Background

Health Strategy and Delivery Foundation (HSDF) aims to strengthen the government to create and sustain high quality health systems, in the states we work, through a research and evidence-based approach. We recently provided technical support to Niger State’s Ministry of Health in conducting its first ever sub-national multi-year health accounts study, a collaborative process with other ministries, departments, and agencies.

The multi-year sub-national health accounts study was done to provide detailed information on health spending across public and private sector, which serves as a tool for policy and/or decision-makers to inform better planning, thereby improving health system performance.

Methodology

We retrieved health spending data from government institutions, donors, non-government organizations, enterprises, private health insurance, and households for the period of study, to evaluate health system financing.

Use of Evidence

The health accounts study has proven to be a valuable tool as acknowledged by the decision-makers.

“It may interest you to know that we have utilized the findings from the health accounts during our advocacy visit on health resource mobilization to the Honorable Speaker of the Niger State House of Assembly.” – Dr Mohammed B Usman, Chair Health Financing, Technical Working Group

Indeed, the state has swung into action by using the findings of the health accounts for planning, supporting decisions, and for advocacy for additional funding in the health sector.

• Advocacy to increase budgetary allocation to the health sector
The state health accounts showed low level of government expenditure on health (at 6%). It also reveals the high burden on households when seeking care and heavy reliance on donor funding to execute programs in the state. In response, a resource mobilization committee of the Ministry of Health used the results of the study, alongside previous budget allocation and performance to advocate to the State House of Assembly and the House Committee on Health for increase in budgetary allocation to the health sector. Following the advocacy visits, commitments and individual pledges were made to a subset of the population. However, these would need to be followed up for implementation.

• Inform Health Strategic Plan
Unlike the traditional planning approaches to policy implementation and budgeting, which were based on extrapolations and historic reference. The state is adopting a clear evidence-based approach in planning, policy implementation, monitoring, and evaluation by leveraging information and data from past studies and reports (including the health accounts), recent estimates, and quotations to inform the medium-term sector strategy (MTSS) for 2021–2023. This approach informs development options for financing health in Niger State; for example, there is a move towards public funding with increased predictability within the three years of the MTSS.

• Supporting the design of Niger State Health Insurance Scheme (premium setting)
The health accounts showed high out-of-pocket spending on health and an average amount of NGN 961, that citizens are willing to pay for premiums. In response, the state contributory health management scheme, in their ongoing effort to roll out a prepayment scheme, have defined the premium contribution for individuals using estimates derived from the willingness to pay from household analysis.

By HSDF’s Health Financing team. Specific contributors were: Azara Agidani and Yewande Ogundeji.