Supporting strategic health purchasing: a case study of annual health budgets from General Tax Revenue and Social Health Insurance in Abia State, Nigeria

The recent health financing reforms in Nigeria such as the Basic Healthcare Provision Fund (BHCPF) and state-supported Social Health Insurance (SHI) schemes recognize the critical roles of state governments and related agencies in defining, deciding, implementing, and managing healthcare purchasing functions within decentralized health financing mechanisms, as a means of fast-tracking the country’s achievements of Universal Health Coverage by 2030. To this end, States have been encouraged to establish SHI schemes to increase access to health services and reduce high out-of-pocket spending estimated at 76% of Total Health Expenditure.

Through the BHCPF, States are funded to set up the SHI schemes, and channel BHCPF subsidies to cover priority health services. Abia State in Nigeria has proposed to set up a State Social Health Insurance Scheme (SSHIS) to cover all of its residents. The SSHIS design was intended to overcome the shortcomings of the annual budgets funded through General Tax Revenue (GTR) by creating a purchaser-provider split, contracting of providers using output-based provider payment methods, and improving quality assurance. This study examined purchasing functions within the GTR and the proposed SSHIS to determine if the shortfalls of the GTR have been overcome, identify factors that shape health purchasing at sub-national levels, and provide lessons for other states in Nigeria pursuing a similar intervention.


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Chinyere Mbachu
Chinyere Okeke
Chinonso Obayi
Agnes Gatome-Munyua et al.