In order to attain the Universal Health coverage for all, the Nigeria government developed the Nigerian National Health Act 2014 which proposes a shift in health financing in Nigeria through the establishment of a fund – Basic Healthcare Provision Fund, (BHCPF).
Key stakeholders at national, sub-national and local levels have raised concerns over the management of the BHCPF with respect to the roles of various stakeholders in ensuring accountability for its use, and the readiness of the implementers to manage this fund and achieve its objectives.
In order to improve the management of the funds and provide effective and efficient quality service delivery, it is necessary that strategies or mechanisms are in place to ensure accountability between the different stakeholders responsible for implementing the BHCPF at state, local and facility levels.
Today, Lafiya, a seven years United Kingdom Program that supports health in Nigeria is working with stakeholders to put in place strategies for monitoring the management of BHCPF to ensure transparency and accountability.
Dr Dayyabu Mahmoud Yusuf is the State Team Leader for Department for International Development (DFID) now Foreign and Commonwealth Office (FCO), Lafiya Funded Program in Kano.
He says the BHCPF is one of the most noble programs of the federal government of Nigeria because it provides social security for the poorest of the poor in terms of access to health services.
He says it took for years between 2014 to 2018 when the first appropriation was done and even after funds were appropriated, it took close to another one years for some states to meet the requirements to get the funds to basically commence the provision of services.
And after close to three years of struggle, only 16 states in the country met the requirement and received disbursement of funds from both National Health Insurance Scheme (NHIS) and NPHCDA gateways.
After getting the funds before the states could commence the provision of services, the National Assembly halted the process due to irregularities that needed to be addressed within the former guideline to reflect the current circumstances within the operational guideline.
The Nigerian National Health Act 2014 specified that any state that wants to key into it must provide 25% counter-part contribution but it was not emphasized in the former guidelines and states got disbursement without paying the counter-part funding.
For example, Kano state has received about N1.8b but because of directives to halt the process for capacity building and other things that needed to be done, the actual disbursement to facilities for service delivery has not commenced.
Dr Dayyabu says a review of the 2018 national operational guideline has been done by the National Assembly and the new one has been approved by the national council on health in August, 2020.
He says his organization is working with Kano State Led Accountability Mechanism (KanSlam) to quickly push to ensure government they key into the initiative and quickly commence provision of health services using the funds through meeting all the training requirements for National Primary Health Care Development Agency (NPHCDA) and NHIS to do the final verification and certification to confirm that states (Kano) is ready to commence provision of services.
KanSalm is a coalition of government officials, civil society organizations and journalists promoting accountability in the state.
Recently, the Lafiya Program supported KanSlam to organize a 2-day BHCPF Orientation Workshop for some Civil Society Organization (CSOs) and the Media practitioners to develop accountability framework for tracking the implementation of BHCPF in Kano.
Dr Dayyabu says BHCPF recognizes the roles of CSOs and Media in ensuring that accountability is entrenched in its implementation; the orientation workshop is to give them deeper knowledge and good understanding so they can support and strengthen accountability for the use of the funds.
Mohammed Isyaku Yanmedi is State Coordinator, NHIS, Kano State Office.
He says most beneficiaries (pregnant women, children under 5, people with disability, aged people and the poor and vulnerable) of BHCPF are not aware of their rights especially when accessing care, and there are challenges of poor data management, state government delay or default in paying its 25% contribution to the program, mismanagement of resources at facility levels and the preparedness of Local Government Health Authorities to manage the Fund.
In all these instances, Yammed says the Media, CSOs and other stakeholders have a duty of enlightening beneficiaries to know their rights when accessing care at both government and private Primary Health Centers.
He says CSOs also have a role to develop an accountability framework for implementing the BHCPF, which should have mechanisms for strategic planning, strong and transparent monitoring and supervision systems and systematic reporting.
The Director Planning, Monitoring and Evaluation, State Primary Health Care Management Board (SPHCMB), Bashir sunusi says the challenge in the implementation of the BHCPF is in the design; it’s a national one plan fits all.
He says states are mandated to keep N100m as counter part fund regardless of the number of Local Government Areas (LGA). Kano for instance has 44 LGAs, 484 wards and over 1200 facilities.
Sunusi says the N100m is not enough for trainings and to meet all the requirement processes for take-off and the community governance structure, that is the membership of Ward Development Committees (WDC) is another challenge because attrition.
He says with all these challenges, the SPHCMB has done the state training of trainers (ToT), cascade training for 484 facilities with 4 participant par facility and have developed the annual quality improvement plan and the annual business plan.
Sunusi says SPHCMB has met most of the requirements and is on verge of collation which will lead to verification by the national office.
He says the 2019 fund is already at the Central Bank of Nigeria (CBN) waiting for the verification by the national team for the disbursement to begin for the facilities that are qualified.
At the end of the 2-day training, KanSlam and other stakeholders are at work-in-progress to finalize a simple accountability framework that provides mechanism for monitoring how funds are allocated and spent to support the implementation of BHCPF in Kano.
A participant at the training, Salisu Yusuf, Public Relation Officer, Kano State Led-accountability Mechanism (KanSlam) says it was refresher, but he now has better knowledge of the reviewed BHCPF; it has also improved his capacity to advocate to government to not to delay in paying its counter-part fund.
Another participant, a media practitioner, Hauwa Sani Zahradeen says her knowledge of BHCPF improved and her capacity to sensitize and mobilize the public to benefit from BHCPF has been enhanced.