Reimagining Health Systems for Healthier Lives and Social Justice: New Social Contract Through Abia State Health Insurance Scheme to Achieve Universal Health Coverage in Nigeria.

Group-based community (GBC) engagement such as town hall meetings (THM) may promote informed decision-making for healthcare, governance, social voice, community participation, and access to quality healthcare services. In Nigeria, very little evidence is documented on the influences of community engagement on the health systems. This paper explores gains from community engagement efforts in implementing the Basic Health Care Provision Fund (BHCPF) in Nigeria’s Abia State. Qualitative/community dialogue sessions (n=292) reached 40,471 residents with BHCPF information and highlighted areas where communities can support strengthening the health systems. State Joint Core Team on community engagement was inaugurated, community engagement plan and dialogue facilitation guide were designed and validated with key stakeholders. A multi-sectorial pool of facilitators was oriented on the modalities of the group-based dialogue session. The GBC engagement reached about 40,471 residents-ranging from politicians, technocrats, and civil servants, town union presidents, traditional and religious leaders, pregnant women, youths, health workers, disabled and elderly with BHCPF messages. Tracking tools and team debriefing meetings were deployed to guide the harvesting of the wins from the dialogue sessions. Facility tours were conducted to validate the wins from community stakeholders in various facilities. GBC engagement led to social reinforcement in learning about BHCPF and generated demand for BHCPF (from 0-89,826). The dialogue sessions provided avenues for triangular accountability discussions– politicians, community leaders, and other citizens from the locales committed resources and time to improve quality and equitable access to health care. The discussions translated to the community stakeholders renovating, constructing, and maintaining their respective health facilities and equipment, providing security, and mobilizing domestic resources within the community spectrum to improve the PHCs. It engendered a high level of acceptance and ownership of the BHCPF and provided opportunities for grievance redress and quality feedback regarding provider and community health-seeking experiences. Key community stakeholders now advance BHCPF messages through various community-based structures identified during the GBC dialogue sessions. GBC engagement approaches such as THM have great potential to integrate new and existing services and interventions within the health systems and serve as a Community Led Performance and Accountability Mechanism which may ensure community ownership, sustainability, and accountability.