Access to healthcare in Nigeria has historically been a significant challenge, with out-of-pocket (OOP) expenditure accounting for about 70% of healthcare financing, one of the highest rates in the world. To address this, the Nigerian Federal Government introduced the Basic Health Care Provision Fund (BHCPF) under the National Health Act to ensure sustainable financing for primary healthcare nationwide.
The BHCPF aims to improve access to essential healthcare services, particularly for vulnerable populations, by making primary and secondary healthcare services more affordable and accessible. Despite its implementation in 2019, the effectiveness of the BHCPF in reducing OOP expenditures and increasing life expectancy remains under-explored.
Implementation of the BHCPF in Kano State
The BHCPF provides a Basic Minimum Package of Health Services (BMPHS) to reduce OOP healthcare costs and ensure that at least one primary healthcare center (PHC) per political ward is fully functional.
This initiative involves direct funding to healthcare facilities through three main avenues: the National Health Insurance Scheme, National Emergency Medical Treatment, and the National Primary Health Care Development Agency (NPHCDA). Funds from the NPHCDA cover essential medications, vaccines, and consumables, and support the maintenance of healthcare facilities, equipment, and human resources.
In Kano State, the BHCPF is operationalized through three gateways: the Kano State Primary Health Care Management Board (KSPHCMB), the Kano State Contributory Health Management Agency (KSCHMA), and the State Emergency Medical Treatment Committee.
These organizations ensure equitable access to healthcare by effectively distributing funds, engaging healthcare workers, and providing essential health services to vulnerable populations.
Setting a Benchmark
Kano State’s implementation of the BHCPF focuses on accountability and continuous improvement, involving stringent retirement processes for funds, quality improvement plans, and regular supervision and audits. These practices have improved service delivery and set a benchmark for other Nigerian states.
- Timely Retirement Process: Health facilities must adhere to strict timelines for fund retirement, ensuring prompt and effective use of funds.
- Quality Improvement Plans: Each healthcare facility develops a comprehensive Annual Quality Improvement Plan, covering infrastructure to community engagement, with detailed quarterly business plans. This meticulous planning ensures wise fund allocation in line with quality standards.
- Supervision: Rigorous supervision ensures effective plan implementation, with corrective actions, including potential refunds, for any deviations.
Surpassing Expectations
Kano State has exceeded the ambitious targets set by the BHCPF, achieving 70% PHC functionality ahead of schedule. Since the program’s inception, the state has utilized BHCPF funds to improve healthcare facilities, hire essential staff like midwives, and provide life-saving drugs and equipment. By May 2024, the state had enrolled 162,165 people to receive essential healthcare services.
Impact and Challenges
The BHCPF has significantly reduced the financial burden of healthcare in Kano State, lowering OOP expenditures and improving health outcomes. Beneficiaries, particularly vulnerable groups like women, children, and people with disabilities, have reported improved health and well-being.
However, challenges remain, including delays in fund disbursement, data inaccuracies, and bureaucratic hurdles. For instance, Kano State has yet to receive national-level disbursements for the first two quarters of 2024, affecting program momentum. Delays in work plan approvals have also hindered implementation.
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Bottom Line
The BHCPF is a critical step towards achieving Universal Health Coverage (UHC) in Nigeria. While challenges persist, Kano State’s successes demonstrate the program’s potential to transform healthcare delivery. Strengthening the BHCPF in other states, following Kano’s approach, is important for nationwide health improvement.
Implementing timely fund retirement processes, quality improvement plans, and rigorous supervision can enhance healthcare access, reduce OOP expenditures, and move Nigeria closer to UHC.
