Exploring the Fundamentals of Health System Governance in Nigeria: an application of the WHO Framework

Abstract

Background:There is need for studies geared at assessing the current state of health systems governance in the WHO African Region, with a view generating strategies for strengthening the governance function. There is a dearth of literature on the governance of the health system in the African Region. This study aimed to assess the level of health system governance (HSG) in Nigeria.
Methods:The main study areas were the Federal Capital Territory Abuja, Enugu and Anambra states of Nigeria. However, data was also collected from respondents from other parts of the country. The methods for the assessment of governance in Nigeria were adopted from the WHO/EMRO Analytical Framework for Assessing Health System Governance. Three data collection tools were developed and pre-tested. These tools were an in-depth interview guide, a questionnaire, and a document review guide.
Results:The key findings were as follows: (i) strategic vision for health and policies exist but people are not generally aware of their implementation; (ii) policies and strategies are not explicitly demand-driven and demand-responsive; (iii) there is sizeable number of people that are ignorant about the legal issues in the health sector; (iv) the general population have poor knowledge about their rights in the health sector; (v) there is limited needs-based resource allocation by the government; (vi) the poor may not be optimally accessing health services; (vii) there is inefficient management of information, finances and human resources leading to sub-optimal coverage of health services; (viii) there is moderate to low level of accountability; (ix) there is good information gathering system and moderate capacity for data analysis but poor information dissemination system; (x) ethics in health sector exists although many people may not be well informed.
Conclusion:The governance of the health system in Nigeria can be improved by the passage of the Health Bill into law by the two chambers of the national assembly, the passage of the Right of Information bill into law and the implementation of existing policies amongst others. Strategies to increase consumer awareness of their rights and improve equity in the delivery of health services should be in place.