NIGERIA Country presentation: State of Health Care Financing by Chima A. Onoka and Chijioke I. Okoli Health Policy Research Group University of Nigeria, Enugu

1. HOW IS REVENUE COLLECTED IN YOUR COUNTRY?

Who are health care funding contributions collected from: – Individuals – Government – Private employer/Company – Donor funds and NGOs  World Bank  WHO  UNICEF

How are these contributions structured? Individuals  OOPS  insurance (national health insurance 5%, CBHI contributions) Government – taxes  direct taxes (10% income taxes from the formal sector)  indirect taxes (VAT 10%, etc)  Revenue (especially from the oil industry)

How are these contributions structured? (contd) Private employer/Company  Prepaid insurance  Waivers Donor funds and NGOs  GRANTS  LOANS  TECHNICAL ASSISTANCE  DONATIONS

Who collects them? Government finance agencies (taxes deducted at source from employees in the formal sector) Health facilities – public and private (OOPs) Community Health Committees (CBHI for the informal sector) Private organization/Corporate bodies (deducted at source from employees’ salaries)

2. How are funds pooled in your country? What is the size of the population?  140 million (70% rural, 30% urban)

Which groups are covered by each financing mechanism? PoolGroups covered% covered OOPsGeneral public75% NHI (formal sector)Formal sector (federal Govt employees) [Mandatory] 5% CBHI (informal sector) Informal sector (Pilot rural communities) [Voluntary] 5% Private/Corporate bodies insurance Employees (families and dependants) [Mandatory] 10% Private voluntary health insurance Individuals5%

What are the allocation mechanisms for distributing pooled resources?

3. How are services purchased in your country?

What services are included in the benefit package OOPsAll health care services NHI (formal sector)Common infectious and non infectious diseases, maternal and child health services CBHI (informal sector) Private voluntary health insurance Private/Corporate body employee insurance All health care services except high cost- demanding chronic illnesses e.g. cancers

What provider’s payment mechanisms are used? Fee for service Capitations Salaries Budget allocation

How equitable is health care financing (both in terms of who bears the burden of health care financing and who benefits from health care)

Based on Socioeconomic groups % HIGHMIDDLELOW SE CLASS BURDEN BENEFIT

Percentage of income spent on healthcare

Based on rural – urban groups

Based on public spending per capita for health ($) 2 8 RURAL URBAN

What factors contribute to equity or inequity in financing in your country? Low budget allocation ( 5% of per capita GDP) Low income per capita Poor solidarity Mal-distribution of Health workers Power (political)

To what extent are households provided with financial protection in your country? Exists only amongst the private organization employee insurance schemes though limited to the very rich ones like oil companies 3 out of 36 states and FCT (Abuja) of the country offer free emergency care for accident victims for the 1 st 24hrs, but only in the tertiary hospital in the states EVERYONE IS ON HIS OWN

Way forward incentives ( rural allowance) for medical personnel (doctors, nurses etc) working in rural areas basic infrastructure like power supply, paved road network and water supply transparency and accountability in the management of CBHI funds expansion of national health insurance (NHI) to state and local government employees Beneficiaries of NHI: who really are employees’ dependents?

Way forward (contd) In PHC centres YOUTH Corps doctors (post- interns) are often used, it relegates usage to low income category and trivializes the set up ensuring that PHCs are consistently manned by qualified medical personnel (in order to increase utilization) commitment on the part of government (policy consistency) consistency in drug supplies De-emphasize political appointments in health ministry (how?)

Thank you