Table 2 Roles of key actors in health financing in Nigeria
Actor category | Key players | Roles |
|---|---|---|
Federal government and line Ministries | Federal Executive Council (FEC) | Approves policies that have macroeconomic and financial implications before operationalization |
Ministry of Finance | Critical role in advising FEC to ensure that health financing reforms align well with macroeconomic realities of the Country | |
National Assembly (NASS) | Responsible for appropriation of budget to health sector and monitoring its implementation through standing (Senate or House) Committees on Health | |
Federal Ministry of Health and its Agencies | Federal Ministry of Health (FMOH) | Pivotal in health financing. Statutorily responsible for developing health policies and designing health programs and interventions. The health financing unit of FMOH is strategically positioned to promote the use of evidence in design and implementation of health financing reforms. It coordinates the Technical Working Group on health financing and engages other stakeholders to ensure support of health financing reforms. FMOH has been working with NHIS and NPHCDA in development of guidelines for management of Basic Healthcare Provision Fund (BHCPF). |
National Health Insurance Scheme (NHIS) | Runs and manages the Formal Sector Social Health Insurance Program (FSSHIP) and statutorily oversees the operations of HMOS in Nigeria. NHIS Zonal and State offices are positioned to provide needed support for State health insurance schemes. | |
National Primary Health Care Development Agency (NPHCDA) | Focuses on improving quality and uptake of essential health services for vulnerable groups through interventions that incorporate both supply and demand-side financing such as the Midwives Service Scheme (MSS), Subsidy Reinvestment Program (SURE-P), and the Nigeria State Health Investment Project (NSHIP). To underscore the role of NPHCDA, a respondent said that ‘NPHCDA’s role is to ensure that services are provided at the PHC level. They have run performance-based financing pilots in some States, and the lessons learnt and experiences gained would be useful going forward” | |
Development partners and other donor agencies | Involved in pooling and management of financial resources Technical expertise and support in health financing and public finance management. Technical support with strategic purchasing of services based on their experiences in using implementing partners (IPs) to deliver critical health interventions to Nigerians. Through this, they have been able to strengthen service delivery, contracting, logistics and payment mechanisms. “For example, CHAI has helped to drive down the cost of drugs by creating a market for drugs. Reference pricing around products and drugs can help us do strategic purchasing of vaccines and essential drugs. DPs have gained experience with contracts with vendors and communities, and making use of their IPs, we can strike a lasting relationship in purchasing services which can help improve quality of health infrastructure and services” | |
Private sector | Upstream actors (e.g. Private Sector Health Alliance) | The upstream actors are those involved in resource mobilization and domestic revenue mobilization, as well as investors. The upstream players also include foundations, and corporate organizations who earmark resources for corporate social responsibility activities. |
Downstream actors | The downstream players are mainly the service providers and it was acknowledged by some respondents that “over 60–65% of health services are delivered by the private sector in Nigeria”. | |
Health Maintenance Organizations | Interface between government and private providers of healthcare in the social health insurance schemes | |
Academia | Expand knowledge base and generate evidence to bridge the policy-research gap. Build capacity for health financing Serve as a repository of knowledge | |
Citizens and citizen groups | Civil Society Organizations (CSOs) | Ensure quality of care by guaranteeing accountability and value for money Informing and mobilizing citizens |
Media | Informing and mobilizing citizens | |
States and Local governments | Important roles in initiating and sustaining health financing reforms. Who did you make policy for when all federal constituencies are situated within a state and their LGAs?” States are expected to own and domesticate all health policies that are approved and adopted by the National Council on Health, to ensure proper implementation. CBHI and mutual aid are often managed at the LGA level by LGA health authority. |