Community based healthcare financing: An untapped option to a more effective healthcare funding in Nigeria

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 with 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 N 4, 835 million-N 17, 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): Community-based healthcare financing has been recognized as a community-friendly 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 non-governmental organizations should collective develop various forms of CBHF to reach out widely to Nigerians.