Lessons on Key Health Service Purchasing Reforms in Nigeria

Abstract

Strategic purchasing of health services has been identified as one of the critical components for countries to progress towards achieving universal health coverage (UHC). Due to decentralized governance, there are multiple purchasers in Nigeria, which has led to fragmentation, lack of coordination, inefficiency in the allocation and use of resources, and duplication of purchasing efforts. This country case study aimed to (i) provide evidence on the purchasing reform processes in Nigeria, (ii) assess the impact of purchasing reforms on UHC objectives, and (iii) synthesize key lessons learnt about major purchasing reforms. A mixed-methods approach was adopted involving triangulation between a literature review and a qualitative study. Semi-structured key informant interviews were conducted with 27 respondents in Nigeria from various national and subnational government ministries, departments and agencies. Study findings indicate the availability of policies that facilitate integration and coordination among purchasers. However, there are several gaps, such as poor implementation of policies, inadequate funding, lack of a national health insurance information management system, and poor political will. The operationalization of the National Health Insurance Authority Act 2022 should help to facilitate increased coverage and coordination. Efforts are needed to strengthen health insurance information management systems, update the Minimum Service Package, and capacity building.

Keywords: Strategic purchasing, universal health coverage, health financing, health insurance, benefit package, health information management, COVID-19, governance, coordination, Nigeria