Health Strategy and Delivery Foundation, Abuja, Nigeria.
Kaduna State Primary Health Care Board, Kaduna, Nigeria.
Front Public Health. 2023 Dec 19;11:1226145. doi: 10.3389/fpubh.2023.1226145. eCollection 2023.
The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.
We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.
We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.
Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.
尼日利亚提供优质初级卫生保健（PHC）服务的能力有限。该 PHC 系统面临着重大挑战，而且由于政府对卫生保健的支出，尤其是对 PHC 的支出较低，因此 PHC 服务的改善和扩大受到限制。在尼日利亚，自付费用（OOP）支出占卫生支出的主导地位，对 OOP 支付的依赖导致最贫穷和最脆弱人群的经济负担加重。为了解决这些挑战，尼日利亚政府实施了多项立法和政策改革，包括 2022 年颁布的《国家健康保险管理局法案》，该法案规定所有尼日利亚公民和居民都必须参加健康保险。我们的研究旨在确定在尼日利亚卡杜纳和卡诺的公共卫生设施提供 PHC 服务的成本。我们将实际提供 PHC 服务的成本与这两个州提供最低服务包（MSP）的规范成本进行了比较。
我们从 50 个卫生设施（每个州 25 个）收集了主要数据，包括 PHC 设施-保健站、诊所、保健中心和综合医院。我们回顾性地收集了 2019 年的设施级经常性成本数据，以从提供者的角度估算经济成本。通过推断抽样卫生设施的 PHC 成本估算值来估算全州的实际成本，而规范成本则是使用标准治疗方案（STPs）和每个州需要 PHC 服务的人群推导出来的。
我们发现，根据政府指南，在 PHC 设施中提供的 PHC 服务应该是大多数，因此 PHC 设施中人均实际 PHC 成本在卡杜纳州为 18.9 美元至 28 美元，在卡诺州为 15.9 美元至 20.4 美元，具体取决于使用的估算方法。当还考虑到在两个州提供的 PHC 服务在综合医院的成本时（在这两个州，大约三分之一的 PHC 服务都是在综合医院提供的），人均 PHC 服务的实际成本在卡杜纳州为 20 美元至 30.6 美元，在卡诺州为 17.8 美元至 22 美元。所有人均 PHC 实际成本的估算都明显低于向所有需要的人提供高质量 PHC 服务的规范人均成本，预计在卡杜纳州为 44.9 美元，在卡诺州为 49.5 美元。
要弥合这一资源差距，需要大幅增加这两个州对 PHC 的支出。这些结果可为正在进行的关于 NHIA 法案实施的讨论提供有用信息，包括对提供者支付策略的细化，以确保 PHC 提供者得到公平报酬，并激励他们提供高质量的 PHC 服务。
