Health Care Financing Training for HFG-Supported States (Nigeria) – Agenda

Health Care Financing Training for HFG-Supported States 

June 27 – July 1, 2016
Lagos, 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, June 27

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. Commissioner of Health, Lagos State
  • HFG Country Manager, Elaine Baruwa
08:50 – 09:00
Workshop Objectives

  • Dr. Sylvester Akande
09:00 – 09:10
Goodwill Messages

  • Partner: USAID
09:20 – 09:30
Presentation 1: Understanding the concept of Universal Health Coverage

Presenter:  Dr. Elaine Baruwa and Dr. Francis Ukwuije

  • 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

09:30 – 10:20
Presentation 2: Health financing within the overall health system

Presenter: Prof. Tanimola Akande and Dr. Francis Ukwuije

  • Understanding health system framework;
  • Situating health financing within the health system framework;
  • Health financing functions; and
  • National Health Act (NHAct) and opportunities for health financing reform in Nigeria.

Discussion, Questions & Answers

10:20 – 11:10
Tea break 11:10 – 11:30
Presentation 3: Raising revenue for health

Presenter: Dr. Elaine Baruwa

  • 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; and
  • Opportunities for increasing fiscal space for health

Discussion, Questions & Answers

11:30 – 12:15
Presentation 4: Lagos state Fiscal Space for SHIS Analysis

  • Presenter: Lagos State SMoH (person TBD)
12:15 – 12:30
Panel Discussion 1

Panelists: FMoH, NHIS, NPHCDA, Lagos State (MoBEP), Prof Akande
Panel chair: Dr. Elaine Baruwa

Discussion Themes:

  • NH Act and opportunities for improved health funding in Nigeria;
  • What fiscal reforms are needed for successful introduction and sustainability of health insurance: Lagos and other examples;
  • Sustainability of health insurance financing at the state level; and
  • Gathering political support for  health insurance financing.
12:30 – 13:30
Lunch 13:30 – 14:30
Group Discussion 1 led by Dr. Gafar Alawode

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 are the other non-Government funding sources that can be explored?
14:30 – 15:15
Group Presentation 1 15:15 – 16:00
Wrap-up 16.00 – 16.15


Day 2, Tuesday, June 28

Introduction to Universal Health Coverage (UHC) and basic health financing concepts II

Moderator: Dr. Ekpenyong Ekanem

Welcome and day 1 Recap – Moderator + Rapporteur 08:30 – 09:00
Presentation 4: Understanding the concept of risk pooling

Presenters: Dr. Gafar Alawode and Prof. Tanimola Akande

  • An overview of concept of risk pooling and prepayment;
  • Basic principles of risk pooling that promotes 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 – 10:00
Presentation 5: Purchasing health services towards UHC: How do we get it right?

Presenters: Dr. Sylvester Akande and Prof. Tanimola 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

10:00 – 11:00
Tea break 11:00 – 13:00
Presentation 6: Risk pooling and purchasing through CBHIS schemes in Nigeria: What have we learned?

Presenter: Micheal Akpabio

11:30 – 12:00
Panel Discussion 2

Panelists: NHIS, Hygiea HMO and Ukana West II CBHI
Panel Chair: Prof. Tanimola Akande

  • NHIS experience of risk pooling and health purchasing: what works, what does not?
  • Pooling and purchasing lessons learned from CBHIS operators’ point of view: and
  • What critical reforms do we need to scale up to UHC?
12:00 – 13:30
Lunch 13:30 – 14:30
Group Discussion 2 – NHIS

Discussion Guide

  • What is your state’s experience with health insurance programs?
  • 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 community based health insurance schemes into state supported health insurance schemes.
14:30 – 15:15
Group Presentation 2 15:15 – 16:00
Wrap up for Day 2 16.00 – 16.15


Day 3, Wednesday, June 29

Frameworks for health care financing reform at the state level

Moderator: Dr. Sylvester Akande

Day 2 Recap and Setting the Stage for Wednesday through Friday

Dr. Gafar Alawode

08:30 – 09:00
Presentation 8: Policy framework for health care financing reform in Nigeria

Presenter: Dr. Francis Ukwuije (FMoH)

  • Highlights of key policy issues around health financing functions; and
  • Template and processes for developing health financing policies

Discussion, Questions & Answers

09:00 – 09:45
Presentation 9: Legal framework for State Supported Health Insurance Programmes

Presenter: Dr. Jonathan Eke (NHIS)

  • The importance of health insurance legal framework;
  • Lessons learnt on health insurance legal framework and implications for the states; and
  • Basic components of legal framework template.

Discussion, Questions & Answers

09:45 – 10:30
Tea break 10:30 – 11:00
Panel Discussion 3

Panelists: FMoH, NHIS, Lagos HCF unit, Lagos SHoA
Panel chair: Prof. Tanimola Akande

  • Processes of developing health financing policy at state level: key lessons learnt;
  • Processes of enacting state health insurance law: key lessons learnt;
  • What is the operational feasibility of informal sector premium contributions?
  • How best to identify the poor for premium payment exemptions?
11:30 – 13:00
Group Discussion 4 – Dr. Elaine Baruwa

Discussion Guide

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

  • Revenue Generation – earmarking funds, mandatory participation, donor and formal sector contribution
  • Pooling-private sector involvement, what population groups should Government subsidize?
  • Who should purchase health services from providers?
13:00 – 14:00
Lunch 14:00 – 15:00
Group presentation 3 15:00 – 16:00


Day 4, Thursday, June 30

Frameworks for Healthcare Financing Reform at State Level II

Moderator: Dr. Ekpenyong Ekanem

Welcome and recap of day 3- Moderator + Rapporteur 08:30 – 09:00
Presentation 10: 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 (by FMOH);
  • Structure, functions and accountability mechanism for state supported health insurance programmes (by NHIS); and
  • Primary Health Care under One Roof (PHCOUR) as a policy lever for supply side financing: What do states need to do? (by NPHCDA).

Discussion, Questions & Answers

09:00 – 10:30
Tea break 10:30 -10:45
Panel discussion 4

Panelists: FMoH, NHIS, NPHCDA, Lagos HCF unit, CRS HCH
Panel chair: Prof. Tanimola Akande

Discussions themes:

  • Current institutional arrangement for health insurance at the national level and lessons learnt?
  • Addressing capacity gaps facing institutions involved in delivering health financing functions.
  • Accountability mechanism for social health insurance schemes.
10:45 – 12:00
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:

  • Merit and demerits of SHIS as an autonomous entity;
  • Experience of relationship between existing parastatals and SMoH;
  • Potential frameworks for coordinating multiple MDAs; and
  • What are the potential mechanisms for holding MDAs accountable?
12:00 – 13:00
Group presentations 4 13:00 – 14:00
Lunch 14:00 – 15:00
Presentation 11: 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
15:00 – 15:30
Group Discussion 5 – Dr. Gafar Alawode

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)
15:30 -16:15


Day 5, Friday, July 1

Road-map for Healthcare Financing Reform at the State Level

Moderator Dr. Elaine Baruwa

Welcome and recap of day 4 – Moderator + Rapporteur 08:30 – 09:00
Introduction to group Discussion 6

Dr. Gafar Alawode

09:00 – 09:15
Group Discussion 6 – 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.

09:15 – 11:00
Tea break 11:00 – 11:30
Group presentation 6 11:30 –  13:00
Next steps 13:00 – 13:30
Closing remarks
Vote of thanks
13:30 – 14:00


14:00 – 15:00


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