Challenges in actual implementation of health policies: a review of payment exemption in Nigeria.

Abstract

Background: As a response to the negative impact of implementation of user fees for health care services, an exemption scheme from payment was developed in many low-income countries including Nigeria with the aim of increasing access to health care services for poor individuals and households. This paper revisits the issue of exemption in Nigeria, the recent interest in implementing such schemes, the challenges that should be kept in view if exemptions have to be implemented, and finally, makes recommendations for improving implementation practices for exemptions.
Methods: We searched two electronic databases - Ovid PUBMED/MEDLINE, and Global Health for relevant articles. This was done by restricting search to papers discussing exemption in West African countries. In addition, we examined gray literature related to the issue of exemption implementation in Nigeria. Data from identified eligible studies were then abstracted into a table and organized based on thematic areas, which have been used to discuss the findings.
Findings: Exemption policies are receiving increased political and social attention especially with the evolving democratic atmosphere in Nigeria. However, the implementation of exemption policies is faced with numerous challenges which lead to a failure of attainment of objectives of such a social policies. These implementation challenges could be political, financial, technical or organizational. The said challenges make exemption policies ineffective, demanding a change in policy implementation practices.
Conclusion: Though exemption policies exist, they are ineffective as several factors pose challenges, which impede implementation of such a desirable policy. We note that exemption systems should give way to more sustainable prepayment financial risk protection systems in the long-run.

Key words: Exemption policy, user-fees, Nigeria