Health Policy Research Group, College of Medicine, University of Nigeria, UNTH Road, Enugu State 400001, Nigeria.
Department of Community Medicine, University of Nigeria Teaching Hospital, P M B 01129, Enugu State, Nigeria.
Health Policy Plan. 2021 Aug 12;36(7):1045-1057. doi: 10.1093/heapol/czab051.
In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff's expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders' recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.
在未来几年，预计约有十几个中等收入国家将因其经济增长而逐步退出卫生发展援助（DAH）。在需要加快实现全民健康覆盖（UHC）的情况下，外部资金的这种预期损失令人担忧。评估国家向国家拥有卫生计划过渡的准备情况是实现全民健康覆盖目标的关键步骤。我们使用深入访谈来探讨：（1）尼日利亚卫生系统向 DAH 过渡的准备情况；（2）尼日利亚现有的过渡政策和战略；（3）实施这些政策的路线图；（4）在推进这些政策方面的挑战和建议。我们将 Vogus 和 Graff 的扩展过渡准备框架应用于尼日利亚背景下，以综合准备计划、差距、挑战和利益相关者的建议，以维持捐助计划的成果并实现全民健康覆盖。已经采取了一些措施，以便根据全民健康覆盖的要求，整合和体制化服务提供流程，实现可持续的免疫接种和响应性初级保健。正在就将艾滋病毒服务与其他服务整合以及将艾滋病毒服务纳入国家健康保险计划（NHIS）的可能性进行讨论。与艾滋病毒方案相比，我们在免疫方案中确定了更多的过渡准备计划。然而，我们发现该框架的所有九个组成部分都存在差距，必须填补这些差距，才能维持成果并在国家所有权和全民健康覆盖方面取得重大进展。尼日利亚需要通过确定系统性差距来专注于建设整个卫生系统，而不是继续投资于并行方案。方案需要在整个卫生系统、卫生筹资重点和政策内加以整合。一个全面和有效的结构将提供连续性，即使在外部资金减少或捐助方退出的情况下也是如此。
