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The Impact Of Private Financing Of Health Care System In Nigeria
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In neighboring the country; Ghana, has proposed the introduction of a
“one-time NHIS premium payment (OTPP) policy†as an avenue to financial
risk protection to those not employed in the formal sector. [10]
The
way a country finances its health care system is a critical determinant
for reaching UHC. This is so because they determine whether health
services exist and are available and whether people can afford to use
health services when they need them. This can be achieved by a
well-planned combination of all healthcare financing mechanisms, which
include: Tax-based financing, OOPs, donor funding, health insurance [1]
exemptions, deferrals and subsidies. The main thrust is how to generate
adequate revenue to finance health services from a diversified group of
people, without over tasking the formal sector workers. Since in
Nigeria, the formal sector workers are the group that their
contributions are its tax or agreed deduction, can easily be access from
source and this constitutes 47% of the working population. The
situation is different when informal sector (about 53% of the working
population) is considered, due to infective tax collection system,
inefficient formula to calculate the amount to collect, and lack of
confidence on those that will be mandated to collect the fund.
In
Nigeria, revenue for financing the health sector is collected majorly
from pooled and un-pooled sources. The pooled sources are collected from
budgetary allocation, direct and indirect taxation as well as donor
funding. However, the un-pooled sources contribute over 70% of total
health expenditure (THE) and this can be: OOPs in the forms of fees
(informal or formal direct payments to healthcare providers at the time
of service) about 90% and payments for goods (medical products such as
bed-nets, or condoms) and about 10%. Despite these health financing
options in Nigeria, the finances are still disproportionately
distributed across the health system and with regional inequity in
healthcare expenditure.
Therefore, achieving successful health care
financing system continues to be a challenge in Nigeria. This review
draws on available and relevant literature to provide an overview and
the state of public health care financing in Nigeria.
Data for this
publication were generated through two approaches: A review of relevant
literature and the authors’ experiences. A systematic review of the
literature, policy documents and grey articles was conducted. Documents
reviewed provided information on health care financing, especially in
Nigeria. We searched PubMed, Medline, The Cochrane Library, Popline,
Science Direct and WHO Library Database with search terms that included,
but were not restricted to health care financing Nigeria, public health
financing, financing health and financing policies. Further
publications were identified from references cited in relevant articles
and reports. We reviewed only papers published in English. No date
restrictions were placed on searches. Extra information was obtained
from the experiences of the authors. These comprised of experiences
gathered from working with different level of health care: Primary,
secondary and tertiary health care, as well as interaction with private
health sectors workers, participating in workshop and conference
presentations and interaction with the population during field work. One
focus group discussion was organized during which the authors discussed
their different experiences with regards to UHC and overview of Nigeria
health care financing. Their contributions were included in the
different thematic areas.
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