Health financing mechanisms and extension of health coverage to the poor and vulnerable groups: What options are available in the Nigerian context?

Abstract

Background: Prepayment health-care financing mechanisms are recommended for achieving universal health coverage (UHC) as it prevents catastrophic health-care expenditure and poverty. This preference is due to the inadequacies of the out-of-pocket model in many low- and middle-income countries such as Nigeria. However, it took Nigeria several decades to operationalize the national health insurance scheme in 2005. This review aimed at highlighting various health-care financing options and their suitability for providing health care to all (including the poor and vulnerable groups). Materials and Methods: Data for this review were obtained from searching Google Scholar, MEDLINE (via PubMed), and African Journal Online, using relevant terms (in English language) that addressed health-care financing options and their suitability for UHC (including the poor and vulnerable groups) and were published between January 2007 and May 2019. Studies published in other languages were excluded for lack of resources to translate them. Results: Out-of-pocket, general taxation, private, community-based, and social health insurance, and innovative financing were found to have differing attributes. The social health insurance adopted by low- and middle-income countries such as Nigeria appears promising but not without challenges. Conclusion: A mixed model of social health insurance and general taxation is a prospect in extending health coverage to all citizens including the poor and vulnerable groups. Information on health financing options offers stakeholders the opportunity to understand the attributes of these options, an essential in the choice of a suitable mechanism that can deliver UHC.