How a nation finances its health care delivery system could be a clear indicator in assessing the premium placed on its people’s health. As a critical component of development, the health sector requires adequate funding. The financing of Nigeria’s health care delivery system is mainly through tax revenue, out-of-pocket payments or user fees, donor funding and social health insurance. Due to rising demands of funding health in an economy facing perennial shortages of qualified and competent health personnel, and shortages of drugs and sound health infrastructures, the federal government introduced the National Health Insurance Scheme (NHIS) in 1999. The scheme was intended to guarantee access to efficient and quality health care services that reduce catastrophic household out-of-pocket health expenditures.
Sokoto has an estimated population of 5.3 million people with about 4.5 million without health insurance. In efforts to ensure the actualization of universal health coverage for the indigent, poor and vulnerable residents of Sokoto state, the United State Agency for International Development (USAID) funded Health Finance and Governance (HFG) Project supported the mobilization of their domestic resources, reducing financial barriers, expanding health insurance, and implementing provider payment systems.
This support resulted in the establishment of the Sokoto State Contributory Health Care Management Agency (SOCHEMA) scheme bill in 2016 by Governor Alhaji Aminu Tambuwal. In anticipation of the actualization of the scheme bill, the project conducted a wide array of efforts to engage state-wide stakeholder buy-in through workshops and advocacy visits. The Sokoto State House of Assembly conducted a public hearing on the SOCHEMA bill that was attended by key stakeholders from different sectors, including community, religious leaders, trade unions, labour unions, MDAs, professionals, and the private sector, who expressed their endorsement.
Provisions for additional sources of funding incorporated an increase from 1% to 2% of the state consolidated revenue fund (CRF), 1% contribution from local government associations (LGAs), 240 million NGN monthly from the Zakat fund (funds collected from obligatory annual payments under Islamic law on certain kinds of property, and used for charitable and religious purposes), and 0.5% of contract funds. A seminar was also organised for journalists and media practitioners to sensitize the public on the components of the health contributory scheme for effective communication of its benefits to the public. HFG supported the development of a draft Health Financing Policy Framework document which will guide all health financing mechanisms in the state across the 3 health financing functions, and was in alignment with the National Health Financing Policy. HFG also provided SOCHEMA with organizational development support that resulted in capacity enhancement training of staff and coordination support to ensure improved efficiency and alignment of financing goals.
The SOCHEMA bill was passed into law by the House of Assembly on February 2018, and will be launched by the Governor in July 2018. Key stakeholders in the state are excited and have branded the passing of SOCHEMA into law as a legacy of the current administration, as captured in Dr. Shehu Balarabe Kakale, the Honourable Commissioner of Health’s, comment below:
“Establishment of SOCHEMA Agency with a legally binded Bill is the greatest achievement under this present administration led by Rt. Hon. Aminu Waziri Tambuwal CFR. It is a legacy that I am proud to live behind as the Commissioner of Health, I believe it is a machinery of reforming and a revolution of Healthcare services towards minimizing out of pocket spending to the barest minimum for the attainment of a sound Universal Health Coverage in our Communities”.
There are grounds to expect improvements in health financing in Nigeria as a whole, as both the executive and legislative branches of the federal and state government are now attending to the challenges as demonstrated by Sokoto state. This successful policy choice in Sokoto state also evolved as a result of the combination of multiple sources generated from the Zakat Fund and the CRF. Dr. Muhammad Ali Inname, Special Adviser to the Governor on Contributory Scheme said that:
“Sokoto State has made history as the only state with Health Financing system that is based on Islamic Takaful (providing guarantee in an Islamic way) insurance principles. Indeed the passage of SOCHEMA into law has open a new chapter with redefined Health Care Services in all the 23 Local Governments of Sokoto State”.