Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
Institute of Public Health, University of Nigeria, Enugu-Campus, Enugu, Nigeria.
Int J Equity Health. 2018 Jul 11;17(1):100. doi: 10.1186/s12939-018-0807-z.
The Nigerian National Health Act proposes a radical shift in health financing in Nigeria through the establishment of a fund - Basic Healthcare Provision Fund, (BHCPF). This Fund is intended to improve the functioning of primary health care in Nigeria. Key stakeholders at national, sub-national and local levels have raised concerns over the management of the BHCPF with respect to the roles of various stakeholders in ensuring accountability for its use, and the readiness of the implementers to manage this fund and achieve its objectives. This study explores the governance and accountability readiness of the different layers of implementation of the Fund; and it contributes to the generation of policy implementation guidelines around governance and accountability for the Fund.
National, state and LGA level respondents were interviewed using a semi structured tool. Respondents were purposively selected to reflect the different layers of implementation of primary health care and the levels of accountability. Different accountability layers and key stakeholders expected to implement the BHCPF are the Federal government (Federal Ministry of Health, NPHCDA, NHIS, Federal Ministry of Finance); the State government (State Ministry of Health, SPHCB, State Ministry of Finance, Ministry of Local Government); the Local government (Local Government Health Authorities); Health facilities (Health workers, Health facility committees (HFC) and External actors (Development partners and donors, CSOs, Community members).
In general, the strategies for accountability encompass planning mechanisms, strong and transparent monitoring and supervision systems, and systematic reporting at different levels of the healthcare system. Non-state actors, particularly communities, must be empowered and engaged as instruments for ensuring external accountability at lower levels of implementation. New accountability strategies such as result-based or performance-based financing could be very valuable.
The key challenges to accountability identified should be addressed and these included trust, transparency and corruption in the health system, political interference at higher levels of government, poor data management, lack of political commitment from the State in relation to release of funds for health activities, poor motivation, mentorship, monitoring and supervision, weak financial management and accountability systems and weak capacity to implement suggested accountability mechanisms due to political interference with accountability structures.
尼日利亚国家卫生法案提议通过建立一个基金——基本医疗保障基金（BHCPF），在尼日利亚的卫生融资方面进行重大改革。该基金旨在改善尼日利亚初级卫生保健的运作。国家、次国家和地方各级的主要利益攸关方对 BHCPF 的管理表示担忧，涉及确保对其使用进行问责的各利益攸关方的作用，以及执行者管理该基金并实现其目标的准备情况。本研究探讨了该基金实施的不同层面的治理和问责准备情况；并有助于围绕该基金的治理和问责制制定政策实施指南。
使用半结构化工具对国家、州和 LGA 各级的受访者进行了访谈。选择受访者以反映初级卫生保健的不同实施层面和问责层次。预计实施 BHCPF 的不同问责层面和主要利益攸关方包括联邦政府（联邦卫生部、国家初级卫生保健发展署、国家卫生保险计划、联邦财政部）；州政府（州卫生部、州初级卫生保健委员会、州财政部、地方政府部）；地方政府（地方政府卫生当局）；卫生设施（卫生工作者、卫生设施委员会（HFC）和外部行为体（发展伙伴和捐助者、民间社会组织、社区成员）。
总的来说，问责制的策略包括规划机制、强大和透明的监测和监督系统，以及医疗保健系统不同层面的系统报告。非国家行为体，特别是社区，必须赋予权力并参与其中，作为确保在较低实施层面进行外部问责的手段。新的问责策略，如基于结果或基于绩效的融资，可能非常有价值。
确定的问责制主要挑战包括卫生系统中的信任、透明度和腐败问题、政府高层的政治干预、数据管理不善、国家在卫生活动资金方面缺乏政治承诺、激励、指导、监测和监督不力、财务管理和问责制系统薄弱、以及由于政治干预问责制结构，实施建议问责机制的能力薄弱。
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