A Proposal to Improve the Nigerian Primary Health Care System timothy attoye

A Proposal To Improve The Nigerian Primary Health care system

A Proposal To Improve The Nigerian Primary Health care systemA digital Artifact for the MOOC on financing for development by Timothy E.O [email protected]

Situation AnalysisLand Mass: 910770square kilometersPopulation size: 177.5 millionOver 60% below the poverty lineNo of health personnel to people : Approx 1.4 per 1000Government facilities vs private facilitiesInherent inefficiencies of public sector provisionPoor regulation of the private sector.Serious mismatch in number needed and in geographical coverage of health facilities (US Govt Interagency Team (2011))A digital Artifact for the MOOC on financing for development by Timothy E.O Attoye2

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Financing Financing: GDP- USD 568.5BHealth expenditure % of GDP: 3.9%Out of pocket expenditure over 95%Major percentage of government expenditure on staffing salaries.Less than 5% from Social insuranceA digital Artifact for the MOOC on financing for development by Timothy E.O Attoye3

Health System PerformanceLife expectancy: 52 yearsInfant Mortality Rate: 72 per 1000 live birthsMaternal mortality ratio: 814 per 100,000birthsEpidemic of noncommunicable diseasesA digital Artifact for the MOOC on financing for development by Timothy E.O Attoye4

The SolutionIncrease spending on healthA mechanism to ensure that the poorest quintiles can access health care.Better location and distribution of health care personnel and facilities as well as more efficient management of the facilities.A digital Artifact for the MOOC on financing for development by Timothy E.O Attoye5

The ProposalShift government focus to financing and regulation of healthcare and increase private sector participation in health care provision with potential efficiency gains.

A digital Artifact for the MOOC on financing for development by Timothy E.O Attoye6

FeasibilityTwo proofs of concept. NHIS scheme: Primary Health services can be provided for 750 naira capitation (approx. 3USD) per monthThe capitation model can be used by the private sector in a sustainable and profitable way of running primary care in Nigeria; demonstrated by the Hygeia/Lagoon group


ExecutionComprehensive situation analysisGeographical distribution of health facilities and staff needs to be carried out to demonstrate clearly where new facilities would need to be cited what staff need to be employed.Clearly define the market; map citizens to health facility, creating catchment areas and clearly defining the market for each service provider.


Execution (contd)Financing for each facility to be based on the number of people in the catchment area and on the basis of 750 per person per month.Sourcing: the previous allocations to health by the different tiers of government; both from the local to federal levelsA digital Artifact for the MOOC on financing for development by Timothy E.O Attoye9

Execution (contd)Private development partners, particularly to be contracted to run existing facilities and build new ones where needed under the build-own-operate arrangements These could be for profit health maintenance organizations or new private development partners.


Value PropositionReduced barriers to entry in the case of existing health facilities. Limited competition in catchment area a ready market Government risk mitigation by the assurance of income stream based on the capitation model . A digital Artifact for the MOOC on financing for development by Timothy E.O Attoye11

Potential challenges and solutionsA massive undertaking requiring tremendous technical know how and possibly external aid which the World bank is eminently qualified to provide.Substantive contributions and collaborations from the ministry of health and finance, between the legislative and executive armsStarting with a proof of concept at a local/ regional level before a national roll-out.


Thank you for your timeA digital Artifact for the MOOC on financing for development by Timothy E.O Attoye13

Sources

The World Bank, World Development Indicators (2013). Nigeria: World development Indicators; Retrieved from http://data.worldbank.org/country/nigeria#cp_wdiFederal ministry of Health. Nigeria Strategic Health Development Plan 2010-2015. Retrieved from http://www.health.gov.ng/doc/NSHDP.pdfUnited States Government Interagency Team (2011): Nigeria Global Health Initiative Strategy 2010 2015 Retrieved from http://www.ghi.gov/whereWeWork/docs/NigeriaStrategy.pdf https://openknowledge.worldbank.org/bitstream/handle/10986/5958/540370PUB0heal101Official0Use0Only1.pdf?sequence=1 Ejughemre, U. J. (2014). Accelerated reforms in healthcare financing: The need to scale up private sector participation in Nigeria. International journal of health policy and management, 2(1), 13.Adefolaju, T. (2014). Repositioning Health Insurance in Nigeria: Prospects and Challenges. International Journal of Health Sciences, 2(2), 151-162.


A Proposal to Improve the Nigerian Primary Health Care System timothy attoye

Healthcare

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