🌍 UNIVERSAL HEALTH COVERAGE

From Policy to Community Reality

For more than two decades, the leadership behind Health Access Covenant Foundation has contributed to Nigeria’s Universal Health Coverage (UHC) movement through research, policy engagement, and published work on health financing and reform.

Health Access Covenant Foundation (HACF) now exists to translate Universal Health Coverage from national policy aspiration into structured, community-level implementation.

We align our work with Nigeria’s health sector reform agenda, the mandate of the National Health Insurance Authority, and global UHC principles advanced by the World Health Organization.

Our focus begins in Ekiti State, with the ambition to develop a scalable model for Southwestern Nigeria.

🏥 Who We Are

Health Access Covenant Foundation is a non-partisan, community-centered, non-governmental organisation committed to sustainable reform of Nigeria’s primary healthcare system.  We advance Universal Health Coverage by integrating:

    Neighbourhood embedded primary healthcare clinics

    Structured financial protection mechanisms

    Evidence-informed systems strengthening

    Constructive policy engagement

We believe UHC must function not only at federal policy level, but at neighbourhood level.

💡 Our Core Philosophy

Sustainable Universal Health Coverage can only be achieved when communities are structurally integrated into health financing, service delivery, and accountability systems — not treated as passive beneficiaries of health access.   This ideal is achieved through: 

Health of the people. By the people. For the people.

Communities must be co-financiers, co-governors, and co-accountability partners in their health system.

🎯 Our Vision

To develop an accessible, affordable, evidence-based, culturally appropriate, self-sustaining, and technology-enabled primary healthcare model that contributes meaningfully to the attainment of Universal Health Coverage in Nigeria.

🚀 Our Mission

To establish a cooperative-based primary healthcare network of clinics in Ekiti State that integrates health insurance, ambulatory medical services, and telemedicine — serving as a scalable model for Southwestern Nigeria.

🤝 Community Mutual Health Association Clinics

HACF will establish a network of Community Mutual Health Associations (MHAs) — neighbourhood-based primary healthcare clinics owned and governed cooperatively by their members.

These clinics will operate as structured, walk-in community health centres integrated with health insurance mechanisms.

Members receive access to:

        Annual preventive health assessments

        Primary care consultations

        Essential medicines within approved treatment protocols

        Coordinated referral to specialist care

        Community-based continuing follow-up after hospital discharge

Services will be delivered through structured insurance and cooperative financing systems to ensure continuity and sustainability.

💳 Membership Structure

HACF operates two membership pathways:

1. Open Membership

Entry-level community registration available to all residents in participating neighbourhoods.

Benefits include:

        Initial health assessment

        One medical consultation

        Short-term care coordination support by a Key-Worker

Open Membership enables structured onboarding into the cooperative health system.

2. Insured Membership

Annual prepaid contribution providing defined ambulatory primary healthcare access for one year.

Annual Contribution for 2026 is NGN 22,500 (approximately USD 15) per member.

Benefits include:

        Ongoing primary care access

        Essential medicines within protocol

        Referral coordination

        Liaison with secondary health institutions on behalf of members

        Post-discharge follow-up

Insured Membership operates within cooperative and NHIA-aligned financing structures.

🛡 Subsidy Framework

HACF is committed to ensuring that inability to pay does not exclude vulnerable individuals from structured healthcare access.

We will implement a community-validated, means-tested vulnerability assessment to identify individuals eligible for membership support.

The assessment protocol will ensure:

        Accurate identification of vulnerability

        High Inter-rater reliability of the assessment tool

        Transparency and community oversight

Subsidy allocation will be supervised by elected community governance structures.

Partnerships

We seek partnership with government, philanthropists, and institutional donors to support vulnerable individuals through structured membership sponsorship.

Strategic partnerships

Targeted subsidies for vulnerable households

Our model promotes long-term stability, reduces dependence on episodic outreach funding, and reduces the risk of catastrophic out-of-pocket health expenditures and ensures that grants and palliatives reach deserving individuals.

💼 Sustainability Model

HACF operates a blended financing structure combining:

        Cooperative membership contributions

        Capitation payments through NHIA-aligned insurance mechanisms

        Institutional grants

        Philanthropic support

Critical Mass of Enrollees

Our model of supporting vulnerable people does not involve free indefinite health care but a requirement for everyone to make a pre-payment where cross subsidy will be feasible. This requires that we have a critical mass of enrollees of about 8000 members per Mutual Health Assocition. 

📊 Measuring Impact & Accountability

HACF is committed to measurable, transparent performance reporting.

We will track:

        Enrollment and retention growth

        Primary care service utilization rates

        Financial protection outcomes

        Key health indicators

        Comparative trends with similar non-participating communities

Financial Transparency

Mutual Health Association in each neighbourhood will elect a local management committee responsible for monitoring revenues and expenditures. The committee will use local data to implement service initiatives.

Financial statements will be independently reviewed and made publicly accessible at the association office.

Monitoring & Evaluation

Community Mutual Health Committees will publish periodic performance reports covering:

        Enrollment and retention

        Service access indicators

        Financial performance

        Member satisfaction

Reports will be available to members and institutional partners.

🌱 Contribution to Sustainable Development Goals

A key measure of our progress will be the percentage of residents in participating Ekiti communities enrolled in structured primary healthcare and insurance mechanisms within three years.

Our annual score card will be based on observable milestones and measurable advancement toward Universal Health Coverage in alignment with Sustainable Development Goal 3 of the United Nations.

🏛 Governance and Institutional Integrity

Health Access Covenant Foundation operates under:

        A Board of Trustees

        Medical Advisory Committee overseeing clinical audits

        Community-elected cooperative committees

        Independent financial oversight

        Conflict-of-interest and financial disclosure policies that are in place for         all governance bodies.

We are committed to professionalism, transparency, and constructive engagement with public institutions while advocating for expanded, inclusive health coverage.

In summary

At HACF, we are building a structured, cooperative, community-owned primary healthcare system designed to advance Universal Health Coverage sustainably and at scale. A critical mass of enrollees is required to make each neigbourhood mutual health association successful.

Problem statement (health inequity in Nigeria)

The disparity in health access in Nigeria generally and in Ekiti State in particular is legendary. The burden of care falls largely on families, friends, and well-wishers. 

Health insurance remains unpopular and most Nigerians are uncovered.

HACF intervention logic

Our unique approach is to combine health delivery with health insurance under one roof. Our Mutual Health Associations all over the state requires membership fees to join and uses this membership fees to provide health services for the people.

Sustainability pathway

Our operations are sustained by the contribution of members. We do not believe that healthcare can be completely free of all fees but prepayments in form of membership fees will be required to sustain our organisation.

Monitoring & Evaluation framework

We cover distinct geographical areas and our impact will be measured by the improvement in population health in areas we cover.

Our members and community leaders are integral part of our management system with representatives participating in service delivery as volunteers, in decisions regarding what services to provide and how to provide them and in evaluating the operations of the NGO.