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Is the Basic Health Care Provision Fund the Silver Bullet to Achieve Universal Health Care in Nigeria: Lessons from Dukpa PHC

Participants at the Town Hall Engagement Meeting conducted by Nigeria Health Watch at Gwagwalada Area Council FCT. Photo credit: Nigeria Health Watch

Sustained Health financing is an integral part of achieving Universal Health Coverage (UHC) and this year, as the world commemorated UHC day on the 12th of December, the theme, “Leave no one’s health behind: invest in health systems for all,” emphasised the need for governments to make smart investments in their country’s health systems.

The Basic Health Care Provision Fund

Nigeria’s commitment to UHC can be traced all the way back to 2014 at the Presidential Summit on UHC where the Federal Government reaffirmed its political commitment towards providing equitable, quality and universally acceptable healthcare for all Nigerians.

This commitment was further reinforced in the National Health Act (NHAct 2014) which vowed to earmark 1% of Consolidated Revenue Fund (CRF) in addition to grants from donors, partners, and other funding sources to be channeled through a Basic Health Care Provision Fund (BHCPF). Since the inception of the BHCPF however, none of the yearly allocations have reached the recommended 1%. In 2020, the BHCPF allocation was about 50% less than the value of 1% of the CRF.

Implementation of the BHCPF commenced in 2019. Thus far, a total of 6,287 health facilities across 31 states have received funds from the BHCPF. In the Federal Capital Territory (FCT) 62 health facilities have also been registered and are receiving funds.

Image credit: Nigeria Health watch

Dukpa Primary Health Centre

To commemorate UHC day, on Monday, December 13, Nigeria Health Watch under the Community Health Watch project, organised a townhall meeting in Dukpa Community, Gwagwalada Area Council, where community members, health workers and local government officials discussed the implementation, utilisation, and impact of the BHCPF. Gwagwalada Area Council has 10 wards, and in each ward, one health facility is registered under the BHCPF. Dukpa PHC is one of the health facilities funded by the BHCPF in the FCT.

Primary Health Center at Dukpa Community Gwagwalada Area Council FCT. Photo credit: Nigeria Health Watch

The community members exhibited a high level of understanding about the BHCPF as the health workers at the PHC partnered with officials from the area council to sensitise them on the program and its benefits. Pregnant and nursing mothers confirmed that they had received treatment and even given birth for free at the PHC.

Image credit: Nigeria Health Watch

According to Timzing Auta, the health worker in charge of Dukpa PHC, under the BHCPF, there are currently over 120 registered beneficiaries. He said that all children under 5, pregnant women and elderly people 65 years and above, are treated for free, while others currently not covered in the priority groups are eligible to access malaria treatment, high blood pressure and diabetes screenings, free of charge. Auta added that the facility receives NGN 100,000 monthly to carry out basic maintenance, buy cards for registration and drugs for the beneficiaries. The funds are received in two parts and between October 2020 and September 2021, Dukpa PHC received a total of NGN 900,000.

Mr. Timzing Auta, the health worker in charge of Dukpa PHC Photo credit: Nigeria Health Watch

Sazia Muhammed, a beneficiary, said that when the programme started, she was registered, given a card and allowed to access care for free. Joseph Sarki, a community member who confirmed that his children had benefited from the program said, “It has been very helpful. Our children are healthy, and we have been treated well”. Expressing his gratitude for the initiative, Ishaku Danjuma, Mai Anguwa of Dukpa Community said the biggest impact of the program is on their children. “Since this programme started our children have received the care that they need, when they need it, and we don’t have to spend any more money.”

Dr Adeyemi Adeniran, Director, PHC services, Gwagwalada Area Council said his office provides oversight to monitor how the funds are spent. To promote accountability and ensure that the funds are used judiciously, before they receive the funds, each facility prepares and submits a business and quality assurance plan. “Each month we visit all facilities to determine how they are spending and if they are up to date with their plans for the month,” he added.

Dr. Adeyemi Adeniran, Director, PHC services, Gwagwalada Area Council at the Town Hall Engagement Meeting conducted by Nigeria Health Watch. Photo credit: Nigeria Health Watch.

Although the BHCPF appears to be running smoothly in the facility, further conversation revealed some challenges. Auta said inconsistency in the release of the funds is hindering the smooth running of the programme. The second batch of funds were released 6 months later than expected, long after they had run out of drugs. “The NGN100,000 monthly stipend is not enough. We need more than 5 million naira to renovate our clinic,” he added. An examination of the facility revealed that it was also in need of a dedicated source of water, a proper waste disposal system and toilets.

Image credit: Nigeria Health Watch

A functional Primary health care system is a critical milestone in order to achieve UHC. The World Health Organisation considers investments in quality primary health care as the cornerstone for achieving UHC around the world. The Federal Government must therefore do its utmost to uphold the commitment made in 2014 by ensuring that the complete 1% CRF allocated to the BHCPF in the 2021 appropriation budget is released in 2022. N54 billion has allotted for the BHCPF in the proposed 2022 budget.

Mismanagement and diversion of funds have been a key challenge to the successful implementation of past financial reforms. To prevent the same from happening, strong accountability mechanisms and clear guidelines for how the BHCPF should be spent, should be put in place.

People need to be carried along by government in a way that allows them to fully understand what solutions are being proposed and what these solutions mean for them as Nigerians. When communities do not understand the system and their rights within it, accountability suffers because they do not know what to hold their government accountable for.

Dukpa PHC is in an obvious state of disrepair. Fifteen percent of the 1% CRF is earmarked for the renovation of primary healthcare facilities, like Dukpa PHC that are in dire need of repair. We cannot say that the BHCPF is being successfully implemented if it is being done in a rundown health facility that is poorly equipped. There are only 10 BHCPF-funded facilities in the Gwagwalada Area Council, and we urge the Federal Capital Territory and area council to ensure that the funds allocated for renovations are released and used to renovate and equip the health facilities.

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