BACKGROUND

The National Health Insurance Authority (NHIA) Act, signed into law in May 2022, marked a significant milestone in Nigeria’s healthcare reform, aimed at improving access to healthcare for the most vulnerable populations. This Act repealed the previous National Health Insurance Scheme (NHIS) Act of 2004, and it established a mechanism to ensure that every Nigerian, regardless of their socioeconomic status, has access to basic health services. A core component of this Act is the creation of the Vulnerable Group Fund (VGF), which specifically provides financial support to vulnerable individuals, including children under five, pregnant women, physically and mentally challenged persons, the elderly, and indigent people.

The Vulnerable Group Fund was designed to subsidize healthcare costs for the aforementioned groups by covering or paying their health insurance premiums. This Act aligns with global efforts toward achieving Universal Health Coverage (UHC) and Nigeria’s commitment to the Sustainable Development Goals (SDGs), particularly the goal focused on ensuring healthy lives and promoting well-being for all at all ages.

The Lady Helen Child Health Foundation (LHCHF) has been at the forefront of advocating for the rights of vulnerable children in Nigeria, especially in the realm of healthcare access. Through its tripod program of Research, Advocacy, and the Patient Treatment Assistance Program (PTAP), LHCHF engages policymakers, stakeholders, and healthcare institutions to ensure that children who are otherwise unable to access medical services receive the care they need.

Advocacy for the NHIA Act and the FOI Requests

In 2019, the foundation held its inaugural lecture themed “Facing the Challenges of Delivering Healthcare to Vulnerable Children in Nigeria – The Need for Good Governance in the Health Sector.” This event was pivotal in drawing attention to the challenges facing the Nigerian healthcare system, particularly concerning vulnerable children. One key outcome was the emphasis on the need for a dedicated social health insurance scheme for orphans and vulnerable children. This led LHCHF to intensify its advocacy efforts to engage with stakeholders such as the Federal Ministry of Health, the National Assembly, and the National Health Insurance Scheme (NHIS).

Following this advocacy, the foundation submitted a Freedom of Information (FOI) request in 2020 to the NHIS, seeking data on the disbursement and uptake of health insurance by children between the ages of 0-18 over the previous three years. Unfortunately, the response to this request was not encouraging, as the foundation encountered significant delays and barriers in obtaining the requested data. This experience underscored the challenges of accessing critical information from government institutions and highlighted the gaps in the enforcement of the FOI Act 2011.

Despite these setbacks, LHCHF continued its advocacy efforts. In 2021, the foundation engaged with the Senate Committee on Health to address the issue of healthcare financing for vulnerable children. The discussions focused on ensuring that Nigerian children benefit from a well-structured and equitable healthcare system that reduces out-of-pocket expenses for the most vulnerable. During this period, LHCHF also worked closely with the House Committee on Health Care Services, advocating for legislative action to facilitate the passage of the NHIA bill and the establishment of the Vulnerable Group Fund (VGF).

The foundation’s advocacy efforts, alongside those of other stakeholders, culminated in the signing of the NHIA Act in May 2022. This Act is expected to cover over 83 million vulnerable Nigerians, ensuring that indigent children have access to quality healthcare through the National Health Insurance Scheme.

FOI Request Regarding the Vulnerable Group Fund (2024)

To further its mission of advocating healthcare access for vulnerable children, LHCHF submitted further FOI request to the National Health Insurance Authority (NHIA). This request was aimed at obtaining detailed information about the implementation plan for the Vulnerable Group Fund (VGF) established under the 2022 NHIA Act.

The FOI request sort the following information:

1. Implementation Plan: A copy of the detailed implementation plan for the VGF, including timelines, key activities, and the roles of responsible parties.
2. Coverage Details: Specific information on the healthcare services covered for vulnerable children, including preventive, curative, and emergency services.
3. Eligibility Criteria: Guidelines used to identify and enroll vulnerable children in the NHIS.
4. Monitoring and Evaluation: Frameworks for assessing the effectiveness of the VGF’s implementation.
5. Stakeholder Engagement: Details on how NGOs and community organizations are involved in the implementation of the VGF.
6. Progress Reports: Any available reports or assessments on the progress of the VGF since the NHIA Act was passed.

LHCHF’s request reflected its commitment to holding public institutions accountable and ensuring that the funds earmarked for vulnerable children are used effectively. The foundation’s continued engagement with the NHIA and other stakeholders is critical to ensuring that the objectives of the NHIA Act are met and that the healthcare needs of Nigeria’s most vulnerable children are prioritized.

OUTLINE OF FINDINGS:

The NHIA response provided detailed information on the phased implementation of the Vulnerable Group Fund (VGF). According to the data, the initiative will be publicly announced in Week 1, establishing the VGF with a commitment to cover 5 million vulnerable individuals within the first 100 days. During Weeks 2-4, extensive media outreach and stakeholder meetings will take place, alongside the production of Information, Education, and Communication (IEC) materials to raise awareness and understanding of the VGF among the public and target beneficiaries. Stakeholder engagement will continue in Weeks 5-8, involving traditional, religious, and community leaders, as well as State Primary Health Care Development Agencies and Medical Directors of State Secondary Health Care facilities to address operational issues and ensure readiness for the enrollment of beneficiaries.

