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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.

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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.  



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Innovations for Successful Societies (ISS) is a program of Princeton University's
Woodrow Wilson School of Public and International Affairs 

ISS Monthly Newsletter Archive

October 2019 - Seattle Earthquake Preparedness

September 2019 - Indoneisa Anti-Corruption

August 2019 - Amazon Rainforest

July 2019 - Tirana, Albania

June 2019 - Early Childhood Development Urban95

May 2019- Vietnam Health

April 2019 - Uganda Revenue Authority

February 2019 - Cape Town Water

January 2019 - Ethiopia Health

December 2018 - Ethiopia Tax

November 2018 - Colombia Health

October 2018 - South Africa Health

September 2018 - Rwanda Health, South Bend Smart City

August 2018- Vietnam Tax Chicago Smart City

July 2018 - Nuevo León Police

June 2018 - US Ebola Response

May 2018 - Rwanda Revenue Authority

April 2018 - Indonesia Tax

March 2018 - Human Trafficking

February 2018 - Liberia Payroll US TIGER

January 2018 - US Heirs Property

December 2017- Indonesia Land Agency

November 2017 - India Open Defecation

October 2017: Anti-Corruption Series

September 2017: Rwanda Land, Colombia Coffee

August 2017: Indonesia Corruption , Brazil Soy

July 2017: Tanzania and Australia Land

June 2017: Reforming Procurement Systems in South Africa

May 2017: Tunisia Open Government

April 2017: Liberia Ebola Response

March 2017: Land Administration

February 2017: Brazil Anti Corruption

January 2017: Property Rights & Land Administration

December 2016: Reconciling the Impossible: South Africa's Government of Unity

November 2016: The Ongoing Drive for Sustainable Cattle Ranching in Brazil

October 2016: Managing Tense Elections

September 2016: Indonesia's 2014 Presidential Transition

August 2016: Reforming Brazil's Military

July 2016: Graduates to Government: The President's Young Professionals Program In Liberia

June 2016: Delivering on Presidential Goals in the Dominican Republic

May 2016: Pockets of Effectiveness in Senegal and Indonesia

April 2016: Evaluation in Benin & Croatia Defense Reform

March 2016: Powersharing in Tunisia and Kenya

February 2016: Morocco Water, Tunisia Microfinance

January 2016: Mexico Veracruz and Ghana Presidential Transition

December 2015: Peru and Kenya Judiciaries

November 2015: Protecting Forests, Mitigating Climate Change

October 2015: Open Government Partnership

September 2015: Mexico's Presidential Transition

August 2015 Indonesia Military

July 2015: Kenya 2030 Strategy

June 2015: Calderon's Prexidency in Mexico, Anti Corruption in Luthuania

 May 2015: Bihar India Modernizing Systems to Improve Service Delivery

 April 2015: Two New Case Studies on the Philippines

 March 2015: Monitoring Kosovo's Courts 

 February 2015: Pakistan's Citizen Feedback Monitoring Program

 January 2015: ISS Announces a New Online Course

 January 2015: Reducing Deforestation in the Brazilian Amazon 

December 2014: Lagos State and Vietnam: Promoting Reform at the Local Level 

November 2014: Political Transitions in Chile

October 2014: Tunisian Elections

 September 2014: Strategy Development in Serbia and Estonia

 August 2014: Strategy Development in Malayasia

 July 2014: Effective Reforms in Brazil

June 2014: Public Sector Innovation in Mexico

May 2014: Short-Route Accountability in Afghanistan

April 2014: Elections in India

March 2014: Transforming Citizen Services

February 2014: Short-Route Accountability in Indonesia & the Philippines

January 2014: Anti-Corruption Agencies

December 2013: South Africa's Transition to a Non-Racial Democracy

November 2013: Reform Leaders on Effective and Accountable Civil Service

October 2013: Improving Policy Management and Service Delivery

September 2013: Combatting Corruption and Mediating Election Conflict

 August 2013: Improving Service Delivery and Reducing Election Violence 

July 2013: Increasing Accountability and Efficiency in Civil Service

June 2013: Government Delivery Units

May 2013: Anti-Corruption Commissions

April 2013: Election Reforms in Zambia and other Countries

March 2013: Civil Service Reforms in Brazil

February 2013: Infrastructure Projects, Government Investments and Obstacles

 January 2013: Anti-Corruption Efforts in the Baltics and Nigerian Elections

December 2012: Reforming City Management in Palmero and Johannesburg

November 2012: ISS Marks 100 Case Studies

October 2012: Kenya Open Data and the Rapid Results Approach

September 2012: Cabinet Reform and Anti-Corruption Agencies

August 2012: City Management in Bangalore and Rapid Results in Madagascar

July 2012: Indonesian and Georgian Reforms

June 2012: Revenue Collection in Liberia

May 2012: Center of Government in the Batics

April 2012: Indonesian Accountability and Nigerian Electoral Reform

March 2012: Improving Government Accountability, Leading Reform

Spring 2012 Newsletter

Summer 2012 Newsletter