ISS MONTHLY NEWSLETTER

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November 2019

Making Good on a Promise: Boosting Primary Health Care Funding in Nigeria

In the first decade and a half after Nigeria returned to democracy in 1999, the country of nearly 120 million people struggled to adequately fund its primary health-care system. Despite a nearly 10-fold increase in the size of the economy in the previous 15 years, Nigeria was still spending only US$11 per capita on health care in 2014---equal to only 6% of total government expenditure and far below regional norms and the nation's own stated aspiration. As a result, Nigerian citizens were paying 69% of their medical expenses out of pocket, and the cost discouraged many from seeking treatment.

The National Health Act, adopted in 2014 after a decade of delay, raised hopes for a solution by stipulating that at least 1% of the government budget go into a new fund to improve basic services at the thousands of primary health-care clinics located throughout the country. The funds would flow directly to the clinics instead of through intermediate levels of government. And the planned approach included crucial steps that would ensure financial accountability. To demonstrate the viability of the program, Health Minister Isaac Adewole and his team won international backing for a pilot project and built a support coalition that spanned the government and civil society.

The effort took three years, but in 2018, the Nigerian legislature passed an appropriations bill that for the first time included the 1% allocation for the fund, which significantly boosted the resources available to improve the quality and accessibility of primary health-care services across Nigeria. Even more significantly, in September 2019, the government declared the fund a statutory allocation that it would automatically renew every year, and clinics in three states began receiving the new resources in November 2019.

National roll out of the Basic Healthcare Provisions Fund in Osogbo, Nigeria.
Photo credit: This Day Live.

Featured ISS Interviews

In his interview with ISS, Nyimbi Odero explains how the Independent National Electoral Commission (INEC) utilized technology to improve election administration in Nigeria. A technical consultant for INEC, Odero describes the steps he took to improve transparency and increase efficiency and cost effectiveness. He details how INEC redesigned its power system to run on extended lithium ferrous phosphate batteries, took advantage of open course software, and used social media to engage the Nigerian electorate. He also explains how the widespread use of mobile phones helped improve security and information sharing during the electoral process.

In his two interviews with ISS, Bitange Ndemo discusses his experience as the Permanent Secretary of Kenya's Ministry of Information and Communication. Ndemo explains the steps he took to build the infrastructure for open government in Kenya and how he overcame ministerial resistance. Responding to requests from Kenyan youth and entrepreneurs for more access to government data, Ndemo secured presidential support and launched Kenya's open data portal. He describes how he established a legal framework for open data in the government and joined the Open Government Partnership.

ISS MONTHLY NEWSLETTER