In Weeks 9-12, retraining workshops on the VGF and Financial Management System will occur, alongside the disbursement of funds and the commencement of enrollment for potential beneficiaries. By Weeks 13-16, the production of ID cards for registered vulnerable individuals will be initiated, culminating in the official flag-off of the VGF at both national and state levels. Ongoing management of the program will include the payment of capitation and fee-for-service, alongside rigorous monitoring of the quality of healthcare services provided to enrolled beneficiaries. The comprehensive approach emphasizes initial awareness creation and stakeholder engagement, followed by operational readiness and beneficiary enrollment, ensuring effective implementation and sustained success in providing healthcare coverage for vulnerable populations in Nigeria.

Additionally, the framework for coverage and eligibility highlights that vulnerable children are covered under the VGF through the NHIA and SSHIA, with eligibility criteria based on inclusion in relevant databases. The monitoring and evaluation framework focuses on tracking key indicators such as coverage rates and service quality, while stakeholder engagement involves various governmental and non-governmental organizations to ensure a collaborative and transparent implementation process. Overall, the response underscores the commitment to a structured and inclusive approach in providing healthcare for vulnerable individuals.

ANALYSIS OF INFORMATION

The data obtained from the implementation plan of the Vulnerable Group Fund (VGF) reveals several positive trends and critical challenges in the rollout of the National Health Insurance Authority (NHIA) Act. Notably, the commitment to cover 5 million vulnerable individuals within the first 100 days sets an ambitious target that reflects a proactive approach to healthcare access for marginalized populations. This aligns with the expectations that prompted the Freedom of Information (FOI) request, which sought to understand the effectiveness and efficiency of health coverage initiatives for vulnerable groups.

However, while the initiative’s framework is promising, challenges persist, particularly in reaching rural and hard-to-access areas. The emphasis on media engagement and stakeholder meetings is a strong strategy for awareness creation; yet there may be gaps in ensuring that these efforts translate into effective enrollment, especially among populations less connected to digital media or lacking access to information.

Furthermore, although the monitoring and evaluation framework outlines key performance indicators, there are indications of limitations in data completeness and independent evaluations. For instance, while the indicators tracked—such as coverage rates and service quality—are essential for assessing program effectiveness, the absence of detailed independent evaluations may hinder transparency and accountability.

In summary, while the data showcases commendable progress in establishing the VGF and its ambitious enrollment targets, challenges remain in implementation, particularly regarding rural outreach and sustainable funding. Addressing these gaps will be crucial for enhancing the overall effectiveness of the VGF and ensuring that it meets its intended goals of providing healthcare coverage to vulnerable populations in Nigeria.

CONCLUSION AND SUGGESTIONS

Summary of Key Findings

The data obtained from the implementation plan of the Vulnerable Group Fund (VGF) under the NHIA Act reveals notable progress in setting ambitious targets for vulnerable population coverage. The commitment to enrolling 5 million individuals in the first 100 days and ultimately covering 150 million people in four years highlights the government’s focus on healthcare equity. The phased rollout strategy, which includes media engagement, stakeholder meetings, and the production of IEC materials, indicates a strong effort toward raising awareness and operational readiness. However, challenges were noted, particularly in ensuring that rural areas are adequately reached and that sustainable funding mechanisms are maintained. Furthermore, gaps in the monitoring and evaluation framework, specifically regarding independent evaluations, could impact the overall transparency and effectiveness of the program.

SUGGESTIONS FOR EFFECTIVENESS

1. Strengthen Rural Outreach Efforts: It is essential to implement more targeted strategies to reach vulnerable populations in rural and remote areas, potentially through partnerships with local community organizations and mobile health initiatives.
2. Enhance Funding Mechanisms: To ensure long-term sustainability, the government should explore additional funding sources, such as public-private partnerships, to support the Vulnerable Group Fund and its expansion efforts.
3. Improve Monitoring and Evaluation: Establish independent oversight and evaluation mechanisms to enhance the transparency and accountability of the program. This would involve incorporating third-party audits and regular public reports to track progress against key performance indicators.
4. Increase Stakeholder Engagement: Continuous engagement with key stakeholders under the VGF is recommended to ensure that all segments of the population are informed and actively involved in the enrollment and implementation process.

By addressing these gaps and implementing the recommended strategies, the VGF can become more effective and sustainable in providing essential healthcare services to vulnerable populations across Nigeria.

Acknowledgement; The cooperation of the NHIA information office in providing useful documentation about the implementation strategy is appreciated and the Lady Helen Child Health foundation will be following up with further progress monitoring of this process as we look forward to more impactful engagement.

Use of any information from this publication must contain full acknowledgement of the authors of this writeup.

Corresponding Author; Dr Benjamin Odeka mbbs dch ma frcp frcpch- director of research Lady Helen Child health Foundation;                                         www.ben@ladyhelenchildfoundation.com.