Anambra State Universal Health Coverage and Healthcare Reform Bill

Purpose

To establish a comprehensive framework for universal health coverage in Anambra State: strengthening primary healthcare, building sustainable and equitable healthcare financing, integrating public, private, faith-based and community providers into one coordinated system, and protecting residents from catastrophic health expenditure.

Problem Statement

Many residents across Anambra State cannot access essential healthcare without severe financial hardship, primary healthcare centres often lack staffing, medicines and equipment, and existing health-insurance coverage remains fragmented across separate state and federal schemes rather than working as one coordinated system.

Legislative Objectives

• Progressively guarantee every eligible resident access to an essential package of healthcare, regardless of income, occupation or location.
• Develop a State healthcare-financing framework working toward a single-payer architecture, integrated with the Anambra State Health Insurance Agency (ASHIA), the National Health Insurance Authority (NHIA) and the Basic Health Care Provision Fund (BHCPF).
• Establish an Equity and Vulnerable Persons Fund subsidising coverage for residents who cannot reasonably afford their contribution.
• Strengthen primary healthcare as the foundation of the system, with a published minimum standard for every facility.
• Accredit and strategically purchase services from qualified public, private, faith-based and community healthcare providers.
• Establish standards for healthcare quality, digital health, medicines, workforce and infrastructure, with public reporting and complaints redress.

Definitions

Universal Health Coverage

Access to needed, quality healthcare services without financial hardship.

Single Payer

A healthcare-financing architecture in which a designated public purchaser pools and uses healthcare funds to purchase covered services for enrolled residents, without requiring every provider to be government-owned.

Primary Healthcare Centre

A first-contact, publicly designated health facility providing essential community-level healthcare, the foundation of the wider system under this Bill.

Accredited Provider

A public, private, faith-based or community healthcare provider approved to deliver publicly financed services after meeting prescribed quality and safety standards.

Proposed Provisions

1. 1.Establishment of a State universal health coverage financing framework, coordinated with ASHIA, NHIA and BHCPF rather than duplicating them.
2. 2.A phased single-payer direction, subject to constitutional competence, actuarial sustainability and a fiscal-sustainability assessment before major expansion.
3. 3.An Equity and Vulnerable Persons Fund prioritising indigent households, children, pregnant women, elderly persons and persons with disabilities.
4. 4.Provider accreditation and strategic-purchasing rules covering qualified personnel, equipment, medicines, infection prevention and patient safety.
5. 5.A primary-healthcare minimum standard covering power, water, medicines, diagnostics, maternal and child services, digital records and referral capability.
6. 6.A twelve-month requirement for a Universal Health Coverage Implementation Roadmap, plus annual public reporting to the House of Assembly.

Institutional Responsibilities

• Relevant Anambra State ministry of health and the Anambra State Health Insurance Agency (ASHIA) to lead statewide implementation and coordinate with the National Health Insurance Authority (NHIA).
• Office of the Member representing Nnewi South I to advocate for early primary-healthcare implementation locally, coordinated with the Primary Healthcare Revitalisation Bill.
• Accredited public, private, faith-based and community healthcare providers to deliver covered services under agreed quality and payment terms.

Financing Implications

Financed through State appropriations, lawfully authorised health-insurance contributions, federal healthcare funds and BHCPF-related resources, development-finance and donor support, and, where applicable, employer contributions; no funding mechanism, including single-payer expansion, proceeds without a prior actuarial and fiscal-sustainability assessment.

Implementation Mechanism

2027: baseline assessment (coverage, workforce, medicines, digital health) and publication of the Implementation Roadmap. 2028 onward: phased rollout of primary-healthcare standards, provider accreditation and financing integration, sequenced against the Roadmap and fiscal-sustainability findings.

Monitoring Mechanism

Tracked under a Health category of the Accountability Dashboard: enrolment, facility performance, health outcomes, medicine availability, out-of-pocket expenditure and complaints resolved, with an annual report to the House of Assembly.

Expected Outcomes

• Expanded, coordinated health-insurance coverage rather than fragmented, overlapping schemes.
• Primary healthcare centres meeting a published minimum standard statewide.
• Reduced catastrophic out-of-pocket healthcare expenditure for residents.
• A transparent, accredited provider network spanning public, private, faith-based and community healthcare.

Legal Considerations

This proposal is intended to operate within the legislative competence of the Anambra State House of Assembly and in conformity with applicable federal law, including the Constitution of the Federal Republic of Nigeria, the Land Use Act, the Public Procurement Act and relevant sector legislation. Final drafting will be reviewed by legislative counsel prior to introduction. The single-payer financing direction will be developed in coordination with the National Health Insurance Authority Act 2022 and existing ASHIA and BHCPF arrangements, and any major financing expansion is subject to a prior actuarial and fiscal-sustainability assessment.