Pillar 1: Health Infrastructure Within Neighbourhoods

Pillar 2: Modules of Community Health Personnel

Pillar 3:  Membership Fee As Health Financing:        

Pillar 4: People Involvement

Pillar 1: Primary Healthcare Infrastructure:

Open Access, Walk-In Clinics in peoples' neighbourhood across the state. The Clinics will be equipped with essential medicines and essential diagnostic point of treatment kits. The Clinics will publish daily doctors' visiting hours.

Pillar 2: Modules of hierarchical community health personnel

A Module of personnel consists of 16 Key Workers recruited and ttrained to resspond to contacts from the people about their health needs. The 16 Key Workers Task Sharing and Task Shifting 4 qualified nurses using approved Clinical Protocols supervised by a registered medical practitioner

Pillar 3: Health Financing and Health Insurance

Residents of the local neighbourhoods will have open access to the Walk-In cliniics. They will be enrolled as members of Mutual Health Associations. The membership fees of the MHA will be used as insurance premium for members. 

Pillar 4: People Involvement

Mutual Health Associations will manage the Walk-In Clinics through organising membership of the association. Membership will be free for one month when free medical check up will be carried out. Thereafter, membership fees will be payable and this will be used as insurance premium for primary healthcare and ambulatory care of members. 

These pillars combine Community Governed Primary Healthcare and Community Governed Health Insurance into an innovative Model to deliver Universal Health Coverage in Ekiti State, Nigeria

1. Background and Rationale

Nigeria has committed to Universal Health Coverage (UHC), yet insurance enrollment remains limited and out-of-pocket health expenditure remains high. Primary healthcare delivery is fragmented, and communities are often treated as service recipients rather than structural participants in financing and governance.

Healthcare Access Covenant Foundation (HAC) was established to translate UHC from policy aspiration into community-level implementation. Our model aligns with the mandate of the National Health Insurance Authority and global UHC principles advanced by the World Health Organization.

Ekiti State provides a viable reform environment for piloting a scalable cooperative-based primary healthcare system that integrates insurance enrollment, prepaid financing, and accountable community governance.

2. Problem Statement

Key challenges include:

Low enrollment in structured health insurance mechanisms

High out-of-pocket primary care expenditure

Limited integration of private providers into insurance networks

Weak community participation in health financing governance

Vulnerable populations excluded from prepaid systems

Without structured enrollment and local ownership, progress toward UHC remains uneven.

3. Project Goal

To establish a cooperative-based, community-governed primary healthcare network in Ekiti State that integrates insurance financing, structured service delivery, and measurable accountability systems.

4. Project Objectives (36 Months)

Establish 3–5 Community Mutual Health Association (MHA) Clinics in selected Ekiti communities, in the first year and 22 Clinics in the second year.

Enroll 5-8000 individuals per clinic into structured primary healthcare delivery and membership pre-payment insurance mechanisms.

Provide targeted contribution subsidies to 23,000–50,000 vulnerable individuals within our enrolled population, identified through a validated means-testing protocol.

Demonstrate measurable improvement in financial protection and primary care utilization.

Demonstrate sustainability of our service-insurance hybrid approach

Develop a scalable implementation framework for expansion within Southwestern Nigeria.

5. Intervention Model

Community Mutual Health Associations (MHAs)

Neighborhood-based clinics owned and governed cooperatively by members.

Services include:

Preventive annual assessments

Ambulatory primary care consultations

Essential medicines within approved protocols

Coordinated referrals

Community-based follow-up after hospital discharge

Membership Structure

Open Membership: Community registration and initial access services

Insured Membership: Annual prepaid contribution (NGN 22,500 in 2026) providing defined primary care access

Subsidy Framework

A community-validated, means-tested vulnerability assessment tool will identify individuals eligible for sponsored membership contributions. Inter-rater reliability and transparency safeguards will be built into the protocol.

6. Financing Strategy

The model operates through blended financing:

Cooperative membership contributions

Capitation payments via NHIA-aligned insurance mechanisms

Institutional grants

Targeted subsidies for vulnerable households

The objective is gradual transition toward operational sustainability by Year 3.

7. Expected Outcomes

By the end of Year 3:

*More than 10% of the population of Ekiti are enrolled in structured primary healthcare

*Increased insurance participation within target communities

*Reduced risk of catastrophic out-of-pocket primary care expenditure

*Improved utilization of preventive and ambulatory services

*Community-elected governance structures actively overseeing performance

*Contributing to Sustainable Development Goal 3 of the United Nations.

8. Monitoring & Evaluation

HAC will implement a structured Monitoring and Evaluation framework tracking:

Enrollment and retention rates

Service utilization indicators

Financial performance metrics

Member satisfaction

Comparative analysis with non-participating communities (where feasible)

Independent financial review and periodic impact reporting will be conducted.

9. Governance & Institutional Capacity

HAC operates under:

A Board of Trustees

Clinical Audit Committee

Community-elected cooperative committees

Independent financial oversight mechanisms

Conflict-of-interest and financial disclosure policies are in place.

10. Funding Request

HAC seeks an investment of USD 1.2 – 1.8 million over 36 months to support:

Establishment of 40-45 Cooperative clinics in Ekiti neighbourhoods

Digital enrollment and health records systems

Initial staffing and operational support

Vulnerable household subsidy pool

Monitoring, evaluation, and independent assessment

Detailed budget breakdown and implementation timeline are available upon request.

11. Conclusion

Healthcare Access Covenant Foundation is building a structured, cooperative, community-owned primary healthcare model designed to advance Universal Health Coverage sustainably and at scale.

This initiative represents an opportunity to move from policy commitment to measurable implementation within a replicable Nigerian context.