supervision Fig. 2 Flows of funds through BHCPF Research methods: Document reviews Interviews with key actors in Anambra State and Federal Capital Territory Stakeholder analysis The results of the enquiry were used to propose an accountability framework for the fund (Figs 3 -5) Fig 5: Systematic reporting Results (Figures 3 – 5) Framework to strengthen accountability at each level of government include: 1. Mechanisms for strategic planning 2. Strong and transparent monitoring and supervision systems 3. Systematic reporting Recommendation State government 1. Provide supportive supervision to LGHA through mentoring and training 2. Consider making the dispersal of funds to the LGHA conditional on results of previous disbursements 3. Employ qualified finance managers Demonstrate transparency by separating BHCPF account from the State health account & making financial reports available to the public Local government Produce a plan for how the BHCPF will be disbursed to facilities 2. Employ qualified finance managers Demonstrate transparency by separating BHCPF account from other sources of funding for PHC facilities Health facilities 1. Produce a plan for how the BHCPF will be spent Health Facility Committees should monitor how revenue is spent Put in place systems for keeping records about how funds are managed Use e-payment or banks to process consumer payments Community members and other external actors 1. Community members, through Health Facility Committees, should be involved in decisions regarding how health facility revenue is spent 2. Development partners and CSOs should monitor the release of funds at each level of the health system Fig 1: Basic Health Care Provision Fund Fig: 3: Strategic Planning