How we shared N12.7 billion Nigeria health fund – Official

On Tuesday, an official of the National Health Insurance Scheme (NHIS) announced that the agency has received ‘the larger part’ of the Basic Health Care Provision Fund (BHCPF).

His statement added a new layer to the momentum trailing the release and launch of the fund.

Uchenna Ewelike, the technical adviser to the overseeing director of the NHIS, at an event held to celebrate the achievements of the outgoing 8th assembly, said the scheme received N6.5 billion from the BHCPF and would soon commence disbursement to states.

He later clarified to PREMIUM TIMES that a total of N12.7 billion had been released on far.

He clarified how the NHIS will manage and disburse the funds in an interview with this paper on Thursday.

What is BHCPF?

The BHCPF is the fundamental health funding provided by the National Health Act. It was only included in the budget last year for the first time since the Act was signed in 2014.

It provides for not less than one per cent of the Consolidated Revenue for health funding.

When passing the 2018 budget in May, the National Assembly earmarked N55 billion for the BHCPF, as stipulated by the Act. Funding from donor organisations and other sources also forms part of the BHCPF.

Only 25 per cent of the 2018 fund has, however, been released so far.

Following the flag off of the BHCPF by President Muhammadu Buhari in January, health minister Isaac Adewole has in the past few weeks been moving from state to state, launching the pilot scheme of the programme which started with four states – Osun, Niger, Abia and Katsina.

The ministerial train was in Abia on Friday and the next stop will be Katsina to complete the first phase of the launching.

‘How NHIS Will Disburse the Fund’

Mr Ewelike explained the role NHIS will play in the disbursement of the fund.

The BHCPF was mostly meant for providing adequate care and services at the Primary Health Care (PHC) level, mostly for the vulnerable population so as to reduce out-of-pocket expenses.

The National Health Act created three gateways for the disbursement of the fund.

The NHIS is supposed to receive 50 per cent while the National Primary Health Care Development Agency (NPHCDA) gets 45 per cent. The remaining 5 per cent was meant for outbreaks and emergency responses.

“Money will flow from the CBN to NHIS to NPHCDA to NCDC (Nigerian Centre for Disease Control) down to the PHCs,” said the health minister in an interview with the medium last year.

Mr Ewelike said N12.7 billion (25 per cent) was the total sum total released so far.

“The NHIS received 6.5 billion while N5.8 billion went to NPHCDA with the NCDC receiving N327million,” he told PREMIUM TIMES.

Mr Ewelike said the NHIS has developed an implementation guideline for disbursement.

“The NHIS is just a gateway in the sense that the money passes through the scheme to the PHC level. We are planning to disburse through the State Social Health Insurance Schemes who will now pay the PHCs directly.

The official said the health ministry is responsible for selecting states eligible to access the fund. “It is intended for the 36 states and the FCT but because the act made provision for a counterpart funding of N100 million, some of the states are yet to comply.”

Mr Ewelike said the gateways and fund-flow are designed for accountability mechanism.

“If you pay money you cannot monitor, it will go to waste. This accountability mechanism is already enshrined in the law.”

Some states yet to comply – Minister

Fourteen states are yet to show interest in the BHCPF, said Mr Adewole, while appearing before the Senate plenary on Tuesday.

The minister said 22 states including the four pilot state have complied with criteria for assessing the fund.

Kebbi, Jigawa, Akwa Ibom, Cross River, Gombe, Rivers, Borno, and Zamfara are the states yet to comply.

Others are Ondo, Benue, Taraba, Nasarawa, Ogun and Sokoto.

Apart from the N100 million counterpart funding, Mr Adewole listed other criteria states must meet to access the funds to include the establishment of State Primary Health Care Development Board and State Health Insurance Scheme.

Not Enough

Even though the release and launch of the BHCPF have generated an air of optimism with the health minister describing it as the “game changer”, health experts have some reservations.

They say the fund is not enough to go round the states.

Oladipo Ladipo, the Chairman of the National Advocates for Health, described the 25 per cent released so far as a “drop in the ocean”, shortly before Mr Ewelike made his announcement on Tuesday.

Concerns were also rife chiefly because the fund has not yet been made a Statutory Transfer, meaning there is no guarantee of its continuity and the amount to be released is at the discretion of the president.