The launch of the Basic Health Care Provision Fund (BHCPF) brought smiles on the faces of Nigerians, with high expectations that the fund would reduce the hardship facing many who pay through their nose to combat ill health.
The fund is expected to bring healthcare within the reach of otherwise indigent and vulnerable Nigerians, thereby boosting the country’s match towards Universal Health Coverage (UHC). However, the impact is not felt optimally in the communities due to lack of basic amenities and insecurity.
Funded by the federal and state governments, the BHCPF, a component of the National Health Act of 2014 and signed into the 2019 fiscal budget in 2018 by President Muhammadu Buhari, is designed to provide free minimum basic healthcare to most vulnerable Nigerians through accredited Primary Health Centres (PHCs) across the 36 states of the federation and the federal capital territory (FCT).
The fund is administered through three gateways namely the National Health Insurance Scheme (NHIS), National Primary Health Care Development Agency (NPHCDA) and the Federal Ministry of Health (FMoH). In the NHIS gateway, the Scheme through the State Health Insurance Schemes purchases a Basic Minimum Package of Healthcare Services for all participating Nigerians.
To this end, the federal government in 2019 disbursed the sum of N13.775billion for the initial phase of disbursement of the BHCPF to benefitting states through the NHIS Gateway. The NHIS was expected to disburse the sum of N6.5 billion to 15 states plus the FCT.
Those enrolled in BHCPF are expected to receive free antenatal care, delivery, and postnatal care for pregnant women. Immunisations and treatment for malaria, pneumonia, measles, and dysentery for children Under-5. Malaria treatment, hypertension and diabetes screenings, and family planning for all adults.
In the FCT for instance, Gwagwala Area Council have ten political wards, and one PHC is selected from each ward to benefit from the BHCPF. In Ibwa ward, Dukpa community was selected. The health facility in the community is serving the people even though there are challenges.
During a town hall meeting organised by the Nigeria Health Watch in Dukpa community recently, in commemoration of 2021 Universal Health Coverage Say, the Senior Community Health Worker (SHEW), Timzing Auta Wuyep, said the facility has been receiving funds from the FCT and that the funds have helped to reduce out of pocket expenditure as well as promoting health seeking behavior among the indigent people in the community.
According to him, the facility has so far received the sum of N900, 000 from October 2020 to September 2021. The money, Wuyep said it’s used for the purchasing of drugs, test kits and others.
He said they test and treat pregnant women, under-5 children and the aged in the community.
Yuwep however identified some challenges, including delay in release of the money, saying “If the money is coming regularly the way it supposed to, we could have been going forward, like the one we got now, if we utilise it after January now, if we don’t get another one, the drugs may be finished, we will have to wait till they bring another fund before we can go ahead and buy drugs”.
Meanwhile, one of the beneficiaries of the programme, Diana Ibrahim, thanked the government for the initiative, saying she and her family have really benefited from the programme while narrating her experience during her first pregnancy.
She said “During my first pregnancy, I was brought here, the doctor told me that I had complications and I was taken to a bigger hospital, when I got there, it was the same issue that the doctor saw here that they also saw there and I was brought back here. I had the baby here and the child is four years old now.”
However, some women in the community said during the town hall meeting that they were hearing about the programme for the first time.
In response to the delay in the release of the money, the director, PHC, Gwagwalada Area Council, Dr. Adeyemi Adeniran, said that N300,000 is given to the community quarterly and so far they have received the sum of N900,000 from October 2020 to September 2021. He explained that the facility only gets the next fund after it has retired the previous one saying this sometimes causes delay.
Explaining further, he said “We also have other thematic areas, including infrastructure and employment. If the primary health care centre needs a cleaner, they don’t have to wait for the government, from that money, they can employ a cleaner and pay him or her.”
Meanwhile, a resident of the community, Mahmud Danjuma, who sounded dissatisfied with the intervention said the impact is not felt much in the community largely due to insecurity as the health workers do not work at night for fear of being attacked by bandits.
Danjuma therefore, called on the government to look into the issues, stressing the need for the facility to be fenced and have health workers to run night shifts while citing other challenges such as lack of water and toilets.
It was gathered that though there are eight health workers in the facility, they only work from 8am to 4pm. The implication is that when pregnant women go into labour at night, they are left with the option of being transported through the bad road to Gwagwalada teaching hospital.
The facility also lacks basic amenities like water and power. These obviously affect the impact of the programme in the community
However, Adeniran explained that “I have submitted their name for a new building and borehole but before then painting, not only them but across board. There is a ward health committee in the community, this insecurity is making us take some very hard steps.
The in-charge is in the community, when there is an issue at night, they call on him; even if it is an ordinary headache, he will come around to attend to them. With time, we are going to improve on it, even the national road transport union, we also partner with them in case of emergency. We also have a central ambulance.”
On the essence of the town hall engagement meeting, a health journalist with the Nigeria Health Watch, Dr. Bashar Abubakar, said “The whole essence of this community town hall engagement meeting is to understand the community members, how they are receiving healthcare especially under the BHCPF and this community is one of the 62 health facilities under the FCT that is receiving fund under the BHCPF. We are here to understand the experience of the community members, what has the fund done for them, what impact has it had on them, what impact has it had on the lives of the women, bread feeding mothers, under-five children and the elderly people, that is the whole essence of organizing the community town hall engagement meeting.
“This is under our community Health Watch project which we started in August 2021. The whole aim is to track and monitor and report on BHCPF and access and delivery of primary healthcare services in rural communities across Nigeria. We’ve had several town hall meetings but this is the first in the FCT.
Though governments have made some efforts to bring healthcare closer to the door steps of poor and vulnerable Nigerians, there is the need to provide security, basic amenities and ensure proper utilisation and monitoring of the fund.
This is necessary if the country must meet the 2030 global target on UHC.