Featured Health Policy and Financing

Basic Health Care Provision Fund in Nigeria: Rivalry Between State Ministries Of Health and Primary Health Care Agencies May Stall Implementation

The Government of Nigeria is rolling out a massive revenue and funding plan for health in the Country. The plan sets aside at least 1% of the total consolidated revenue of the government for health. The fund is tagged Basic Health Care Provision Fund (BHCPF).

BHCPF also warehouses funds from donors and other sources. BHCPF is localky calked ‘huwe‘ – a word from the ethnic tribe of Ebira that means life.

There are three pathways through which the fund is expected to be spent: the Primary Health Care Gateway; the Health Insurance Gateway and Medical Emergencies.

BHCPF is even backed by Law – the National Health Act (NHA) of 2014. The BHCPF is not ambiguous. The Law backing it is clear about which government agency should get what and for what purpose.

Sharing of BHCPF According To National Health Act 2016

According to the NHA of 2014, the funds should be shared as highlighted below:

  1. Health Insurance – 50%
  2. Primary Health Care – 45%
    • 20% for essential drugs, vaccines, and consumables for eligible primary health care facilities
    • 15% for maintenance and transportation for eligible primary health care facilities
    • 10% for human resources development for primary health care
  3. Medical Emergencies – 5%

By design, the Health Insurance Gateway is to be managed by the different State Health Insurance Schemes through the National Health Insurance Scheme (NHIS), the Primary Health Care Development Agency is the channel for managing the Primary Health Care Gateway using the different State Primary Health Care Development Agencies/Boards while the Medical Emergency Gateway is to be managed by a committee set up by the National Council on Health, the highest decision making body on health in Nigeria.

In reality, the medical emergency fund is being managed by the Nigeria Centre for Disease Control and the States Ministry of Health to fight infectious diseases and other medical emergencies across Nigeria.

Experts are of the opinion that it is the dawn of a new era for health care in Nigeria with the release of the first tranche of the fund by the federal government.

But there are implementation issues that may threaten the success of the funds, if not properly addressed.

Regulatory Agency Becoming Implementing Agency

The health system in Nigeria operates at three tiers of government. The National government controls the implementation of tertiary care, States control secondary care while the local government is saddled with the responsibility of controlling primary health care.

However, in practice, funding for primary health care services is done by all levels of government.

By design, the Federal and State Ministries of Health perform regulatory roles. The State Hospitals Management and Primary Health Care Boards are into implementation.

Before the clamour for the establishment of State PHC Boards to coordinate PHC implementation, PHC was domiciled in the Department of Public Health of the State Ministries of Health (MoHs).

With the devolvement of PHC activities to PHC Boards, the MoHs of many States still held on to PHC implementation, thus abandoning their regulatory roles, as it were.

“There lies the problem,” a source who wished not to be named told us. “They want to be regulating and implementing at the same time, thereby defeating the purpose for which the PHC Boards were created in the first place.”

Our investigation across Nigeria shows that the problem is pervasive. The PHC Boards are accusing their MoHs of interfering with their independence to act to deliver quality health care to the people.

But the MoHs are quick to respond that as the parent regulatory organization, they must be involved in activities of the PHC Boards.

In some states, Ekiti and Lagos for example, some core PHC programmes are still housed in MoHs, which is against the recommendation of the National Primary Health Care Development Agency.

In some instances, the MoHs create parallel programme offices to compete with PHC Boards.

The situation breeds unhealthy rivalry that affects the smooth delivery of care to the teeming Nigeria population – the real people that matter in health care delivery.

The Commissioners for Health, who should intervene to ensure hitch-free service delivery, are either themselves wrongly informed or are part of the internal wrangling, often for selfish gain.

Oftentimes, partners get caught in the midst of the cold war thus affecting coordination and programme implementation.

As a way out, the Federal Ministry of Health and National Primary Health Care Development Agency needs to convey a high-level meeting among stakeholders across Nigeria, including partners, to harmonize areas of disagreements and ill-feelings to address the problems.

This action is needed so that the introduction of BHCPF, that has been hailed as a game-changer for the Nigeria health system, may not be another passing fad of the Nigerian health system.

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