Policy Without Delivery: The Breakdown of Primary Health Care Financing in Nigeria
Downloads
Primary health care (PHC) is the foundation of a good health system. It provides accessible, affordable, and equitable healthcare services. The World Health Organization (WHO) defines PHC as a community-centered approach that delivers comprehensive care ranging from health promotion to disease prevention and treatment care.1 In Nigeria, however, the primary health care (PHC) system faces serious challenges. From inadequate funding to poor infrastructure in most primary care locations, a lack of power supply, and a shortage of health workers. Only about 30–45% of these centers are fully equipped and managed.2 Rural areas are the worst affected, with clinics lacking essential services and staff.3
1. World Health Organization (WHO). Primary Health Care. https://www.who.int/news-room/fact-sheets/detail/primary-health-care
2. Uzochukwu B, Onwujekwe O, Mbachu C, Okwuosa C, Etiaba E, Nyström ME, et al. The challenge of bridging the gap between researchers and policy makers: experiences of a Health Policy Research Group in engaging policy makers to support evidence-informed policy making in Nigeria. Globalization and Health. 2016 Nov 4;12(1).
3. Alonge SK. Primary health care in Nigeria: an appraisal of the effect of foreign donations. African Journal of Health, Safety and Environment. 2020 Dec 8;1(2):86-100.
4. Fatusi AO. Public health leadership, policy development, and the Nigerian health system. A Paper Presented at the Induction Program of the Institute for Government Research Leadership Technology. Abuja: (2015).
5. Croke K, Ogbuoji O. Health reform in Nigeria: the politics of primary health care and universal health coverage. Health Policy and Planning. 2024 Jan 1;39(1):22-31).
6. Lambo E. Primary health care: realities, challenges and the way forward. A Paper Presented at the First Annual Primary Health Care Lecture. Abuja: (2015). Available from: http://nigeriahealthwatch.com/wp-content/uploads/bsk-pdf-manager/1160_2015_Primary_Health_Care_Presentation_Final,_NPHCDA_1216.pdf
7. Reid M. Nigeria Still Searching for Right Formula. World Health Organization. Bulletin of the World Health Organization. 2008 Sep 1;86(9):663
8. National Policy for Health – Office Of The Secretary to the Government of the Federation (OSGF). https://www.osgf.gov.ng/resources/policies/health/
9. Aregbeshola BS, Khan SM. Primary health care in Nigeria: 24 years after Olikoye Ransome-Kuti’s leadership. Frontiers in public health. 2017 Mar 13;5:48.
10. Aigbiremolen AO, Alenoghena I, Eboreime E, Abejegah C. Primary health care in Nigeria: from conceptualization to implementation. Journal of Medical and Applied Biosciences. 2014;6(2):35-43.
11. Primary Health Care Under One Roof Implementation Scorecard III Report. 2015. https://s3-eu-west-1.amazonaws.com/s3.sourceafrica.net/documents/120413/PHCUOR-Scorecard-3-Narrative-Report-Final.pdf
12. Federal Ministry of Health et. al. National Strategic Health Development Plan (NSHDP) 2010 - 2015. https://ngfrepository.org.ng:8443/jspui/handle/123456789/3170
13. WHO MiNDbank. National Strategic Health Development Plan (NSHDP) (2010 - 2015). http://extranet.who.int/mindbank/item/2140
14. Basic Health Care Provision Fund (BHCPF). National Health Insurance Authority. Nhia.gov.ng. 2022. https://www.nhia.gov.ng/basic-health-care-provision-fund/
15. World Bank Group. Nigeria - Saving One Million Lives Initiative Program-for-Results (PforR) Project. https://documents.worldbank.org/en/publication/documents-reports/documentdetail/322711468100158289/nigeria-saving-one-million-lives-initiative-program-for-results-pforr-project
16. Nigeria Subsidy Reinvestment and Empowerment Programme (SURE-P): Maternal and Child Health Initiative. World Bank.
17. National Health Act 2014. Explanatory Memorandum https://admin.theiguides.org/Media/Documents/National%20Health%20Act%202014.pdf
18. World Health Organization. A Vision for Primary Health Care in the 21st Century: Towards Universal Health Coverage and the Sustainable Development Goals.
19. Downie R. Promoting Accountability in Nigeria's Health System. Center for Strategic and International Studies (CSIS); 2017 Feb.
20. Uzochukwu BS, Ughasoro MD, Etiaba EA, Okwuosa C, Envuladu E, Onwujekwe OE. Health care financing in Nigeria: Implications for achieving universal health coverage. Nigerian journal of clinical practice. 2015 Jun 1;18(4):437-44.
21. Hafez R, Hafez R. Nigeria health financing system assessment. World Bank; 2018 Apr 1.
22. Alonge SK. Primary health care in Nigeria: an appraisal of the effect of foreign donations. African Journal of Health, Safety and Environment. 2020 Dec 8;1(2):86-100.
23. Abdulraheem BI, Olapipo AR, Amodu MO. Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of public health and epidemiology. 2012 Jan 31;4(1):5-13.
24. Aregbeshola BS, Khan SM. Primary health care in Nigeria: 24 years after Olikoye Ransome-Kuti’s leadership. Frontiers in public health. 2017 Mar 13;5:48.
