Financial access is a key contributor to underutilisation of Primary Health Care (PHC) services in Nigeria. Healthcare is financed primarily through out-of-pocket expenditure which as of 2016, accounted for 70% of total health expenditure in Nigeria. As part of on-going national health reforms aimed at reducing Out of Pocket Expenditure (OOPE) through pre-payment mechanisms, HSCL in collaboration with Results for Development (R4D) is providing technical assistance to the government of Kaduna, and Niger states for the design and implementation a social health insurance scheme (pro-poor scheme) in both states.

Project Goal

To improve access to, and utilization of quality primary health care services and the reduction of out-of-pocket payments with an emphasis on pregnant women, children, and those living in poverty.


  • Provide technical assistance for the design of state-level health financing mechanisms
  • Support the implementation, and evaluation of these mechanisms
  • Build the capacity of state actors to continue to provide sustainable implementation support after the duration of the investment.

Related Activities

  • Conducted a baseline assessment to generate evidence to guide scheme design
  • Review of the bill establishing the scheme to ensure alignment with best practices
  • Design of key components of the health insurance scheme including resource mobilization, pooling, purchasing, and performance management
  • Design of mechanisms for the definition, and identification of vulnerable and target populations
  • Support establishment of the Agency responsible for managing the scheme
  • Development of a Monitoring and Evaluation plan for the scheme

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