Table 4

Poor implementation of UHC-relevant policies in Nigeria (summary of participants’ quotes)

SubthemesQuotes
The potential and limitation of the basic healthcare provision fund in accelerating UHC in Nigeria1. ‘The basic health care [Basic healthcare provision fund], if started and if successful, I can assure you that it’s going to be a very remarkable intervention that will help in the provision of the universal health coverage we are targeting. I have never seen any promising intervention like it and we’re praying to see that it succeeds.’ (Subnational-level stakeholder)
2. ‘BHCPF comes in to get more money into the system but also, to use it as a platform for better pooling and particularly pooling for primary health care…’ (Development partner)
3. ‘What has always been the challenge is having the ability to actually implement these various plans and strategies.’ (Federal-level stakeholder)
Limited policy awareness across stakeholder groups4. ‘I’ve never heard about the new [policy maker] talking about UHC, that he is making it a policy agenda. So that’s part of the problem, we need drivers who are driving it. No driver, so you know if there’s no driver within the health sector to drive these things, to get other people on board, create a multisectoral platform, and then you know make it into a movement otherwise we won’t get there.’ (Academic stakeholder)
5. ‘Then the social health insurance scheme too, awareness is just too low. People need to know that we still have to pay for health. Because of the way health has been introduced in the past, [people believe] it has to be free free free free, people don’t seem to know that they have to pay for their health care, for the health care delivery services.’ (Subnational-level stakeholder)
6. ‘Number two is the institutional capacity to implement UHC related policy framework. So, there’s a huge challenge, you have in some ministry, inadequate manpower, very few people that are eligible, working in these areas. When you set up [a] health insurance scheme, to even get [the] right manpower to fill the position is a huge challenge, so, institutional capacity is a very big problem.’ (Development partner)
7. ‘Many times, the people developing our policies are only looking at things from a facility, primary healthcare center perspective. We now need to start looking at the community perspective. We need to look at the people, not just at the services we are providing. We need to take our cultural and religious factors into consideration to make policies. They [Policy developers] do not understand that Nigeria is a complex country. Some of the things that work in Lagos, certainly may not work in Zamfara.’ (CSO)
Limited partner coordination8. ‘…there’s no overall organizing platform and authority, and that’s where we took this bold approach to strengthen the federal ministry of health DPRS [department of planning, research, and statistics] to be coordinator and steward of the sector and to an extent, that has been lacking. It’s causing [a] sort of fragmentation and might undermine things towards UHC.’ (Development partner)
9. ‘We are not able to find or set an agenda for ourselves, you know, using our context-specific data to drive our program intervention so you end up seeing us paddling to whatever is the global agenda or what some really large donor comes and says this is what they want to focus on.’ (Federal-level stakeholder)
  • BHCPF, basic healthcare provision fund; CSO, civil society organisation; UHC, universal health coverage.