By: Obinna Onwujekwe, Nathaniel Otoo, Stella U. Matutina, Uchenna Ezenwaka, Augustine Kuwawenaruwa , Joël Arthur Kiendrébéogo

Strategic Purchasing Africa Resource Centre (SPARC) is a hub in sub-Saharan Africa that serves as a go-to source of information, support and capacity building for strategic purchasing to get better value for health spending to advance universal health coverage. Governance challenges which can be gross irregularities such as delays in provider payment, corrupt practices, and weak monitoring and accountability mechanisms, historical budgeting (not evidence-based), provider/purchase split and roles that are not clearly defined etc., affect the efficiency of health insurance schemes in Nigeria. In addition, some providers still dispense branded drugs and stockouts persist, coupled with an increasing rate of denial of referrals by HMOs. And finally, performance information is not linked to payment decisions, even as leakages also occur in the system, revealing lack of accountability, which also manifests in alleged misconduct among providers and HMOs. To address these many challenges affecting health insurance schemes in Nigeria, strategic purchasing is recommended.

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