Nigeria Health Care Financing Training for Bauchi and Sokoto States – Agenda

Health Care Financing Training for HFG-Supported States (Bauchi and Sokoto)

February 6 – 10, 2017
Abuja, Nigeria


Workshop Objectives

  1. To deepen the participants’ knowledge and understanding of health financing concepts.
  2. To familiarize participants with the processes for healthcare financing policy and strategy development through the adaptation of existing policy frameworks to their specific state context.
  3. To acquaint participants with the legal framework and processes needed to execute health care financing reforms – state supported health insurance programmes, etc.
  4. To support participants identify the necessary institutional arrangements required to support and implement health care financing reforms in their states.
  5. To outline a road-map of specific actions that the states must undertake in terms of data management, planning, advocacy and partnerships needed to successfully implement healthcare financing reforms.


Day 1: Monday, February 6

Introduction to Universal Health Coverage (UHC) and Basic Health Financing Concepts I

Moderator: Dr. Gafar Alawode

Participant Registration        08:00 – 08:30
Overview of Health Financing workshop and self-introductions  08:30 – 08:50
Welcome and Opening Remarks

  • Hon. Commissioners of Health – Sokoto, Bauchi, Niger and Kaduna States
  • HFG Chief of Party, Dr. Gafar Alawode
08:50 – 09:10
Workshop Objectives

  • Juliana Aribo-Abude
09:10 – 09:20
Goodwill Messages

  • Partner: USAID
09:20 – 09:40
Health Financing Direction, Progress, Issues and Lessons Learnt

  • Director, Planning Research and Statistics – Bauchi, Sokoto, Niger and Kaduna States
09:40 – 10:20
Presentation 1: Understanding the concept of Universal Health Coverage

Presenter: Dr. Gafar Alawode and FMoH

  • An overview of UHC concept and why UHC?
  • Dimensions of UHC and pathways towards UHC
  • Where are we on UHC in Nigeria and the way forward?

Discussion, Questions & Answers

10:20 – 11:00
Tea break 11:00 – 11:30
Presentation 2: Health financing within the overall health system

Presenter: Prof. Tanimola Akande and FMoH

  • Understanding health system framework;
  • Situating health financing within the health system framework;
  • Health financing functions; and
  • Opportunities for health financing reform in Nigeria.

Discussion, Questions & Answers

11:30 – 12:10
Presentation 3: Raising revenue for health

Presenter: Dr. Frances Ilika

  • More money for health and more health for the money: understanding the link between  health expenditure and health outcomes;
  • How much is enough? Health spending benchmarks and indicators;
  • Can we spend more on health? Understanding concept of fiscal space for health;
  • Opportunities for increasing fiscal space for health; and
  • Revenue Generation in Resource Constrained settings.

Discussion, Questions & Answers

12:10 – 13:00
Lunch 13:00 – 14:00
Panel Discussion 1: Expanding Fiscal Space for Health at the Sub-national Level

Panelists: FMoH, NHIS, NPHCDA, WB, Sokoto and Kaduna SMoH
Panel chair: Dr. Gafar Alawode

Discussion Themes:

  • Opportunities for improved health funding in Nigeria: NHAct, SOML, SSHIS
  • What fiscal reforms are needed for successful introduction and sustainability of health insurance: State level examples.
  • Gathering political support for implementation of the NHAct.
14:00 – 15:15
Presentation 4: World Bank supported initiatives in Nigeria – SOML, GFF, and BHCPF

Presenter: Olumide Okunola

  • How states can benefit from these?

Discussion, Questions & Answers

15:15 – 16:00
Group Discussion 1 led by Dr. Sylvester Akande

Discussion guide

  • How is health situated in the overall policy direction of your State?
  • What is the state’s Government’s policy thrust on health?
  • Discuss current resource commitments to health in your state (trend of health allocation as a percentage  of total budget)
  • Can Government earmark funds for health?  Any example of existing earmarking?
  • Specific recommendations on how Government can spend more on health.
  • What channels can be used by your state to advocate for BHCPF implementation?
  • What are the other non-Government funding sources that can be explored?
16:00 – 17:00
Wrap-up 17:00

