The Lancet Nigeria Commission: investing in health and the future of the nation

Ibrahim Abubakar; Sarah L. Dalglish; Blake Angell; Olutobi Sanuade; Seye Abimbola; Aishatu Lawal Adamu; Ifedayo M.O. Adetifa; Tim Colbourn; Afolabi Olaniyi Ogunlesi; Obinna Onwujekwe; Eme T. Owoaje; Iruka N. Okeke; Adebowale Adeyemo; Gambo Aliyu; Muktar H. Aliyu; Sani Hussaini Aliyu; Emmanuel A. Ameh; Belinda Archibong; Alex Ezeh; Muktar A. Gadanya; Chikwe Ihekweazu; Vivianne Ihekweazu; Zubairu Iliyasu; Aminatu Kwaku Chiroma; Diana A. Mabayoje; Mohammed Nasir Sambo; Stephen Obaro; Adesola Yinka-Ogunleye; Friday Okonofua; Tolu Oni; Olu Onyimadu; Muhammad Ali Pate; Babatunde L. Salako; Faisal Shuaib; Fatimah Tsiga-Ahmed; Fatima H. Zanna

doi:10.1016/S0140-6736(21)02488-0

The Lancet Nigeria Commission: investing in health and the future of the nation

Ibrahim Abubakar, Sarah L. Dalglish, Blake Angell, Olutobi Sanuade, Seye Abimbola, Aishatu Lawal Adamu, Ifedayo M.O. Adetifa, Tim Colbourn, Afolabi Olaniyi Ogunlesi, Obinna Onwujekwe, Eme T. Owoaje, Iruka N. Okeke, Adebowale Adeyemo, Gambo Aliyu, Muktar H. Aliyu, Sani Hussaini Aliyu, Emmanuel A. Ameh, Belinda Archibong, Alex Ezeh, Muktar A. GadanyaChikwe Ihekweazu, Vivianne Ihekweazu, Zubairu Iliyasu, Aminatu Kwaku Chiroma, Diana A. Mabayoje, Mohammed Nasir Sambo, Stephen Obaro, Adesola Yinka-Ogunleye, Friday Okonofua, Tolu Oni, Olu Onyimadu, Muhammad Ali Pate, Babatunde L. Salako, Faisal Shuaib, Fatimah Tsiga-Ahmed, Fatima H. Zanna

Research output: Contribution to journal › Review article › peer-review

91 Scopus citations

Original language	English (US)
Pages (from-to)	1155-1200
Number of pages	46
Journal	The Lancet
Volume	399
Issue number	10330
DOIs	https://doi.org/10.1016/S0140-6736(21)02488-0
State	Published - Mar 19 2022

ASJC Scopus subject areas

General Medicine

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10.1016/S0140-6736(21)02488-0

Cite this

Abubakar, I., Dalglish, S. L., Angell, B., Sanuade, O., Abimbola, S., Adamu, A. L., Adetifa, I. M. O., Colbourn, T., Ogunlesi, A. O., Onwujekwe, O., Owoaje, E. T., Okeke, I. N., Adeyemo, A., Aliyu, G., Aliyu, M. H., Aliyu, S. H., Ameh, E. A., Archibong, B., Ezeh, A., ... Zanna, F. H. (2022). The Lancet Nigeria Commission: investing in health and the future of the nation. The Lancet, 399(10330), 1155-1200. https://doi.org/10.1016/S0140-6736(21)02488-0

Abubakar, I, Dalglish, SL, Angell, B, Sanuade, O, Abimbola, S, Adamu, AL, Adetifa, IMO, Colbourn, T, Ogunlesi, AO, Onwujekwe, O, Owoaje, ET, Okeke, IN, Adeyemo, A, Aliyu, G, Aliyu, MH, Aliyu, SH, Ameh, EA, Archibong, B, Ezeh, A, Gadanya, MA, Ihekweazu, C, Ihekweazu, V, Iliyasu, Z, Kwaku Chiroma, A, Mabayoje, DA, Nasir Sambo, M, Obaro, S, Yinka-Ogunleye, A, Okonofua, F, Oni, T, Onyimadu, O, Pate, MA, Salako, BL, Shuaib, F, Tsiga-Ahmed, F & Zanna, FH 2022, 'The Lancet Nigeria Commission: investing in health and the future of the nation', The Lancet, vol. 399, no. 10330, pp. 1155-1200. https://doi.org/10.1016/S0140-6736(21)02488-0

