Civil society and accountability: A game-changer for UHC

We explain what these strategies mean and the role of civil society in ensuring their success.

In theory, Nigeria should achieve Universal Health Coverage (UHC) by 2022. There are two main conditions for this. The first is that the country must fully implement the 2018-2022 Second National Strategic Health Development Plan (NSHDP II) as part of the Nigerian health sector’s plan for improving primary health care (PHC) and achieving UHC. The second is that plans should be sufficiently resourced with Nigerian funds instead of relying on donor funding. In order to achieve these two conditions, Nigerians and civil society must hold government and other stakeholders responsible for implementing these plans, to account.

Government Strategies for Universal Health Coverage

On 8 January 2019, Nigeria’s President Muhammadu Buhari launched the NSHDP II and three other documents aimed at achieving UHC;

1. The Third Generation Country Cooperation Strategy
2. The Framework for Reduction of Maternal and Child Mortality in the States
3. The Huwe Operations Manual, which outlines how to put in place the Basic Health Care Provision Fund (BHCPF).

Nigeria’s Health Minister, Professor Isaac Adewole explained that the Health Ministry had prioritised the strengthening of the PHC system to achieve UHC in line with Primary Health Care Under One Roof (PHCUOR).

The NSHDPII provides a policy framework that guides national and sub-national governments on the priorities of the health sector. The Basic Health Care Provision Fund, will pay for the Basic Minimum Package of Health Services, including basic emergency obstetric and newborn care (BEmONC). The fund is made up of 1% of the country’s consolidated revenue fund and distributed to PHC facilities through the National Primary Health Care Development Agency (45%), the National Health Care Insurance Scheme (50%), and the Federal Ministry of Health (5%).

If the strategies are implemented well, Nigeria’s key health indicators should improve substantially, with the following targets:

• A 31% maternal mortality ratio reduction – from 576/100,000 live births to 400/100,000 live births
• A 33% neonatal mortality rate reduction – from 39/1,000 live births to 26/1,000 live births
• A 29% Under-5 mortality rate reduction – from 120/1,000 live births to 85/1,000 live births.

Funding and Accountability

During the launch of the plans, Nigeria’s President Muhammadu Buhari acknowledged the importance of accountability, saying: “I am told that very strict accountability and transparency mechanisms have been put in place to ensure there is no corruption in the use of the funds.”

These plans will only succeed if they are adequately and efficiently funded. Communities, civil society organisations and development partners have an important role to play to ensure funds are released and allocated appropriately to the health sector.  Over the last seven years, Evidence for Action has promoted accountability initiatives by helping to create and put in place state-led accountability mechanisms (SLAMs) in a number of states with funding from international bilateral donor organisations. Currently, the programme supports SLAMs in Lagos, Bauchi and Gombe states, and has supported PHCUOR advocacy in nine states altogether.

The programme is currently gearing up to support the people of Nigeria to achieve the objectives of NSHDP II and BHCPF.

See its recommendations for how civil society and community members can hold government and key stakeholders to account, to ensure these health strategies succeed, on the MamaYe website.