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IFC's SmartLessons, Real Experiences, Real Development

International Financial Corporation takes a closer look at SafeCare's Private-Public-Partnership in the Ogun State in Nigeria.

SmartLessons is an awards program to share lessons learned in development-oriented advisory services and investment operations.

The Ogun State Private Public Partnership with SafeCare was published in IFC.

Background: Since the 1990s, CBHIS have been implemented in several African countries, including Burkina Faso, Ghana, Rwanda, Senegal, and Tanzania, and some people see them as an “ideal” risk-pooling mechanism for minimizing catastrophic payments in low-resource settings, and ensuring responsiveness to local health needs. However, despite some major accomplishments in countries with strong national-government stewardship, most CBHIS have been limited in scope and success: they face major challenges with initiation, sustainability, and scale-up; they usually are unable to reach high levels of population coverage; and with small and fragmented risk pools, they most often require subsidies for poor and vulnerable segments of the population.

Findings: Lesson 1: Community participation is required for implementation of a successful state-sponsored health insurance scheme to promote social capital and ownership. Lesson 2: Successful schemes benefit from extensive learning and knowledge transfer. Lesson 3: To enhance continuity and ownership, it is essential for governments
to create a policy environment conducive to the support of any health-insurance scheme. Lesson 4: State-supported schemes benefit from high-level leadership: Involvement is bottom-up; commitment is top-down!

Conclusion: The NHIS has provided the required leadership for setting up the state schemes, providing a template for legislation, and offering to build the required ICT infrastructure, which will go a long way toward offsetting the impact of fragmentation in the development of the several state schemes. Enforcement of these back-end activities
through substantial financial incentives is a good omen. Adoption of community structures in governing these
schemes, as inherited from the original CBHIS designs, represents an essential innovation for marketing, enrollment, identification of the poor, and sometimes prevention of fraud.

Find the full article here.


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