Dr. KICHA .D.
SUBMITTED BY :
ASOGWA INNOCENT KINGSLEY
HEALTH FOR ALL
HEALTH FINANCING IN NIGERIA
SOCIAL HEALTH INSURANCE
NHIS AND HEALTH FOR ALL
Over the years, nations have realized
the need for developing effective
Such systems seek to protect their
citizens from financial consequences of
Health care affordability and access
have become central themes.
Providing Health for All is a function of
access, affordability and equity.
of access to basic healthcare
Inadequate preventive health care services.
Inadequate health resources.
Inefficient utilization of scarce health
Goals of equitable access to quality health
care rarely achieved.
Poorly performing health systems.
o About US$9.44.00 per capita(WHO recommends
Poor health indices
< 5% of total budgetary expenditure (WHO recommends
minimum of 15%)
High IMR: 100/ 1,000 (NDHS 2003)
MMR: 1100/ 100,000 live births (WHO 2007)
Reduced life expectancy (about 43 years)
Inequitable distribution of health care resources
between urban and rural areas
Stewardship role of government – Ineffective.
Limited access to quality healthcare.
Median National HIV Prevalence:
Total Health Expenditure as Ratio of GDP
Declaration by WHO members in 1978 for
attainment by year 2000.
Global priorities and targets that would
enable people worldwide to reach and
maintain the highest attainable level of
Fundamental principle based on equity –
equal health status for people and countries
and an equitable distribution of health
Attainment of the HFA goals anchored on
primary health care
“… the attainment by all peoples of the
world by the year 2000 of a level of health
that will permit them to lead a socially
and economically productive life”.
Alma Ata declaration of 1978
Development of a global strategy and
Nations and regions to adapt based on global
strategy according to particular health problems
Equity, solidarity and social justice core to goal
Funding and allocation of healthcare resources
key to attaining goals.
Primary health care as core operational strategy.
Improvement in healthcare facilities.
Primary health care adopted as means of
Community participation an integral part of
Bamako initiative and DRF as parts of effort
to improve resources and their allocation.
Strategies short of attaining HFA goals.
Millennium Development Goals introduced to
augment other strategies.
General Taxation- up till late 80’s
Social Health insurance – 2005 to date.
Gaining global acceptance.
Introduced in Nigeria in 2005.
Based on mutual ethic of social
Equity in access and in financing as core
Community participation expressed
through contribution into the fund.
Ensures that all people in need have
effective access to at least essential care.
Alleviates the burden posed by ill health, loss
of income etc.
Coverage reduces the indirect costs of
disease and disability, such as care of family
members, lower productivity, and hampered
education and social development of children
due to sickness.
Plays a significant role in poverty reduction
Incorporates all strategies for achieving HFA,
including the MDGs.
“Implementing universal social health
protection might turn out to be a
milestone for achieving the MDG by
An agency of the Federal Government
established by Act 35, 1999 to promote,
regulate and administer the effective
implementation of social health insurance
programmes in order to ensure easy access to
qualitative and affordable health
to all Nigerians.
Improve access to good healthcare services (physical and financial)
Protect families from the financial hardship of huge medical bills
Limit the rise in the cost of health care services
Equitable distribution of healthcare costs
among different income groups
Improve standard of healthcare in Nigeria
Improve and harness private sector participation
Ensure equitable distribution of health facilities within the
Remove discrimination and ensure equitable patronage of all
levels of healthcare
Ensure the availability of funds to the health sector for improved
Based on social health insurance principles.
Contributions are income – related.
Operated on Public – Private Partnership basis.
Compulsory for certain populations such as formal
Contributions pooled into a single fund for Formal
Financing separate from health service delivery.
To secure access to adequate health
care for all Nigerians at an affordable
rate (universal coverage) by the year
Formal Sector Programme (FSP)
Public Sector Programme (PSP)
Fed. Civil Service, State Civil Service, Local
Government Civil Service, Tertiary
Institutions, Military, Police and other
Organized Private Sector Programme (OPSP)
Informal Sector Programme (ISP)
Rural Community, Urban Self- Employed,
Voluntary Participants, Retirees, Other
For those in formal employment
Compulsory for these workers
Contributions are paid by employers and employees
Total contribution is equal to 15% of basic salary
Enrollees enjoy a benefit package made of health
services from three levels of healthcare
Can attend private or Government hospital.
For those in the rural communities, self employed,
the poor, pregnant women and Children Under 5
Requires targeted subsidy from Governments and
Efforts are on to secure Government financing of
the subsidy gap.
Benefit package in line with the minimum basic
Services to be provided mainly by Primary health
NHIS well structured to achieve HFA.
Programmes designed to cover all
citizens of Nigeria.
Incorporates the core features of HFA –
equity, community participation,
intersectoral collaboration etc.
NHIS advocacy needed for achieving HFA.