Table 3

Key findings and potential policy implications of the Kaduna State health accounts 2016

Key findingsPolicy implications
A very high proportion of health spending is borne by households, which exposes Kaduna citizens to catastrophic expenditure.For Kaduna to achieve the recommended benchmark of 30% OOP as a percentage of THE, it is critical that the newly signed into law contributory health insurance scheme is well designed, successfully implemented and financially sustainable. The scheme will ensure that Kaduna households are protected from the financial shock of seeking and paying for healthcare.
Government contribution to health spending is relatively low.Government spending onhealth can be improved by (1) Increasing allocation of resources towardshealth. (2) Adequate cash backing of health budgets by the state government. The State Ministry ofHealth can facilitate this by demonstrating value for money in healthcarespending and actively engage the Ministry of Finance and the Commission ofBudget and Planning in ensuring cash backing and release of budgeted funds.
Preventive care accounts for a negligible proportion of current health spending while parasitic diseases including malaria, HIV/AIDS and vaccine preventable diseases are the major expenditure drivers.A shift from curative to preventive care especially at the PHC level may reduce healthcare costs for the system while improving overall health of citizens in the long run. Kaduna State and Nigeria have a lot to gain from innovative financing for preventive health services. The Astana declaration which Nigeria is a signatory to, provides a renewed political commitment for policy makers and political actors to prioritise disease prevention and health promotion services as a means of improving health and strengthening PHC.
Less than 25% of government HE was spent in PHCs. This is quite low given that PHCs cater to more than 60% of the population of the state.Kaduna State can reprioritise and reallocate resources towards PHCs in the future through successful implementation of the service delivery plan and cash backing for operational expenses at PHCs. In addition, a successful roll-out and implementation of the basic healthcare provision fund (an earmarked fund aimed at improved government financing of both supply and demand sides of basic health services) at both federal and state levels will contribute to improving allocation of funds toPHCs.