Strengthening the Primary Care Delivery System: A Catalytic Investment Toward Achieving Universal Health Coverage in Nigeria

Distribution of health facilities in Nigeria: Implications and options for Universal Health Coverage

“…For Nigeria to adopt a UHC strategy, another major health system reform is necessary. The current structure where local governments are responsible for primary health facilities, state governments are responsible for secondary health facilities, and the federal government is responsible for tertiary health facilities is not achieving its desired goals . The role of private health facilities that account for 33% of health facilities in the country, a significant proportion of secondary health facilities, attends to a higher proportion of the population and contributing twice the government expenditure on health has only just been given an opportunity for incorporation into the formalized Nigerian government health system in the recently assented National Health Act .…”

“…Nigeria has faced several shortcomings in the management of its health system over decades resulting in repeated reforms of the sector . Unfortunately, these reforms have not significantly impacted the health status of the 184 million residents.…”

“…The Nigerian constitution allocates the responsibility for the provision of primary health care (PHC) services to the local government authorities, secondary health care services to the state government, and tertiary health care services to the federal government . However, the different levels of government have not characteristically stayed within their constitutional responsibilities.…”

“…However, the different levels of government have not characteristically stayed within their constitutional responsibilities. In addition, the responsibility for the provision of the basic health services to the population lies with the local government authorities that characteristically have the weakest governance structure, thereby challenging their ability to deliver on their mandate . The establishment of a Federal Institution, the National Primary Healthcare Development Agency (NPHCDA), in 1992 was designed to help provide support for the weak PHC system in the country but has faced various challenges in carrying out these responsibilities, which has resulted in continued poor performance of the PHCs .…”

The Nigerian health information system policy review of 2014 : the need, content, expectations and progress

“…Governance of the health system in general has been a main problem, especially in a decentralised system as practiced in Nigeria (Eboreime et al., ; Uneke, Ezeoha, Ndukwe, Oyibo, & Onwe, ; Uneke et al., ). The recent drive to ensure Universal Health Coverage needs to be backed by evidence to show areas of progress or gaps in order to redirect investments (Tilley‐Gyado, Filani, Morhason‐Bello, & Adewole, ). A viable RHIS should guide investments in the health system in a country.…”