HEALTH ACCESS COVENANT
Advancing Universal Health Coverage Through Community-Governed Primary Healthcare
Health Access for everyone, everytime, everywhere
Health Access Covenant (HAC) is a new Nigerian non-governmental organisation established to translate Universal Health Coverage (UHC) from policy aspiration into structured, community-level implementation for Ekiti people.
Building on over two decades of national advocacy and published work on health financing reform, HAC focuses on developing a scalable, cooperative-based primary healthcare model in Ekiti State that integrates health insurance, community medical services, and structured accountability systems.
Our work aligns with the mandate of the National Health Insurance Authority and global UHC principles advanced by the World Health Organization. We borrow ideas from the International Health Cooperative Organisation.
The Problem
Despite national commitment to Universal Health Coverage, many Nigerians remain outside structured health financing systems, thereby creating barriers to Universal Health Coverage part8cularly for residents of Ekiti, a predominantly agro based state. Ekiti people endure:
Low insurance enrollment
Fragmented primary healthcare delivery
High out-of-pocket expenditure
Limited participation in governance and financing mechanisms.
Without structured enrollment and community participation and ownership of health delivery system, UHC remains unachuevable.
Our Solution
HAC is establishing Community Mutual Health Associations (MHAs) — neighborhood-based primary healthcare clinics owned and governed by their members. This primary healthcare based universal health coverage model integrates:
Prepaid annual membership contributions
NHIA-aligned insurance mechanisms
Preventive and ambulatory primary healthcare services
Essential medicines within approved protocols
Coordinated referral pathways
Community-based follow-up Members discharged from hospital
Our model replaces episodic outreach programmes with structured, sustainable access.
Financing Model
HAC operates a blended financing framework combining:
Annual Cooperative membership contributions per insured member
Capitation payments through NHIA mechanisms
Institutional and philanthropic grants
Targeted subsidies for vulnerable individuals
A community-validated, means-tested protocol to identify vulnerable individuals eligible for contribution sponsorship.
This model reduces catastrophic out-of-pocket expenditure by spreading contributions over a critical mass of contributors, while promoting local accountability.
Impact Objectives (First 3 Years)
In the first three years, HAC aims to achieve:
Significant enrollment growth in participating Ekiti communities
Measurable improvement in primary care utilisation
Increased financial protection among members
Demonstrable progress toward Sustainable Development Goal 3 of the United Nations
Where feasible, outcomes will be compared with non-participating communities to assess aany significant impact.
Governance & Accountability
HAC operates under:
A Board of Trustees
Medical advisory oversight with responsibility for Clinical Audits
Community-elected cooperative committees for financial oversight
Independent financial review mechanisms
Periodic impact and financial reports publicly published.
The Investment Opportunity
HAC seeks institutional partners to:
Support initial cooperative clinic establishment
Deploy artificial intelligence in Cooperative Clinics
Subsidise vulnerable individuals pending a critical mass of membership
Strengthen monitoring and evaluation systems
Scale the model across Ekiti State and Southwestern Nigeria.
Our objective is not temporary service delivery, but the development of a replicable, community-governed primary healthcare financing model that advances Universal Health Coverage sustainably and at scale.
Join us today and begin to enjoy primart healthcaew services
Help Ekiti State to achieve universal health coverage by funding our services.
Opportunities exist to pay for Membership fees of named individuals in the community.
WHY UNIVERSAL HEALTH COVERAGE STILL MATTERS
A large proportion of Ekiti people, probably larger than the national figure of 70%, still pay for health care out-of-pocket. There is limited enrollment with National Health Insurance Authority. The out-of-pocket financial burden falls on friends and families. This leads to fragmented access to healthcare that can be prohibitively expensive and out of reach of ordinary people.
Overreliance on vertical programmes
Through Ulerawa, the government of Ekiti has made concerted provision to deliver health care for some groups of vulnerable people. Free ante-natal care, free delivery, free child health services are available.
