As defined by the World Health Organization (WHO), health financing is the “function of a health system concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively, in a health system.”
It is a no brainier, that healthcare system in Nigeria is suboptimal, especially at the Primary health care level, which caters for the less privileged and people at the bottom of the pyramid. Several interventions have been deployed by Government and Development partners with little or no result. All effort seems to be like a drop in the ocean.
The Primary Health Care System is driven by the Primary Healthcare Centres, which are encumbered with several issues limiting them from providing essential health services, such as; poor staffing, sub-optimal equipment, and lack of essential drugs, all which is tied to funding.
With about 30,000 PHCs around the country, only 20 per cent of these facilities are functional. The inability of funds in reaching these healthcare facilities is a major hindrance to financing their activities, despite the appropriations of funds from different levels and donor to them. The monies diminish in one way or the other before they get to the health care centres.
Though, some programs have designed health financing strengthening processes, to guide the flow of funds from the states to the health facilities, this model is yet to be fully adopted by all the programs under the PHC. Programs that have adopted this accountability framework in financial management strengthening have experienced improvement in the conduct of activities at the health facilities which has impacted positively on the health outcomes.
Similar accountability framework in financial management strengthening is what has been developed and instituted for the Basic Health Care Provision fund, which was brought to existence by the National Health Act.
The National Health Act in Nigeria was signed into law to improve to Universal Health Coverage substantially by increasing available resources for Primary Health Care (PHC) services through the Basic Health Care Provision Fund (BHCPF)
The Basic Health Care Provision Fund (BHCPF) was designed to help reduce out of pocket expenses and provide affordable and quality healthcare for Nigerians.
The government currently sets aside 1 per cent of its yearly consolidated revenue and channels same towards the implementation of BHCPF, in addition to funds from donors.
The BHCPF is being disbursed through 3 gateways, namely, National Primary Healthcare Development Agency (NPHCDA Gateway), National Health Insurance Scheme (NHIS Gateway) and Federal Ministry of Health (DHS/NCDC Gateway).
All the Federal and State Government institutions involved in the disbursement of the Basic Health Care Provision Fund is expected to open a Treasury Single Account with the Central Bank of Nigeria for control and monitoring of all contributions and disbursements.
With the steps taken by the government to jump-start health financing with guided accountability, it’s time for the commercial banks to make themselves available to support the initiative and tap into this opportunity. Firstly, all health facilities in Nigeria is expected to open bank accounts to receive and manage these funds, and this is the first step by the banks to engage on the initiative. The banks should work with the Local Government Authorities, and ensureall health facilities under the LGAs in Nigeria have banks accounts to receive the Basic Healthcare Provision fund.
Under the BHCPF model, designed by the Government under the Federal Ministry of Health, health facilities are to be strengthened to receive and manage their own funds, which is not limited to the BHCPF. The Health facilities are expected to prepare for other donors funding, which will support them in financing the activities carried out at the facilities. They are expected to develop capacity to develop annual business plans, carry out procurements, undertake internal and external audit exercises as the case may be, making them run like a business entity, so to say.
Currently, most commercial banks in Nigeria carry out one form of CSR program or the other in healthcare sector and the outcomes have not made much impact. Supporting these health facilities under the BHCPF, will go a long way in strengthening their health outcomes and achieving the desired impact at the primary healthcare level.
Most assuredly, the opening of bank accounts for these health facilities with minimum account opening requirements, will create ways for banks to cross sell other products like Agency Banking which will ultimately drive financial inclusion in addition to improving healthcare coverage across Nigeria.
Therefore, the resolution for commercial banks will be firstly to commence discussions with LGAs across Nigeria, and begin opening of bank accounts for their health facilities, secondly, to look into plugging their agency banking solution into this model, and lastly, to commence product development for the undeserved and help reduce financial exclusion at the bottom of the pyramid.
Ultimately, a well-designed health financing & strengthening framework will attract local and foreign donors to the healthcare space, which will better our health care systems at the grass root and also make money for the banks.
Next steps for banks will be to partner with the Basic Health Care Provision Fund and provide their support by making account openings seamless for the health facilities, in addition to supporting capacity building for the health facilities to enable them manage their books and execute their annual business plans. It will not be out of place if banks can donate tools like computers and alternative power sources to assist these health facilities to become fully functional healthcare business entities. They are an SME hub waiting to explode if fully supported.
Finally, though, the FGN will be providing 1 per cent CRF annually into the BHCPF basket account, in addition to other development partners, it will not be out of place for the banks to support with their widow’s mite in contributing financially into this basket fund, because a healthy people is a wealthy economy.
Olayinka Dada
Olayinka Dada, a Healthcare Development Consultant, he can be reached on 09090656935
