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Accepted Paper:

Social protection and healthcare services in Africa: The collapse of a community-based health insurance programme in rural Nigeria  


Afeez Lawal (University of South Africa)

Paper short abstract:

Community-based health insurance have been promoted as a means of promoting financial protection in healthcare, developing countries. However, it is yet to provide coverage to a significant fraction of the population in Africa. Funding and management are central to its stoppage in rural Nigeria.

Paper long abstract:

In the recent years, social protection programmes have been promoted as a means of ensuring equality and improving the welfare of people across countries. Consequently, several social protection programmes have been rolled out in the global south where these challenges are rife. To promote financial protection in healthcare, low-and-middle income countries have been urged over time to embrace community-based health insurance (CBHI) as health financing option for providing coverage for the populace, especially the poor. With over twenty years of implementation in Africa, CBHI is yet to provide healthcare coverage to a significant fraction of the population. In Nigeria, CBHI was implemented as a partnership programme in selected rural communities in Kwara State. The partnership was between a Dutch agency, Health Insurance Fund and the Kwara State Government to provide primary and some secondary healthcare services to the people at subsidized cost. The programme commenced in 2007 and collapsed in 2016. Consequently, the people are back to the pre-2007 era of poor access to healthcare. Using the Walt and Gilson’s health policy triangle, the study examines the main reasons behind the stoppage of the programme. Mixed methods approach was adopted for data collection in 11 Local Government Areas (LGAs) in Kwara State where the programme operated. The findings indicate that issues of funding and management are central to the stoppage of the programme. Also, it shows that attaining UHC through CBHI will take several decades. Thus, the chapter recommends the need for a comprehensive and long-term ideational commitment to the provision of healthcare services in the global south.

Panel P50d
Evaluation in times of COVID-19 in the Global South IV