1. Country: Nigeria Case: Legislation
Sabin peer review workshop on sustainable immunization financing Abuja, Nigeria April 2016
Country: Nigeria
Case: Legislation

2. The new practice Description:
An Act of the National Assembly (Parliament) that provides dedicated funding for health care delivery including vaccines
What problem does the new practice address?
Inadequate funding for the health sector
How was the problem identified?
Persistent underfunding of health by state and local governments and interventions from the Federal Government
Explain why the problem is important
Underfunding of the health sector means planned interventions to improve health indices cannot be executed
How long has the new practice been underway?
2016
Of particular interest are new practices- new ways to work- in any of the key institutions concerned with immunization financing (ministry of health, ministry of finance, parliament, local government, non-government organization, other institutions)

3. The new practice
Which institution(s) or organization(s) are involved in the new practice?
National Assembly, Federal Ministry of Health, Federal Ministry of Finance, Budget Office, National Primary Health Care Development Agency, NGOs, CBOs, CSO, Academia, State Primary Health Care Development Agencies, LGAs
How does each organization/institution participate?
National Assembly: Appropriation
Federal Ministry of Finance/Budget Office: Budgetary provision and release of funds
Federal Ministry of Health: Coordination
Of particular interest are new practices- new ways to work- in any of the key institutions concerned with immunization financing (ministry of health, ministry of finance, parliament, local government, non-government organization, other institutions)

4. The new practice
How does each organization/institution participate (cont’d)
NPHCDA: Administration, Monitoring and Disbursement of the fund
NHIS: Provision of basic minimum health care package in eligible facilities
State Ministry of Health: Coordination at state level
SPHCDA/LGAs: Implementation
Health facilities: Service provision
NGOs//CSOs/CBOs: Monitoring, citizen’s voice
How often does the activity take place?
Continuously: Administration, service provision, citizen’s voice
Periodic: Monitoring, disbursement, coordination
Of particular interest are new practices- new ways to work- in any of the key institutions concerned with immunization financing (ministry of health, ministry of finance, parliament, local government, non-government organization, other institutions)

5. How it began
Describe the champions in each institution/organization who developed the new activity
First draft of Bill by Change Agents: 2004
Approval by FMOH, TMC, advocacy by HERFON, NCH approval – 2005
Approval by FEC: 2006
Review by Senate:2006
Approval by National Economic Council: 2006
Passage by House of Reps 2007
Senate did not pass Bill
The practice likely began in bottom-up (operational level), top-down (from the boss), collaborative or horizontal fashion (bringing in another organization). Describe the mechanism

6. How it began (cont’d)
Describe the champions in each institution/organization who developed the new activity
Passed by Senate and House of Reps in 2009
Presidential assent withheld 2011
Harmonized Bill passed by both chambers October 2014
Presidential Assent, 31 October, 2014
The practice likely began in bottom-up (operational level), top-down (from the boss), collaborative or horizontal fashion (bringing in another organization). Describe the mechanism

7. How it began (cont’d)
What challenges or difficulties were encountered and what did the champion(s) do to overcome them?
Availability of committed change agents
Extensive stakeholder consultation across all strata of society
Persistence of CSOs in ensuring the Bill became reality
Activists within the NASS to follow up
Involvement of the media: print and electronic
The practice likely began in bottom-up (operational level), top-down (from the boss), collaborative or horizontal fashion (bringing in another organization). Describe the mechanism

8. National spread, implementation yet to commence
Significance
Scale up and spread
National spread, implementation yet to commence
Widespread interest in implementing the Fund
Has the new practice been taken up by other organizations
Implementation yet to commence
Could the practice be adopted in other countries?
Yes
Effectiveness
How has the new practice moved the country closer to the sustainable immunization financing goal?
No data available to confirm
Is the practice sustainable? Why or why not?
Yes. Funding is from annual national budget as statutory provision
Institutionalization is complete when the new practices are fully adopted across the organizational field and become taken-for-granted (Dacin et al 2002).

9. Emerging issues on the NHAct
Underfunding of the implementation processes
Lack of clarity of roles and responsibilities between levels of government
Tendency towards piecemeal implementation rather than full roll out
Weak coordination and harmonization of the implementation process
Waning interest by key stakeholders on implementation
The practice likely began in bottom-up (operational level), top-down (from the boss), collaborative or horizontal fashion (bringing in another organization). Describe the mechanism