31 Jul Universal health coverage in Nigeria
Emily Gustafsson-Wright and Onno Schellekens recently published a Brookings working paper titled Achieving Universal Health Coverage in Nigeria One State at a Time: A Public-Private Partnership Community-Based Health Insurance Model. [PDF] Download the paper
The paper discusses the topic of universal health coverage in the context of Nigeria, a middle-income country that nevertheless faces enormous health challenges. First, it addresses the constraints that have prevented Nigeria from attaining universal health coverage to date. It continues by presenting promising evidence from large and small-scale insurance interventions in other parts of the developing world.
Next, Gustafsson-Wright (guest scholar at the Brookings Institution and senior researcher at the Amsterdam Institute for International Development) and Schellekens (managing director of the PharmAccess Group) describe a public-private partnership model of community-based health insurance currently operating in Nigeria and other parts of Africa and show evidence of the program’s ability to increase health care utilization, provide financial protection and improve health status in target communities. They outline the program currently being implemented by the Health Insurance Fund and PharmAccess in Kwara, the fourth poorest state in Nigeria. The authors explain how the model works, how it is linked to local partners and how it complements regular public sector health programs. Finally, they highlight the promising impacts of the program and underline that, if Nigeria is to achieve universal health coverage, the program must be sustainable and have the ability to be scaled up.
Scaling up in Kwara State
As a matter of fact, the program is doing just that. In February 2013, the Health Insurance Fund, the Kwara State government and the Nigerian health maintenance organization Hygeia signed a memorandum of understanding to expand the program to cover 600,000 low-income people within the next five years and is currently being developed into a statewide health insurance scheme. Under this agreement, the Kwara State government will contribute an increasing percentage of the premium subsidies and will invest in healthcare infrastructure.
Gustafsson-Wright and Schellekens contend that universal health coverage can only be achieved by addressing both supply and demand-side constraints simultaneously. The solution must also include building on existing public and private institutions and informal networks, leveraging existing capital, and empowering clients and local communities. The innovative model being implemented in one Nigerian state could be replicated in others; tackling this challenge one state at a time, to eventually achieve the goal of access to health care and financial protection for all.