@article{08ffec63f3024598be73bd4645782304,

title = "The Lancet Nigeria Commission: investing in health and the future of the nation",

author = "Ibrahim Abubakar and Dalglish, {Sarah L.} and Blake Angell and Olutobi Sanuade and Seye Abimbola and Adamu, {Aishatu Lawal} and Adetifa, {Ifedayo M.O.} and Tim Colbourn and Ogunlesi, {Afolabi Olaniyi} and Obinna Onwujekwe and Owoaje, {Eme T.} and Okeke, {Iruka N.} and Adebowale Adeyemo and Gambo Aliyu and Aliyu, {Muktar H.} and Aliyu, {Sani Hussaini} and Ameh, {Emmanuel A.} and Belinda Archibong and Alex Ezeh and Gadanya, {Muktar A.} and Chikwe Ihekweazu and Vivianne Ihekweazu and Zubairu Iliyasu and {Kwaku Chiroma}, Aminatu and Mabayoje, {Diana A.} and {Nasir Sambo}, Mohammed and Stephen Obaro and Adesola Yinka-Ogunleye and Friday Okonofua and Tolu Oni and Olu Onyimadu and Pate, {Muhammad Ali} and Salako, {Babatunde L.} and Faisal Shuaib and Fatimah Tsiga-Ahmed and Zanna, {Fatima H.}",

note = "Funding Information: Pooling is the health financing function whereby collected health revenues are transferred to purchasing organisations, which manage revenues and distribute risks. Nigeria should strive to develop large pools because having small, scattered, and uncoordinated pools will not lead to efficient and equitable financial risk protection. However, in the case of multiple pools, such as the various State Social Health Insurance Schemes, the Formal Sector Social Health Insurance Programme, free programmes funded by the budget, community-based health insurance schemes, and private health insurance, risk equalisation can be achieved via mechanisms including a dedicated fund and health re-insurance, under the leadership of the Federal Ministry of Finance, FMoH, the National Council of Health, and the Nigeria Governors Forum. Funding Information: Health spending would therefore be improved by instituting a dedicated pre-determined budget at the federal and state levels, outside of the electoral cycle, and with mechanisms to ensure it is spent efficiently and equitably. The budget must be made public and subject to independent auditors to ensure equity in the distribution of resources and setting of health priorities. An increase in states' internally generated revenues would also lower state dependence on federal funding and refocus priorities on internal needs in determining health spending. A transparent, public process for assigning and using grants from international donor partners, subject to independent regular audits, is also needed. To address some of these issues, in 2014, Nigeria established the Basic Healthcare Provision Fund, financed by an annual federal government grant of not less than 1% of the Consolidated Revenue Fund, grants from external donors, and other sources. 50% of the funds gathered are to be administered by the NHIS to provide basic health services to citizens and for subsidy payments to state insurance agencies to provide health care to the very poor who are unable to afford premium payments; however, more far-reaching reform is needed to reach Nigeria's goal of universal health coverage. Funding Information: We are grateful to the Bill & Melinda Gates Foundation for funding this Commission and to the UK Wellcome Trust and Wellcome Collection for hosting the first meeting of the Commission. We are also grateful to the following individuals for their contribution to various stages of the Commission and meetings: Sarah Sterlini for administrative support and project management; Kwame Sakyi, Prince Owusu, Janelle Zora, Fatema Tuz Zohra, and Paige Thieda (Ghana health insurance case study); Charles Ezenduka (Anambra health insurance case study); Jessica Moriera (financing case study); Engr. Emmanuel John (Ochenuel Mobility in Abuja); Olamide Udoma-Ejorh (Lagos Urban Development Initiative); Charles Orjiakor (policy landscape review); Loretta F Ntoimo (report of key informant interviews on the history of Nigeria's health-care system); David Adewole and Mutiat Oladejo (background research on history and policy); Mohsen Naghavi, Maha Ezalarab, Scott Glenn, and Ally Walker (Institute for Health Metrics and Evaluation?bespoke GBD analysis and comparison paper); Rukevwe Aliogo for her support mapping health facilities using ArcGIS; and Caroline Jehu-Appiah (BMGF). IA acknowledges funding from the National Institute for Health Research (NIHR; SRF-2011?04?001; NF-SI-0616?10037), the Bill & Melinda Gates Foundation (003254), the UK Medical Research Council, the UK Department of Health, and the Wellcome Trust. IMOA is funded by the UK Medical Research Council and Department for International Development through an African Research Leader Fellowship (MR/S005293/1). The funders of the Commission had no role in design, information, collection, analysis, interpretation, writing of the report, or the decision to submit the paper for publication. TO is supported by the NIHR (16/137/34) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR, or the UK Department of Health and Social Care.",

year = "2022",

month = mar,

day = "19",

doi = "10.1016/S0140-6736(21)02488-0",

language = "English (US)",

volume = "399",

pages = "1155--1200",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier Limited",

number = "10330",

}

TY - JOUR

T1 - The Lancet Nigeria Commission

T2 - investing in health and the future of the nation

AU - Abubakar, Ibrahim

AU - Dalglish, Sarah L.

AU - Angell, Blake

AU - Sanuade, Olutobi

AU - Abimbola, Seye

AU - Adamu, Aishatu Lawal

AU - Adetifa, Ifedayo M.O.

