Community Based Healthcare Financing: An Untapped Option to a more Effective Healthcare Funding in Nigeria

Abstract

Context: The Nigerian health system is characterized by chronic under funding. This has resulted in poor performance of the health sector evident from Nigerian's poor reproductive health indices. Objective: This review evaluates healthcare funding in Nigeria ith respect to health budget and health expenditure, appraises the national health insurance scheme, and examines community health care financing as a plausible option to a more effective funding of healthcare in Nigeria. Pattern of health funding in Nigeria: Federal Government budget on health ranged from N4,835 million-N17,581.9 million from 1996 to 2000. This amount represented only 2.7%-5.0% of the total Federal Government budget. Nigerian's Total Health Expenditure (THE) as a percentage of Gross Domestic Product
(GDP) is low ranging between 4.3 %-5.5 % from 1996-2005. General Government Health Expenditure (GGHE) as percentage of THE is also low ranging from 21.8 %-33.5 %. Private sector expenditure on health as percentage of THE is high ranging between 66.5 %-78.2 % from 19962005, with private households' out of pocket accounting for 90.4 %-95.0 % over the period. Social security fund had no contribution to the general government expenditure over the 10-year period. The National
Health Insurance Scheme (NHIS) currently covers only the formal sector of 4.5 million people (3.2 %) of the population. Community-based healthcare financing (CBHF): Communitybased healthcare financing has been recognized as a communityfriendly and community-driven initiative that has a wider reach and coverage of the informal sector especially if well designed. Experience with the Anambra State CBHF scheme, and a few other similar schemes in Nigeria indicate high acceptability of the people to CBHF scheme. Conclusion and Recommendations: Government and nongovernmental organizations should collective develop various forms of CBHF to reach out widely to Nigerians.

Key words: community-based healthcare financing; untapped option to effective healthcare funding; Nigeria