1. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Models for Expanding Access to Healthcare Services in Nigeria Prepared by Kenneth Ojo, Ph.D. for Health & Managed Care Association of Nigeria in Collaboration with Business Day Conferences on Healthcare Financing Roundtable 2012 titled “ÄIMING FOR GREATER INCLUSION FOR NIGERIANS” 10 th December, 2012.

2. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Five aspects of Access Require Evaluation and Modeling: 1.Availability and Adequacy 2.Physical Accessibility 3.Financial/ Affordability 4.Organizational/Governance and 5.Acceptability: Social or Cultural barriers that limit the Utilization of Services.

3. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Supply Side Models 1.Availability and Adequacy Integrated Model of Service Delivery At best Minimum/essential package of care What about long term and emergency care? 2. Physical Accessibility Geographical Equity Developing Criteria for Sitting of New Health Facilities at all levels

4. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Demand Side Models Models on Sustainable Health Financing/ Financial Risk Protection: 3. Financial/ Affordability Social Health Insurance Private Health Insurance Community-based Health Insurance Other Pre-Paid schemes

5. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Models to create an enabling environment 4. Organizational Restructuring/Governance Integrated organizational change and development re-orientation and strengthening of the human resource capacities. Transparency and Accountability through effective Public Expenditure Management and Anti-Corruption Measures

6. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Models to create effective demand for services 5. Acceptability: Social or Cultural barriers that limit the utilization of services.  Conditional Cash transfer; Incentives to Traditional leaders, TBAs, Community Health Extension Workers (CHEWS) who achieve targets for selected indicators for ANC and family planning (FP)  Health Promotion and Communication Models

7. CENTRE FOR HEALTH ECONOMICS AND DEVELOPEMNT Conclusion  All these will be used in measuring access in terms of utilization not merely adequacy of supply.  Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'.  The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society.  Equity of access may be measured in terms of the availability, utilization or outcomes of services.