CMDA Nigeria Expert Opinion Series 1.04
A CMDA Nigeria commentary on emerging issues

Investing and Reprogramming Public Financing for National Response to COVID-19

Summary

The current multisectoral response to the Corona virus outbreak remains commendable. But central to the response is the need for a more coherent and reprogrammed public financing mechanism in the country.¹ This requires more coordinated investments and reinvestments in core health system functions, complemented by public policy actions beyond the health system.² Our recommendations for public policy includes as below.

Recommendations

1. Rapidly scale up the coordinated mobilization and disbursement of funds through evidenced-based prioritization that ensures transparent reporting mechanisms across all levels of government as a response strategy to the COVID-19 outbreak in the country.
2. Expansion of the fiscal (budgetary) space for health, through necessary legislative and executive actions, as stimulus packages to the health systems’ response to COVID-19 and other potential future emergency health outbreaks in the country.
3. Reprogramming of public funds such as the reallocation of proportions of government health budgets, the Basic Health Care Provision Fund (BHCPF) and Health Insurance funds at national and sub-national levels as an emergency strategic response mechanism to the COVID-19 pandemic.
4. Reprogramming will require the creation of specific budgetary programme for COVID-19 response in revised budgets to facilitate execution and expenditure tracking at national and sub-national levels. It also requires more flexibility for spending for frontline service providers in order to rapidly respond to shortages or stock outs of key supplies (test kits, soaps, medicines, materials, manpower, wages and incentives, etc).
5. Emergency adjustments to health financing policies to remove financial barriers to care. This will include: removal of user-fees for all patients and services related to the Corona virus infection, compensation of health facilities for losses due to user fee waivers, and provide some form of advance payment that may result from increased service demand (through front loading budgets or capitation) or through fee-for-service models for COVID-19 services.
6. Lastly, based on equitable mechanisms, a public coordinated system for multipurpose cash transfers should be adopted and where feasible, digital platforms should be utilized to enhance efficiency, accountability and transperency.²

References

1. World Health Organization (WHO) Responses: Priorities for the Health Financing Response to COVID-19, P4H, 2^nd April, 2020.
2. Paul Harvey and Sara Pavanello, 2018. Multi-Purpose Cashand Sectoral Outcomes: A Review of Evidence and Learning. Online at
   < https://www.unhcr.org/5b28c4157.pdf>.
3. https://cmdanigeria.org/it-is-wartimea-call-to-action-against-covid-19-in-nigeria/