However these are patchy and are unlikely to achieve Universal Health Coverage, UHC, in the next decade. People's active participation in healthcare financing and health service management and culturally appropriate health delivery organisation, the levers of arraining UHC in Ekiti State, are not part of the process. Whilst the government is doing what it can, government policies only endure until the end of government. An imdependent sustainable financing mechanism will benefit the people.
UHC requires structural community integration — not episodic programmes or geographically limited solutions.
OUR APPROACH (3-PILLAR MODEL)
Our Integrated Model consists of:
🏥 A. Community-Embedded Health Access Clinics
Strengthening primary healthcare within neighbourhoods through cooperative clinics and community governance.
💳 B. Structured Financial Protection
Expanding insurance enrollment using Membership contributions and reducing catastrophic expenditure through NHIA-aligned mechanisms.
📊 C. Systems Strengthening & Policy Engagement
Generating evidence to support constructive dialogue and engagement with the policy makers for sustainable reform.
HOW THE COOPERATIVE MODEL WORKS
The Cooperative system of health financing is used by several countries, spearheaded by International Health Cooperative Organisation and International Cooperztive Alliance, to provide health services for their populations. Although it is culturally appropriate in Nigeria, it has never been used as a mechanism to deliver evidence based health care.
Our Model is designed as the Mutual Health Association running Cooperative Clinics in Neighbourhoods throughout Ekiti State. The processes involved are shown below:
Community Enrollment with Mutual Health Association
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Annual Membership Contribution
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Insurance Integration using prepaid Membership fees
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Primary Health Care Services
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Continuing Liaison with named Hospital Consultant
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Continuous Care in the Community
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Community Governance and Oversight
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Medical Governance of health activities with Clinical Audit
What distinguishes this model from anything else practised in Nigeria are the sustainability of the approach and the people ownership of the system.
MEMBERSHIP
Affordable, membership structured to achieve Access to Primary Healthcare for the populati9n of Ekiti.
Membership Contribution per head (NGN 22,500 per year, approx. USD 15 in 2026), will be user as pre-payment for:
*Preventive annual health assessment
*Access to primary care consultations
*Essential medicines within approved protocols
*Coordinated specialist referral to named consultant
*Community medical follow-up and support upon discharge
ENROL NOW
SUBSIDY & INCLUSION SECTION
Section Title: Protecting the Most Vulnerable
Brief explanation of:
Means-tested subsidy model
Grant and philanthropic partnerships
Equity-driven enrollment
IMPACT PREVIEW
Measurable Progress will be built around the follow8ng parameters:
% Enrollment Growth in Pilot LGAs
Reduction in Out-of-Pocket Spending
PHC Utilization Increase
Community Governance Committees Established
POLICY & ADVOCACY SECTION
Evidence-Informed Policy Engagement
HAC will publish annual Ekiti Health Access Reports, convene stakeholder dialogue, and support data-driven reform aligned with national UHC priorities.
PARTNERS & ALIGNMENT SECTION
We collaborate constructively with public institutions, communities, and development partners to advance sustainable Universal Health Coverage in Nigeria.
CALL TO ACTION SECTION
Large centered message:
Join Us to build Sustainable Universal Health Coverage in Ekiti State.
Become a Member
Sponsor a Member
Partner With HAC
Healthcare for everyone, everywhere, everytime.
According to former Director General of WHO, Universal Health Coverage, UHC, is the greatest concept that Public Health has to offer. It offers ths mechanism to provide healthcare for everyone, every where, every time.
Partnership for progress in health in Ekiti State
PARTNERSHIPS FOR UNIVERSAL HEALTH COVERAGE
Health Access Covenant Foundation, HAC, offers an innovative, culture based solution to achieving UHC, through COOPERATIVE VALUES.
We are seeking partnership with:
Ekiti State Government
Federal Ministry of Health
National Health Insurance Authority
Afe Babalola Unversity, Ado-Ekiti
Community Leaders
