Digital Artifact for the Word Bank MOOC on Financing for Development

1. A Proposal To Improve The
Nigerian Primary Health care
systemA digital Artifact for the MOOC on financing for development
by Timothy E.O Attoye
timattoye@gmail.com

2. Situation Analysis
• Land Mass: 910770square kilometers
• Population size: 177.5 million
• Over 60% below the poverty line
• No of health personnel to people : Approx 1.4 per 1000
• Government facilities vs private facilities
• Inherent inefficiencies of public sector provision
• Poor 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 Attoye
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3. Financing
• Financing: GDP- USD 568.5B
• Health expenditure % of GDP: 3.9%
• Out of pocket expenditure over 95%
• Major percentage of government expenditure on staffing
salaries.
• Less than 5% from Social insurance
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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4. Health System
Performance
• Life expectancy: 52 years
• Infant Mortality Rate: 72 per 1000 live births
• Maternal mortality ratio: 814 per 100,000births
• Epidemic of noncommunicable diseases
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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5. The Solution
• Increase spending on health
• A 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 Attoye
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6. The Proposal
• Shift 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 Attoye
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7. Feasibility
• Two proofs of concept.
1. NHIS scheme: Primary Health services can be provided
for 750 naira capitation (approx. 3USD) per month
2. The 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
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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8. Execution
• Comprehensive situation analysis
• Geographical 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.
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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9. 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 levels
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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10. 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.
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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11. Value Proposition
• Reduced 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 Attoye
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12. Potential challenges and
solutions
• A 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 arms
• Starting with a proof of concept at a local/ regional level
before a national roll-out.
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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13. • Thank you for your time
A digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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14. Sources
• The World Bank, World Development Indicators (2013). Nigeria: World development Indicators;
Retrieved from http://data.worldbank.org/country/nigeria#cp_wdi
• Federal ministry of Health. Nigeria Strategic Health Development Plan 2010-2015. Retrieved from
http://www.health.gov.ng/doc/NSHDP.pdf
• United 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/10986/5958/540370PUB0heal101Official0Use0O
nly1.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 digital Artifact for the MOOC on financing for development by
Timothy E.O Attoye
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