AU - Colbourn, Tim

AU - Ogunlesi, Afolabi Olaniyi

AU - Onwujekwe, Obinna

AU - Owoaje, Eme T.

AU - Okeke, Iruka N.

AU - Adeyemo, Adebowale

AU - Aliyu, Gambo

AU - Aliyu, Muktar H.

AU - Aliyu, Sani Hussaini

AU - Ameh, Emmanuel A.

AU - Archibong, Belinda

AU - Ezeh, Alex

AU - Gadanya, Muktar A.

AU - Ihekweazu, Chikwe

AU - Ihekweazu, Vivianne

AU - Iliyasu, Zubairu

AU - Kwaku Chiroma, Aminatu

AU - Mabayoje, Diana A.

AU - Nasir Sambo, Mohammed

AU - Obaro, Stephen

AU - Yinka-Ogunleye, Adesola

AU - Okonofua, Friday

AU - Oni, Tolu

AU - Onyimadu, Olu

AU - Pate, Muhammad Ali

AU - Salako, Babatunde L.

AU - Shuaib, Faisal

AU - Tsiga-Ahmed, Fatimah

AU - Zanna, Fatima H.

N1 - Funding Information: Pooling is the health financing function whereby collected health revenues are transferred to purchasing organisations, which manage revenues and distribute risks. Nigeria should strive to develop large pools because having small, scattered, and uncoordinated pools will not lead to efficient and equitable financial risk protection. However, in the case of multiple pools, such as the various State Social Health Insurance Schemes, the Formal Sector Social Health Insurance Programme, free programmes funded by the budget, community-based health insurance schemes, and private health insurance, risk equalisation can be achieved via mechanisms including a dedicated fund and health re-insurance, under the leadership of the Federal Ministry of Finance, FMoH, the National Council of Health, and the Nigeria Governors Forum. Funding Information: Health spending would therefore be improved by instituting a dedicated pre-determined budget at the federal and state levels, outside of the electoral cycle, and with mechanisms to ensure it is spent efficiently and equitably. The budget must be made public and subject to independent auditors to ensure equity in the distribution of resources and setting of health priorities. An increase in states' internally generated revenues would also lower state dependence on federal funding and refocus priorities on internal needs in determining health spending. A transparent, public process for assigning and using grants from international donor partners, subject to independent regular audits, is also needed. To address some of these issues, in 2014, Nigeria established the Basic Healthcare Provision Fund, financed by an annual federal government grant of not less than 1% of the Consolidated Revenue Fund, grants from external donors, and other sources. 50% of the funds gathered are to be administered by the NHIS to provide basic health services to citizens and for subsidy payments to state insurance agencies to provide health care to the very poor who are unable to afford premium payments; however, more far-reaching reform is needed to reach Nigeria's goal of universal health coverage. Funding Information: We are grateful to the Bill & Melinda Gates Foundation for funding this Commission and to the UK Wellcome Trust and Wellcome Collection for hosting the first meeting of the Commission. We are also grateful to the following individuals for their contribution to various stages of the Commission and meetings: Sarah Sterlini for administrative support and project management; Kwame Sakyi, Prince Owusu, Janelle Zora, Fatema Tuz Zohra, and Paige Thieda (Ghana health insurance case study); Charles Ezenduka (Anambra health insurance case study); Jessica Moriera (financing case study); Engr. Emmanuel John (Ochenuel Mobility in Abuja); Olamide Udoma-Ejorh (Lagos Urban Development Initiative); Charles Orjiakor (policy landscape review); Loretta F Ntoimo (report of key informant interviews on the history of Nigeria's health-care system); David Adewole and Mutiat Oladejo (background research on history and policy); Mohsen Naghavi, Maha Ezalarab, Scott Glenn, and Ally Walker (Institute for Health Metrics and Evaluation?bespoke GBD analysis and comparison paper); Rukevwe Aliogo for her support mapping health facilities using ArcGIS; and Caroline Jehu-Appiah (BMGF). IA acknowledges funding from the National Institute for Health Research (NIHR; SRF-2011?04?001; NF-SI-0616?10037), the Bill & Melinda Gates Foundation (003254), the UK Medical Research Council, the UK Department of Health, and the Wellcome Trust. IMOA is funded by the UK Medical Research Council and Department for International Development through an African Research Leader Fellowship (MR/S005293/1). The funders of the Commission had no role in design, information, collection, analysis, interpretation, writing of the report, or the decision to submit the paper for publication. TO is supported by the NIHR (16/137/34) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR, or the UK Department of Health and Social Care.

PY - 2022/3/19

Y1 - 2022/3/19

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U2 - 10.1016/S0140-6736(21)02488-0

DO - 10.1016/S0140-6736(21)02488-0

M3 - Review article

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AN - SCOPUS:85126593831

SN - 0140-6736

VL - 399

SP - 1155

EP - 1200

JO - The Lancet

JF - The Lancet

IS - 10330

ER -

The Lancet Nigeria Commission: investing in health and the future of the nation

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