Three Day Workshop on Improving Financial Access to Maternal Newborn and Child Health Services for the Poor in Nigeria; 1st – 3rd November 2011.
Tinapa Lakeside Hotel, Calabar, Cross Rivers State Nigeria;
- Despite being 2% of the world's population, Nigeria accounts for 10% of global maternal mortality and together with 5 other countries bears 50% of the global child mortality burden. Out of pocket expenditure on health is high at about 70% and it accounts for high incidence of catastrophic health expenditure in Nigeria. With almost half the population living below a dollar a day, high expenditure on health needs increases the vulnerability of the poor to slip further into poverty; with the impact on the poorest households, likely to be more severe. Poverty analysis indicates differentials across the geopolitical zones in the country, with attendant linkages to health indicators in the zones. Adopting equitable health financing strategies that are sensitive to the needs of the poor, in the country, is therefore critical. This will be one of the steps towards achieving universal health coverage, especially using appropriate financial risk protection mechanisms in Nigeria.
- The Nigerian government is firmly committed to fast tracking progress towards the MDGs and other national development challenges. It has developed a National Strategic Health Development Plan with federal and state component plans, as well as signed the Health Country Compact on mutual accountability for measurable results with development partners. The Health Plans acknowledge the need for health financing policies, strategies and mechanisms that are equitable and reflect commitments to increase the proportion of Nigerians in the bottom 2 quintiles that are covered by any risk-pooling mechanisms from present levels to 30% by 2015. This is in addition to reducing the percentage of Out-of pocket expenditure for health from its current level to less than 50% by 2015. The strategies to achieve these need to be further articulated with results-oriented implementation plans at all levels and by all actors within and outside the health sector.
- Current efforts by the government to address health financing challenges include efforts to improve multi-year budgetary processes linked to strategic results; and the recently passed National Health Bill by both chambers of the National Assembly, which ring-fences resources from the consolidated fund of the federal level account. This fund will be targeted at scaling up primary health care services and extending National Health insurance to all Nigerians. The bill also clarifies statutory roles of all tiers of government in the health sector. The National Health Insurance Scheme, in partnership with the Office of the Senior Special Assistant to the President on MDGs is implementing a maternal and child health fee exemption project targeting pregnant women and children under five years with primary health care services in twelve states. Several states have equally launched free maternal and child health schemes with varied levels of coverage and benefit packages; while some community-type financing schemes and/or equity funds exist in some states.
- In recognition of the aforementioned, as well as, the governance context, national health system and size of the country; the need to ensure continued commitment of federal, states and LGs to improve financial access to health services by Nigerians is considered critical, while promoting buy-in of the private sector and CSOs. Therefore, providing sustained and long term technical assistance; creating platforms for cross learning amongst states and between national entities and regional/developing country initiatives are a few of the agreed collaborative areas between the Nigerian government and its development partners.
- Further to the above, the Nigerian government has continued to engage in various national and international consultations to garner experiences and best practices to improve financial access for the poor in the country. These have included study tours and visits to Ghana, Kenya, India, Rwanda; participation of a delegation at the Harmonization for Health in Africa (HHA) Regional workshop on Financial access for the poor conducted for West and Central African countries in November 2010; as well as, national and zonal consultations on Primary Health Care financing held in 2011, to mention a few.
- A step down workshop for Nigerian actors on Financial access for the poor was agreed to by government and collaborating HHA/IHP+ partners as follow-up to on-going efforts in the country. This is pertinent as each country agreed to establish a knowledge learning network "community of practice" for improving health financing, especially for the poorest households. Government being – The Federal Ministry of Health, National Health Insurance Scheme (NHIS) and National Primary Health Care Development Agency (NPHCDA); while the workshop collaborating partners (in alphabetical order) are – Canadian International Development Agency (CIDA), Department of International Development (DfID), Health Policy Project (HPP), Management Sciences for Health (MSH), Partnership for Transforming Health Systems (PATHS 2), United Nations Population Fund (UNFPA), United Nations Children Fund (UNICEF), United States Agency for International Development (USAID), World Bank (WB) and World Health Organization (WHO).
- The workshop is therefore being designed to not only strengthen the knowledge base of federal and state governments, as well as, the private sector on health care financing for the poor, but also to identify key interventions and draw lessons learnt and best practices from national, regional and developing country perspectives to inform future programming in the country. It is hoped that these will contribute to on-going efforts to achieve the pro-poor indicators in the National and State Health Plans.