Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu Campus, Nigeria.
Health Syst Reform. 2022 Mar 1;8(2):e2074630. doi: 10.1080/23288604.2022.2074630.
For Nigeria to make progress on its commitment to universal health coverage, additional public funding will be required. But more resources alone will not be enough. Government health spending must be more efficient and effective, through more strategic purchasing-a critical policy tool. Studies on health purchasing in Nigeria's health financing schemes are limited, however. This study examines the purchasing arrangements in schemes funded by the federal budget and in the Formal Sector Social Health Insurance Programme (FSSHIP) within the National Health Insurance Scheme. We adopted a qualitative, descriptive case-study approach and collected data through document reviews and key informant interviews based on the Strategic Health Purchasing Progress Tracking Framework. Our analysis used a thematic framework approach. Our findings reveal that legal frameworks and governance structures for strategic purchasing are in place for both schemes. Steps toward strategic purchasing are more advanced in FSSHIP, particularly in the design of benefit packages, accreditation and monitoring of health maintenance organizations (HMOs) and providers, and provider payment mechanisms. The limited share of health funding flowing through these mechanisms, and further fragmentation of that funding, impede strategic purchasing. Strategic purchasing is also hampered by weak regulation and monitoring of providers and purchasers, delays in provider payment, and corrupt practices by HMOs. Improving strategic purchasing in Nigeria will require a concerted effort to reduce fragmentation of health spending, significant investment in human resources, technical know-how, and information systems of purchasing institutions, and actions to improve the accountability of all actors in the system.
为了在全民健康覆盖方面取得进展，尼日利亚需要增加公共资金投入。但是，仅仅增加资源是不够的。政府卫生支出必须更加高效和有效，这需要更具战略性的采购——这是一项关键的政策工具。然而，尼日利亚卫生筹资计划中的卫生采购研究有限。本研究考察了联邦预算资助计划和国家卫生保险计划中的正规部门社会保险方案（FSSHIP）中的采购安排。我们采用了定性、描述性案例研究方法，通过文件审查和关键知情人访谈收集数据，这些访谈是基于战略卫生采购进展跟踪框架进行的。我们的分析使用了主题框架方法。我们的研究结果表明，这两个方案都有战略采购的法律框架和治理结构。FSSHIP 在战略采购方面的步骤更为先进，特别是在福利包的设计、对健康维护组织（HMO）和供应商的认证和监测，以及供应商支付机制方面。这些机制所获得的卫生资金份额有限，而且资金进一步分散，这阻碍了战略采购。供应商和采购方监管和监测薄弱、供应商付款延迟以及 HMO 的腐败行为也对战略采购造成了阻碍。要改善尼日利亚的战略采购，需要共同努力减少卫生支出的分散，对人力资源、技术知识和采购机构的信息系统进行大量投资，并采取行动提高系统中所有行为者的问责制。
