Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria

被引:39
作者
Eboreime, Ejemai Amaize [1 ,2 ]
Abimbola, Seye [2 ,3 ]
Obi, Felix Abrahams [4 ]
Ebirim, Obinna [5 ]
Olubajo, Olalekan [2 ]
Eyles, John [1 ,6 ]
Nxumalo, Nonhlanhla Lynette [1 ]
Mambulu, Faith Nankasa [1 ]
机构
[1] Univ Witwatersrand, Ctr Hlth Policy, Sch Publ Hlth, Johannesburg, South Africa
[2] Natl Primary Healthcare Dev Agcy, Dept Planning Res & Stat, Abuja, Nigeria
[3] Univ Sydney, Sch Publ Hlth, Edward Ford Bldg A27, Sydney, NSW 2006, Australia
[4] Univ Nigeria, Coll Med, Hlth Policy Res Grp, Enugu, Nigeria
[5] Direct Consulting & Logist, Abuja, Nigeria
[6] McMaster Univ, Sch Geog & Earth Sci, Hamilton, ON, Canada
基金
新加坡国家研究基金会;
关键词
Primary healthcare; Implementation fidelity; Decentralization; Nigeria; Health policy; IMPLEMENTATION; PREVENTION;
D O I
10.1186/s12913-017-2179-2
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives. Methods: Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach. Results: Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives. Conclusions: Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.
引用
收藏
页数:13
相关论文
共 35 条
[1]  
Abimbola S, 2015, MHTF BLOG
[2]   How decentralisation influences the retention of primary health care workers in rural Nigeria (vol 8, pg 26616, 2015) [J].
Abimbola, Seye ;
Olanipekun, Titilope ;
Igbokwe, Uchenna ;
Negin, Joel ;
Jan, Stephen ;
Martiniuk, Alexandra ;
Ihebuzor, Nnenna ;
Aina, Muyi .
GLOBAL HEALTH ACTION, 2015, 8 :1-1
[3]   Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low-and middle-income countries [J].
Abimbola, Seye ;
Negin, Joel ;
Jan, Stephen ;
Martiniuk, Alexandra .
HEALTH POLICY AND PLANNING, 2014, 29 :29-39
[4]   The Midwives Service Scheme in Nigeria [J].
Abimbola, Seye ;
Okoli, Ugo ;
Olubajo, Olalekan ;
Abdullahi, Mohammed J. ;
Pate, Muhammad A. .
PLOS MEDICINE, 2012, 9 (05)
[5]  
Aigbiremolen Alphonsus O., 2014, J of Medical and Applied Bioscience, V6, P35
[6]  
[Anonymous], 2012, HLTH POLICY SYSTEMS
[7]  
[Anonymous], 2015, News24
[8]  
[Anonymous], 1984, Policy Analysis for the Real World
[9]  
Asoka T., 2016, AFR HLTH NIGERIA, V38, P47
[10]  
Buse K., 2005, MAKING HLTH POLICY