25. Brinkerhoff DW. 2004. Accountability and Health Systems: Toward Conceptual Clarity and Policy Relevance. Health Policy & Planning 19: 371–9.
26. Ransome-Kuti O. Who Cares for the Health of Africans? Ransome-Kuti O. Who Cares for the Health of Africans: The Nigerian Case. John D. and Catherine T. MacArthur Foundation; 1998.
27. Igbokwe U, Ibrahim R, Aina M, Umar M, Salihu M, Omoregie E, Sadiq FU, Obonyo B, Muhammad R, Isah SI, Joseph N. Evaluating the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway for the Basic Healthcare Provision Fund (BHCPF) across six Northern states in Nigeria. BMC Health Services Research. 2024 Nov 14;24(1):1404.
28. McLoughlin GM, Kumanyika S, Su Y, Brownson RC, Fisher JO, Emmons KM. Mending the gap: measurement needs to address policy implementation through a health equity lens. Translational behavioral medicine. 2024 Apr 1;14(4):207-14.
29. Oduenyi C, Ordu V, Okoli U. Assessing the operational effectiveness of a maternal and child health (MCH) conditional cash transfer pilot programme in Nigeria. BMC pregnancy and childbirth. 2019 Dec; 19:1-2.
30. Ilesanmi OS, Afolabi AA, Adeoya CT. Driving the implementation of the National Health Act of Nigeria to improve the health of her population. Pan African Medical Journal. 2023;45(1).
31. Aregbeshola BS, Khan SM. Out-of-pocket payments, catastrophic health expenditure, and poverty among households in Nigeria. 2010. International journal of health policy and management. 2018 Mar 10;7(9):798.
32. Ichoku EH, Fonta W. The distributional impact of healthcare financing in Nigeria: a case study of Enugu state.
33. National Bureau of Statistics. Nigeria Multidimensional Poverty Index Survey 2021. https://microdata.nigerianstat.gov.ng/index.php/catalog/71/related-materials
34. World Bank (2008). Administered Groba Launches Prepaid Health Insurance Scheme in Lagos, Nigeria. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/
35. Ogbonnaya R (2010). NHIS — Meeting Health Challenges Amidst Obstacles. http://allafrica.com/stories/201001250876.html?page=2
36. Agba AM, Ushie EM, & Osuchukwu NC. (2010). National Health Insurance Scheme (NHIS) and Employees’ Access to Healthcare Services in Cross River State, Nigeria. Glob J Hum Soc Sci;10:9-16.
37. Ibiwoye A, & Adeleke IA. (2008). Does National Health Insurance Promote Access to Quality Health Care? Evidence from Nigeria. The Geneva Papers; 33:219-33.
38. Mohammed S, Sambo MN, & Dong H. (2011). Understanding Client Satisfaction with a Health Insurance Scheme in Nigeria: Factors and Enrollees’ Experiences. Health Res Policy Syst;9:20
39. Kannegiesser L. (2011). National Health Insurance Scheme to Boost Generics Market in Nigeria.
40. HMO Contacts. National Health Insurance Scheme https://www.nhis.gov.ng/hmo-contacts/
41. World Health Organization. World Health Statistics 2015. Geneva: World Health Organization.
42. Olakunde BO. Public health care financing in Nigeria: Which way forward? Annals of Nigerian Medicine. 2012 Jan 1;6(1):4.
43. Adebayo EF, Uthman OA, Wiysonge CS, Stern EA, Lamont KT, Ataguba JE. A Systematic Review of Factors that Affect Uptake of Community-Based Health Insurance in Low-Income And Middle-Income Countries. BMC Health Services Research. 2015 Jun;15:1-3.
44. OCHA Annual Report 2018. https://www.unocha.org/publications/report/world/ocha-annual-report-2018
45. Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IM, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET. The Lancet Nigeria Commission: investing in health and the future of the nation. The Lancet. 2022 Mar 19;399(10330):1155-200.
46. Olaniyan O, Oburota CS. Equitable health care financing and universal health care coverage in Nigeria. African Journal of Health Economics. 2019 Dec; 8:25-31
47. Abdulraheem BI, Olapipo AR, Amodu MO. Primary health care services in Nigeria: Critical issues and strategies for enhancing the use by the rural communities. Journal of public health and epidemiology. 2012 Jan 31;4(1):5-13.
48. Aregbeshola BS, Khan SM. Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study. Journal of Public Health. 2021 Aug; 29:931-42.
49. Ibrahim ZA, Konlan KD, Moonsoo Y, Kwetishe P, Ryu J, Ro DS, Kim SY. Influence of Basic Health Care Provision Fund in improving primary Health Care in Kano state, a descriptive cross-sectional study. BMC Health Services Research. 2023 Aug 22;23(1):885.
50. The Abuja Declaration: Ten Years On 2001 Promises of commitment and solidarity. 2010. https://iris.who.int/bitstream/handle/10665/341162/WHO-HSS-HSF-2010.01-eng.pdf
51. Akintoyese Oyekola I, Olusegun Ojediran J, Albert Ajani O, Joseph Oyeyipo E, Rasak B. Advancing alternative health care financing through effective community partnership: A necessity for universal health coverage in Nigeria. Cogent Social Sciences. 2020 Jan 1;6(1):1776946.