Day 2: Tuesday, February 7

Basic Health Financing Concepts II

Moderator: Dr. Frances Ilika

Welcome and Day 1 Recap 08:30 – 09:00
Presentation 5: Understanding the concept of risk pooling

Presenter: Dr. Gafar Alawode

  • An overview of concept of risk pooling and prepayment;
  • Basic principles of risk pooling that promote access,  financial protection and equity;
  • Different types of insurance schemes as  mechanisms for risk pooling; and
  • Implications of good risk pooling for UHC

Discussion, Questions & Answers

09:00 – 09:50
Presentation 6: Purchasing health services towards UHC: How do we get it right?

Presenter: Dr. Sylvester Akande

  • An overview of health purchasing as a health financing  function;
  • Health purchasing as a lever for efficiency, accountability and equity;
  • Provider payment mechanism options: pros and cons; and
  • Designing a benefit package.

Discussion, Questions & Answers

09:50 – 10:30
Presentation 7: Risk pooling and purchasing through Health Insurance schemes in Nigeria: What have we learned?


  • Bauchi State Formal sector scheme.
10:30 – 11:20
Tea break 11:00 – 11:30
Presentation 8: Primary Health Care for Universal Health Coverage

Presenter: NPHCDA

  • Supply side interventions – Revitalizing PHCs.
  • Improving PHC services – costing and gaps.
12:00 – 13:00
Lunch 13:00 – 14:00
Panel Discussion 2 – Risk pooling and Purchasing of healthcare.

Panelists: NHIS, HMO rep, Private provider rep, NPHCDA and Bauchi SMoH, FCT CBHIS

Panel Chair: Prof. Tanimola Akande

  • Experiences with risk pooling and health purchasing: what works, what does not?
  • Pooling and purchasing lessons learned from insurance operators’ point of view
  • Lessons learned and perspectives from providers’ point of view and
  • What critical reforms do we need to scale up to UHC?
14:00 – 15:30
Presentation 9: Establishing SSHIS – the Lagos State experience

Presenter: Dr Emmanuella  Zamba (Lagos State SMoH)

  • Fiscal context and reforms in Lagos state
  • The design processes.- Benefit package design, Fiscal space Analysis, Legal framework
  • Institutional arrangement – Health Financing Unit, Core implementation unit.
  • Lessons learned – what to do differently.

Discussions Questions and Answers

15:30 – 16:00
Group Discussion 2

Frances Ilika

Discussion Guide

  • Strategies for mobilizing the different population groups for health insurance enrolment. (How do we make insurance appealing to the various population groups?)
  • How to integrate/coalesce existing schemes/programs into state supported health insurance schemes.
16:00 – 16:30
Group Presentation 2 16:30 – 17:00
Wrap-up 17:00

Day 3: Wednesday, February 8

Frameworks for Health Care Financing Reform at the State Level I

Moderator: Dr. Sylvester Akande

Day 2 Recap and Setting the Stage for Wednesday through Thursday 08:30 – 09:00
Presentation 10: Policy framework for health care financing reform in Nigeria

Presenter: Dr Francis Ukwuije

  • Vertical alignment with the National Health Policy
  • National Health Financing Policy – Key Priorities
  • Outline of  National Health Financing Policies for state adaptation
09:00 – 09:20
Group Discussion 3

Prof Akande

Discussion Guide

Discuss the policy options available to the state on revenue pooling and purchasing

  • Revenue Generation – Earmarking of funds, mandatory participation, formal sector contribution, external funding
  • Pooling – Private sector involvement, which population group should Government subsidize?
  • Who should purchase health services from providers?
09:20 – 10:10
Group Presentation 3 10:10 – 10:50
Defining the Theory of Change

Dr. Gafar Alawode

10:50 – 11:10
Tea break 11:10 – 11:30
Presentation 11: Institutional arrangement for health financing reform at the state level

  • Structure and roles of Health Care Financing Unit and Health Care Financing TWG at the state level (FMOH); and
  • Primary Health Care under One Roof (PHCOUR) as a supply side mechanism for SHIS: What do states need to do? (NPHCDA).

