Chukwuma Julia Ngozi, Obi Felix Abrahams
Economics Discipline, The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom.
Results for Development (R4D), Nigeria Country Office, 2nd Floor, 12 TOS Benson Crescent off Okonjo-Iweala Way, Utako, Abuja, Nigeria.
Health Policy Plan. 2025 Apr 9;40(4):459-470. doi: 10.1093/heapol/czaf007.
This article explores the ideologies, interests, and institutions affecting health policymaking in Nigeria, and the role of the private sector therein. It covers the period from the late-1950s, the years leading up to independence, to 2014, when the country enacted its first-ever law to govern its healthcare system. The National Health Act (NHAct) was adopted after a decade of preparation and civil society-driven advocacy, making the objective of universal health coverage (UHC) explicit. However, in its final version, the NHAct earmarked only a small share of public funds for UHC, solidifying the country's reliance on private healthcare and out-of-pocket payments. To examine the specific set of ideologies, interests, and institutions defining Nigeria's pathway toward UHC and the contribution of the private sector, we adopted the political economy framework, situating the genesis of the 2014 NHAct within the broader political and economic context of Nigeria's health system reform process since the 1950s. Drawing on qualitative data collected during interviews and focus groups, we found that the deep entrenchment of private-sector healthcare in Nigeria is the result of a path-dependent process. This implies that Nigeria's current reliance on the private sector is influenced by historical patterns, competing interests, and institutional practices that have reinforced the role of private actors over time. We identified three major explanatory factors that have shaped health policymaking in Nigeria. First, since the 1980s, the ideology that private healthcare is the solution to an underfunded and underperforming public healthcare system has been reinforced by leading international organizations. Second, private actors in Nigeria have been in a strong position to influence health policymaking since independence. Third, Nigeria's challenging socio-economic context and the limitations of its federal governance structure have fostered a general level of public distrust in the capacity of the public sector to provide quality healthcare.
本文探讨了影响尼日利亚卫生政策制定的意识形态、利益集团和制度，以及私营部门在其中所起的作用。其涵盖的时间段从20世纪50年代末（即独立前的几年）至2014年，这一年该国颁布了首部管理其医疗体系的法律。经过十年的筹备以及民间社会推动的宣传倡导，《国家卫生法案》（NHAct）得以通过，明确了全民健康覆盖（UHC）的目标。然而，在其最终版本中，《国家卫生法案》仅划拨了一小部分公共资金用于全民健康覆盖，巩固了该国对私营医疗保健和自费支付的依赖。为了考察界定尼日利亚全民健康覆盖之路的特定意识形态、利益集团和制度，以及私营部门的贡献，我们采用了政治经济框架，将2014年《国家卫生法案》的起源置于自20世纪50年代以来尼日利亚卫生系统改革进程更广泛的政治和经济背景之中。基于在访谈和焦点小组期间收集的定性数据，我们发现私营部门医疗保健在尼日利亚的深度嵌入是一个路径依赖过程的结果。这意味着尼日利亚目前对私营部门的依赖受到历史模式、相互竞争的利益以及随着时间推移强化了私营行为体作用的制度实践的影响。我们确定了塑造尼日利亚卫生政策制定的三个主要解释性因素。首先，自20世纪80年代以来，主要国际组织强化了私营医疗保健是资金不足和表现不佳的公共医疗体系解决方案的意识形态。其次，自独立以来，尼日利亚的私营行为体一直处于能够影响卫生政策制定的强势地位。第三，尼日利亚具有挑战性的社会经济背景及其联邦治理结构的局限性，引发了公众对公共部门提供优质医疗保健能力的普遍不信任。
