Health Financing/Domestic Resource Mobilization

EHAI recognizes that sustainable health financing is the cornerstone of the entire healthcare delivery system. At EHAI we are not simply concerned about raising sufficient money (which is imperative) for healthcare delivery, we are also focused on the Efficient Utilization of the funds to achieve desired health outcomes and optimized value for money spent. We ensure available financial resources are used to achieve adequate coverage of the collective health needs of every individual to achieve Universal Health Coverage (UHC).

To achieve this, we provide technical support to ministries, departments and agencies (MDA) in the health sector for Domestic Resource Mobilization to increase government budgeting and investment in health through:

1. Sustained evidence-based advocacy efforts to relevant policy makers
2. Generation and utilization of evidence for improved health prioritization in state budgets.
3. Improved alignment of budget proposals with State Strategic Development Plans.
4. Improved budget performance (improve release and utilization of health budgets).
5. We also support them to explore other innovative sources of funding to ensure health interventions are sustainably financed.
6. Integrating vertically funded public health interventions such as HIV, TB, and Malaria into the benefit package of social health insurance schemes at the national and state levels.

TB LON 3 DRM PROJECTS (2020 – 2023)

EHAI is also implementing the USAID TB LON 3 Domestic Resource Mobilization projects in Osun state. The project is aimed at achieving the following objectives:

1. Increasing Government Funding for TB budget by at least 30% and mobilize additional funds for sustainable financing of TB programs
2. Documenting the feasibility of successful and sustainable integration of TB Services into the benefit package of the State Social Health Insurance Schemes

In Osun State where we have been implementing the project since November 2019, we have achieved the following:

1. Advocacy to High Level Policy Makers: Advocacy on increasing government funding for TB and integration TB services into the benefit package of OHI’S was successfully conducted to all identified high level policy makers.
2. Osun State TB Resource Mobilization Technical Working Group (Osun State TB DRM TWG): The project established a 17 member Osun State TB Resource Mobilization Technical Working Group (TWG) with high level representation from the Health MDAs, State Ministries of Finance and Economic Planning and Budget, State Accountant General, State and National Health Insurance Scheme. The TWG was set up to strengthen the interface and communication between the health sector, budget and finance agencies; ensure increased budget and track budget allocations for TB; track disbursement of funds and expenditure of the released funds. This is the first time in the history of the State that such a strategically selected group has been set up to secure increased Government funding for specific health interventions in the State

• Integrating TB Services into Osun State Health Insurance Scheme (O’HIS) Benefit Package: To achieve this objective, a six-step strategic integration process (illustrated below) was developed and implemented in the State:
  1. Stakeholder analysis and engagement in the State with a bid to gain their support for the integration of TB into the O-HIS benefit package and subsequent delivery of TB services under the health insurance scheme.
  2. Assessment of O-HIS implementation and the status of TB integration, including financial and operational feasibility. This will entail determining the TB Related Services such as chest x-ray and sputum microscopy that are already available on the O-HIS benefit package

• Design of a TB integration roadmap, which will articulate all technical elements involved in the integration process and would also contain well-defined interventions and milestones for the progression of coverage of (a) TB patients; (b) TB services; and (c) TB cost over time.

1. Implementation of TB integration roadmap and coverage by empanelling facilities providing TB services and supporting the SSHIS on an enrolment drive for TB patients.
2. Tracking the progress of the integration roadmap monthly.
3. Carry out an end-of-project evaluation to generate evidence on the impact of integrating TB Services into the SSHIS on Stakeholders, Health Facilities and TB patients in Osun State.

TB LON 2 DRM

EHAI implemented USAID TB LON 2 Domestic Resource Mobilization projects in Akwa-Ibom, Cross Rivers, and Rivers states as a Consultant.

KNCV is the Principal recipient and the focus area of this project is to work with Health, Finance, Economic Planning and Budget, Accountant and State Health Insurance Schemes to increase Government Funding for TB and integrate TB services into the Benefit Package of the Social Health Insurance Schemes in each of these States.

The project is aimed at achieving the following objectives:

1. Increasing Government Funding for TB budget by at least 30% and mobilize additional funds for sustainable financing of TB programs.
2. Documenting the feasibility of successful and sustainable integration of TB Services into the benefit package of the State Social Health Insurance Schemes.

Community Based Social Health Insurance (CBSHIP)

One of our major areas of interest which we strongly believe is germane to achieving universal access to affordable and quality health care is sustainable health financing through financial risk pooling mechanisms especially in a country like ours where ability to pay severely limits access to health care. We understand clearly that to achieve universal access, user fees and other out-of-pocket payments (which can be impoverishing) must be reduced drastically if not eliminated completely. We strongly believe that a comprehensive, widespread and transparently managed social health insurance scheme that covers the formal and informal sectors, urban and rural areas as well as the high- and low-end social class of our country is the panacea to most of the challenges facing our health system.  To achieve this, we have been accredited by the National Health Insurance Scheme (NHIS), since 2016, to serve as Technical Facilitators / Program Managers / Third Party Agents on Social Health Insurance Schemes in Nigeria.

As part of our drive for evidence-based approach to program planning and implementation, we have been able to carry out a comprehensive State-wide Willingness and Ability to Pay for Community Based Health Insurance Survey in Ondo State. The result of the survey, which was carried out in 2014, has been shared with NHIS and the State Ministry of Health. We are also utilizing the result of the survey to strategically plan our intervention and we have commenced community mobilization for the scheme in Ondo State. We believe that we will create a financial pool that will meet the health needs of the community, especially the low income and informal group. The scheme we are implementing is unique in that will provide an opportunity to support the enrolees with income generating activities through skill acquisition and access to microfinance. This income-generating scheme is specifically targeted at empowering women who are usually the most vulnerable in the society. This scheme will not only ensure access to health care but also help eradicate poverty.

We successfully set up the Moferere Oja Mutual Health Association, a CBSHIP initiative in Moferere Oja Community in Ondo West Local Government Area of Ondo State, with almost 1000 enrolees since inception in 2015. We also engaged the Ondo Diocese of the Catholic Church in setting a CBSHIP scheme for its parishioners. The Catholic Church scheme currently has over 1000 enrolees. We are leveraging on available technology to introduce Mobile Money Technology to entrench cashless processes into premium payments. This enhances ease of payment, transparency and accountability.