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Country: Nigeria Case: Legislation

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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


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