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[afro-nets] Nigeria's health sector reform

Nigeria's health sector reform
Vision, Objectives and Strategic partners

The seed for the current health sector reform underway in Nige-
ria was sowed sometime back in year 2000 in the early days of
President Obasanjo's first term in office. For reasons not en-
tirely clear, the reform could not be initiated during the
president's first term.


The vision for the health sector reform was "to improve the
health status of all Nigerians, and to attain a level of health
care that would permit all Nigerians to live a socially and eco-
nomically productive life." This vision as enunciated in a Draft
Plan of Action 2000-2002 prepared for the UK Department for In-
ternational Development (DFID) identified thirteen (13) reform
objectives for realization as follows:

Objectives of the reform:

Objective 1 - Expand and strengthen primary health care services
throughout the country.
Objective 2 - Eradicate, eliminate and control childhood and
other vaccine preventable diseases through adequate routine im-
munisation activities.
Objective 3 - Integrate and strengthen all disease control ef-
forts and health promotion activities into health care at pri-
mary care level.
Objective 4 ­ Address the demographic problems through the pro-
vision of family and reproductive health services including the
necessary services to reduce the incidence of STD and HIV infec-
Objective 5 - Reduce environmental and occupational health re-
lated morbidity and mortality.
Objective 6 - Rapidly resuscitate and improve the services of
secondary health care to serve as an effective referral for PHC.
Objective 7 - Improve investigative, diagnostic and treatment
capability of tertiary health facilities to serve as an effec-
tive apex referral system to all health facilities in the coun-
Objective 8 ­ Ensure the attainment of the goals and objectives
of the National Drug Policy (NDP), which focuses on self-
reliance in essential drugs, vaccines and biologicals through
local manufacture and an effective drug administration and con-
trol system.
Objective 9 ­ Protect the public from the harmful effects of
fake drugs, unregistered medicines and processed foods.
Objective 10 - Ensure that the support given by donors, NGOs and
UN agencies is provided within the framework of the national
health policy and plans.
Objective 11 - Broaden financing options to expand and improve
access to affordable and adequate health care to a majority of
Objective 12 - Strengthen policy formulation, general manage-
ment, financial management, and planning capacity of the Federal
Ministry of Health and parastatals.
Objective 13 - Strengthen the capacity to develop, implement,
monitor and evaluate evidence-based national health policy,
planning, programmes and activities.

Perhaps to accommodate the interests of new parties to the re-
form, the following set of new objectives has been added:
Objective 14 - Institutionalize managed competition, public-
private partnerships and National Health Accounts.

These fourteen objectives now form the core of Nigeria's 2004-
2007 health sector reform agenda.

Key reform roles were earmarked for the following strategic

A. UK Department for International Development (DFID)

As the 'engineer' of the reform, DFID's roles include among oth-
(i) Institutional strengthening of identified basic health pro-
vider systems like the Christian Health Association of Nigeria
(ii) Support for selected State Health Fund projects (e.g., Be-
nue, Anambra, Ekiti and Osun states: The goal here is to improve
essential health services in target LGAs, hospitals and communi-
(iii) Engagement in Contraceptive Social Marketing for purposes
of increasing knowledge, access and use of modern contraception
for prevention of STDs, HIV/AIDS and unplanned pregnancy, with
major focus on HIV prevention.
(iv) Implementation of strategy for HIV and AIDS prevention,
care and support especially in high risk groups including sur-
veillance, HIV testing, life planning education and counseling.
(v) Support for strengthening of Federal and State health sys-
tems and building capacities to improve health services and out-
(vi) Implementation of rapid impact programmes that will focus
on insecticide treated bednets and immunization.


USAID's roles include assistance and support for child survival
programmes, immunisation and Vitamin A deficiency control, re-
productive health and HIV/AIDS.


The activities of this organization, which already operates
across the country will include ­ provision of basic health ser-
vices, immunisation, safe motherhood, adolescent reproductive
health, MTCT, malaria control, onchoceriasis and guinea-worm
eradication and nutrition programmes.


This agency is to support the Federal, 12 States and their LGAs
in improving quality and access to integrated and sustainable
regional health services, including a focus on adolescent repro-
ductive health.

E. World Bank

The World Bank will have responsibility for crafting a health
systems development programme that will operate in each state
and at federal level and also provide a major loan to support
the Interim Action Plan for HIV control.

Although Professor Eyitayo Lambo, the head reformer and current
Federal Minister of Health characterized the reform as "(Nige-
rian) government-led", "not donor-driven", "but will seek donor
support in implementation"; did someone just ask: "Who truly
owns Nigeria's Health Reform Agenda - the people of Nigeria or
Bilateral and Multilateral organizations?"

Johnson, D.: COUNTRY HEALTH BRIEFING PAPER - Overview of Nige-
ria's Health System and Draft Plan of Action for Health Sector
Reform produced by DFID?s Health Systems Resource Centre for the
UK Department for International Development. October 2000.

A. Odutola
Centre for Health Policy & Strategic Studies
Lagos, Nigeria

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