Department of Pharmacology and Therapeutics, Health Policy Research Group, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria.
Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria Enugu-Campus, Enugu, Nigeria.
Int J Health Plann Manage. 2022 Nov;37(6):3192-3204. doi: 10.1002/hpm.3548. Epub 2022 Aug 17.
Promoting the sub-national ownership of national health initiatives is essential for efforts to achieve national health goals in federal systems where sub-national governments are semi-autonomous. Between 2008 and 2015, Nigerian government implemented a pilot free maternal and child health (MCH) programme in selected states to improve MCH by reducing physical and financial barriers of access to services. This study was conducted to better understand why the programme was neither adopted nor scaled-up by sub-national governments after pilot phase.
We conducted a qualitative evaluation of the programme in Imo and Niger States, with data from programme documents, in-depth interviews (45) and focus group discussions (16) at State and community levels. Data was analysed using manual thematic coding approach.
Our analysis indicates that the programme design had two mutually dependent goals, which were also in tension with one another: 1. To ensure programme performance, the designers sought to shield its implementation from sub-national government politics and bureaucracy; and 2. To gain the buy-in of the same sub-national government politicians and bureaucrats, the designers sought to demonstrate programme performance. The potential for community advocacy for sub-national adoption and scale-up was not considered in the design. Therefore, limited involvement of sub-national governments in the programme design limited sub-national ownership during implementation. And limited oversight of implementation by sub-national government policymakers limited programme performance.
Efforts to promote sub-national ownership of national initiatives in decentralised health systems should prioritise inclusiveness in design, implementation, and oversight, and well-resourced community advocacy to sub-national governments for adoption and scale-up.
在联邦制国家中，为实现国家卫生目标，促进国家卫生倡议在地方层面的拥有权至关重要，因为地方政府在这些国家中具有一定程度的自治权。2008 年至 2015 年期间，尼日利亚政府在选定的州实施了一项试点免费母婴健康（MCH）计划，旨在通过减少获取服务的实际和经济障碍来改善母婴健康。本研究旨在更好地了解该计划在试点阶段结束后，为何既未被地方政府采纳，也未得到推广。
我们对伊莫州和尼日尔州的该计划进行了定性评估，数据来自计划文件、州和社区层面的 45 次深入访谈和 16 次焦点小组讨论。使用手动主题编码方法对数据进行分析。
我们的分析表明，该计划设计有两个相互依赖的目标，这两个目标也相互矛盾：1. 为确保计划绩效，设计者试图将其实施与地方政府政治和官僚主义隔离开来；2. 为获得同样的地方政府政客和官僚的认可，设计者试图展示计划绩效。在设计中没有考虑社区倡导地方采纳和扩大规模的潜力。因此，地方政府对计划设计的有限参与限制了实施过程中的地方所有权。地方政府政策制定者对实施情况的监督有限，限制了计划绩效。
在权力下放的卫生系统中，促进国家倡议在地方层面的拥有权的努力应优先考虑设计、实施和监督的包容性，以及向地方政府提供资源充足的社区倡导，以促进其采纳和扩大规模。
