2016年-世界发展银行全球_Health_System_in_Nigeria___From_Underperformance_to_Measured_Optimism_15页_151kb

Nigeria's Health System: From Underperformance to Measured Optimism

Core Content

Nigeria's health system has historically underperformed, as reflected in its health outcomes and coverage of basic services, despite its economic development. However, there are signs of progress, particularly in the control of diseases such as Guinea worm, poliomyelitis, and Ebola. The document outlines the challenges and opportunities for reforming the health system to achieve Universal Health Coverage (UHC).

Main Viewpoints

1. Historical Context and Underperformance

• Poor Health Outcomes: Nigeria's health outcomes and service coverage lag behind other countries at similar economic levels.
• Systemic Weaknesses: Despite some successes, the health system remains weak due to historical issues such as:
  • Lack of a strong social compact: Government and citizens lack mutual accountability.
  • Entrenched corruption and inefficiency: These undermine public financial management and service delivery.
  • Social determinants: Underperformance in education, agriculture, infrastructure, and environment negatively affects health outcomes.

2. Structural and Policy Challenges

• Federal System Complexity: The concurrent responsibilities among local, state, and federal governments create inefficiencies and dysfunction.
• Weak Institutional Capacity: While Nigeria has well-trained professionals, the institutions fail to institutionalize evidence-based planning and resource allocation.
• Input-Based Financing: The focus on inputs (e.g., number of health centers, health workers, equipment) rather than outcomes has led to poor value for money.

3. Opportunities for Improvement

• National Health Act (2014): Provides a legal foundation for reform, including the establishment of the Basic Health Care Provision Fund.
• Performance-Based Financing: Encouraged by initiatives like the Saving One Million Lives Program, this approach emphasizes results over inputs.
• Private Sector Engagement: The private sector can be leveraged for supply chain and service delivery, improving efficiency and sustainability.

4. Institutional Development

• Nigeria Center for Disease Control (NCDC): Demonstrated effectiveness in combating diseases like Ebola.
• Regional Collaboration: The proposed ECOWAS Center for Disease Control highlights the need for cross-border coordination in public health.
• Public Health Functions: Institutional investments are essential for disease surveillance, epidemic control, and cross-sectoral cooperation.

5. Civil Society and Accountability

• Growing Accountability Movement: Civil society activism and transparency initiatives, such as Nigeria Health Watch and budgiT, are increasing public scrutiny and demand for better governance.
• Social Media Role: The use of platforms to highlight health issues and promote accountability is a positive trend.

Key Information

Current Health Expenditure

• In 2014, Nigeria's total health expenditure per capita was US$118, with 72% from private out-of-pocket payments and 25% from general government expenditure.

Challenges in Health System Governance

• Weak Public Financial Management: Leads to mismanagement and corruption.
• Inefficient Supply Chains: Government-owned medical stores and distribution systems are less effective than private alternatives.
• Policy Implementation Gaps: Despite well-intentioned policies, execution remains weak.

Proposed Reforms

• Strengthening Public Accountability: Requires transparent reporting, public financial management, and local-level performance metrics.
• Institutional Capacity Building: Establishing effective planning, finance, and metrics functions in health ministries.
• Integration of Primary Health Care: The PHC Under One Roof initiative aims to improve service delivery and coordination.
• Coordination of Stakeholders: High-level mapping of stakeholders is needed to align efforts and improve resource allocation.

Conclusion

While Nigeria's health system has faced significant challenges, the document suggests that with informed policy, institutional development, and increased accountability, there is potential for meaningful improvement. The focus on performance-based financing, private sector engagement, and regional collaboration offers a pathway toward achieving UHC and a more equitable health system.