1. 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, 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