Towards Universal Health Coverage in Nigeria: Can Community-Based Health Insurance Be Scaled Up?
Adeyemo, O. (2015) Towards Universal Health Coverage in Nigeria: Can Community-Based Health Insurance Be Scaled Up?, no. 68.
Background: Poverty impacts on health and vice versa. Thus, health security is fundamental to poverty alleviation and development in general. In Nigeria, about a third of the population incur catastrophic health spending annually. This tips more people into poverty and makes those who are already poor poorer. The concept of UHC was introduced in order to guarantee health for all and ensure that people do not become poor or poorer because of health care costs. To achieve this goal, countries must move away from out of pocket payments as a means to finance health costs, instead, institutionalise prepayment funding mechanisms either by tax revenue or health insurance. CBHI has been proposed for countries with large informal sector and rural population who may not be able to use tax-based health financing due to poor tax administrative system. Methods: A literature survey was carried out to identify and review studies that report factors for scaling up CBHI. Results: Five countries were found to have achieved some level of success scaling CBHI: Rwanda, Ethiopia, Mali, Senegal and the 19th century Japan. The Rwanda and 19th century Japan appear to have achieved more perhaps due to compulsory health insurance for all citizens including those in the informal sector instituted by law and also adopting an income-graduated premium contributions from citizens in the spirit of equity. Furthermore, Rwanda has been able to link CBHI to result-based financing to strategically purchase health services from health care providers. Conclusions: Nigeria shares some contextual similarities with these five countries, thus scaling CBHI nationwide may be an option to consider to move Nigeria close to UHC. Strong political stewardship that would standardised a national CBHI model with equitable enrolment is needed. The government of Nigeria may have to mandate health insurance across populations and pool different schemes into a single fund. Cost of health services is just one of the many identified obstacles to accessing health services especially for the poor. Keywords: Community-Based Health Insurance; CBHI; Scale-up; Universal Health Coverage; UHC; Health care; Health costs; Nigeria.