Discussion, Questions & Answers

11:30 – 12:20
Enhancing the effectiveness of TWGs

Dr. Gafar Alawode

12:20 – 12:50
Group Discussion 4 – Dr. Sylvester Akande

Discussion Guide

State groups will discuss how their context will affect institutional arrangement for State Health Insurance such as:

  • Experience of relationship between existing parastatals and SMoH;
  • Potential platform for coordinating multiple MDAs; and
  • What are the potential mechanisms for holding MDAs accountable?
 12:50 – 13:30
Lunch 13:30 – 14:30
Group Presentation 4 14:30 – 14:45
Presentation 12: State Level Peer Learning Network

Presenter: Dr Francis Ukwuije (SMoH)/R4D Rep Rachael

  • Concept of State Level Peer Learning Network
  • Benefits and uses of Peer Learning Network
  • Expectations from the Network
14:45 – 16:00
Wrap-up 17:00

Day 4: Thursday, February 9

Frameworks for Health Care Financing Reform at the State Level II

Moderator: Juliana Aribo-Abude

Day 3 Recap  08:30 – 08:40
Enhancing the Effectiveness of  Institutional Structures  08:40 –09:10
Presentation 13: Legal framework for State Health Insurance Programmes

  • The importance of health insurance legal framework;
  • Basic components of legal framework template.
  • The processes for developing and implementing health insurance legal framework and implications for the states
  • Challenges of legal framework enactment and how to overcome them
  •  Passing the CRSHIS bill into Law
  • Challenges, lessons learnt  and mitigation steps taken

Discussion, Questions & Answers

09:10 – 10:00
Panel discussion 3

Panelists:  Sokoto and Kaduna SMOH, Sokoto and Niger (SHOA), CRS SHOA

Panel chair: Dr Gafar Alawode

Processes of enacting state health insurance law: key lessons learnt;

Major aspects and issues in the SHIS Laws

  • Passage of the Bill
  • Relationship between the Executive and Legislative arms
  • Implementation of the Law

State of the SHIS bill

  • Sokoto and Kaduna states
10:00 – 11:30
Tea break 11:30 – 11:45
Presentation 14: Political economy of healthcare financing reforms

Presenter: Dr. Gafar Alawode

  • Understanding the concept of political economy and its implication for health care financing reform; and
  • A tool for political economy analysis: Influence/interest matrix
11:45 – 12:15
Group Discussion 5

Sylvester Akande/HSDF

State group will develop interest/influence matrix for some contentious policy options such as:

  • Public sector premium contribution
  • Earmarking of funds for health insurance (allocation and release)
12:15 – 13:00
Lunch 13:00 – 14:00
Group Presentation 5 14:00 – 15:00
Presentation 15: Public Financial Management Systems for effective Health Financing

Presenter: Dr Gafar Alawode

15:00 – 15:15
Group Discussion 6

Dr. Gafar Alawode

  • Mapping of PFM processes at the state level
  • Identification of bottlenecks
  • Mitigation strategies
15:15 – 16:00
Group presentation 6 16:00 – 16:30
Wrap-up 16:30 – 17:00

Day 5: Friday, February 10

Roadmap for Health Care Financing Reform at the State Level

Moderator: Prof. Tanimola Akande

Welcome and recap of Day 2 08:30 – 09:15
Presentation 16: Health as a Human Right, Implications for UHC

Presenter: Human Rights Commission Rep

  • Is health a human right in Nigeria?
  • Working with the government to promote the right to health and rights based-approach: expectations, lessons/challenges, recommendations.
09:15 – 09:45
Introduction to group 7 discussion

Dr. Gafar Alawode

09:45 – 09:55
Group Discussion 7 – Roadmap for Health Financing reforms

Dr. Gafar Alawode

Each of the state groups will develop detailed next steps on the legal, policy and institutional framework for state supported health insurance programmes.

The action plan will include detailed activities, timeline, persons responsible, key partners/stakeholders and resources needed.

9:55 – 11:15
Tea Break 11:15 – 11:30
Group Presentation 7 11:30 – 12:20
Next Steps 12:20 – 12:45
Closing remarks and vote of thanks 12:45 – 13:00
Lunch and Departures 13:00


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