ArticleBMJ global health2018
Strategic purchasing for universal health coverage: examining the purchaser-provider relationship within a social health insurance scheme in Nigeria.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 57 citations in OpenAlex.
- The Experiences of Strategic Purchasing of Healthcare in Nine Middle-Income Countries: A Systematic Qualitative Review.International journal of health policy and management · 2023Pooled it
- Community participation and contracting between state and non-state actors in primary care: A scoping review of evidence.International journal for equity in health · 2025Article
- Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review.International journal of environmental research and public health · 2025Article
- Systematic Review of Financing Functions for Universal Health Coverage in Low- and Middle-Income Countries: Reforms, Challenges, and Lessons Learned.Public health reviews · 2025Review
- Regaining policy attention for a health insurance capitation payment reform in Ghana: A prospective policy analysis.PLOS global public health · 2024Article
- Examining multiple funding flows to public healthcare providers in low- and middle-income countries - results from case studies in Burkina Faso, Kenya, Morocco, Nigeria, Tunisia and Vietnam.Health policy and planning · 2023Article
- Preferences of healthcare workers for provider payment systems in The Gambia's National Health Insurance Scheme.BMC health services research · 2023Article
- Exploring the roles of players in strategic purchasing for healthcare in Africa-a scoping review.Health policy and planning · 2023Article
- An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.Frontiers in public health · 2023Article
- The trust and insurance models of healthcare purchasing in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India: early findings from case studies of two states.BMC health services research · 2022Article
- Examining healthcare purchasing arrangements for strategic purchasing in Nigeria: a case study of the Imo state healthcare system.Health research policy and systems · 2022Review
- The Lancet Nigeria Commission: investing in health and the future of the nation.Lancet (London, England) · 2022Article
- Does Insurance Status Influence Outpatient Flow? Cross-Sectional Comparison of Insured and Uninsured Patients in a Tertiary Hospital in Nigeria.Journal of patient experience · 2022Article
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- Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures.Frontiers in public health · 2022Article
- Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria.Health economics review · 2021Review
- Why did Ghana's national health insurance capitation payment model fall off the policy agenda? A regional level policy analysis.Health policy and planning · 2021Article
- How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them.Health policy and planning · 2021Article
- Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study.PloS one · 2021Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn an attempt to achieve universal health coverage, Nigeria introduced a number of health insurance schemes. One of them, the Formal Sector Social Health Insurance Programme (FSSHIP), was launched in 2005 to provide health cover to federal government and formal private sector employees. It operates with two levels of purchasers, the National Health Insurance Scheme (NHIS) and health maintenance organisations (HMOs). This study critically assesses purchasing arrangements between NHIS, HMOs and healthcare providers and determines how the arrangements function from a strategic purchasing perspective within the FSSHIP.
methodsA qualitative study undertaken in Enugu state, Nigeria, data were gathered through reviews of documents, 17 in-depth interviews (IDIs) with NHIS, HMOs and healthcare providers and two focus group discussions (FGDs) with FSSHIP enrolees. A strategic purchasing lens was used to guide data analysis.
resultsThe purchasing function was not being used strategically to influence provider behaviour and improve efficiency and quality in healthcare service delivery. For the purchaser-provider relationship, these actions are: accreditation of healthcare providers; monitoring of HMOs and healthcare providers and use of appropriate provider payment mechanisms for healthcare services at every level. The government lacks resources and political will to perform their stewardship role while provider dissatisfaction with payments and reimbursements adversely affected service provision to enrolled members. Underlying this inability to purchase, health services strategically is the two-tiered purchasing mechanism wherein NHIS is not adequately exercising its stewardship role to monitor and guide HMOs to fulfil their roles and responsibilities as purchasing administrators.
conclusionsPurchasing under the FSSHIP is more passive than strategic. Governance framework requires strengthening and clarity for optimal implementation so as to ensure that both levels of purchasers undertake strategic purchasing actions. Additional strengthening of NHIS is needed for it to have capacity to play its stewardship role in the FSSHIP.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.