National

Health Policy 2016

Promoting the Health of Nigerians to Accelerate
Socio-economic Development

Federal Ministry of Health,

September 2016
 NATIONAL HEALTH POLICY 2016
Promoting the Health of Nigerians to Accelerate Socio -economic Development

Federal Ministry of Health

September 2016

i
 Table of Contents

List of Abbreviations& Acronyms .................................................................................................................... v

Acknowledgement ......................................................................................................................................... x
Foreword ...................................................................................................................................................... xi
Executive Summary ..................................................................................................................................... xiii
Chapter 1: INTRODUCTION ............................................................................................................................ 1
1.1 Justification for Developing a New National Health Policy ..................................................................... 1
1.2 The National Context for Health Development ...................................................................................... 1
1.3 The Global Context for Health Development ......................................................................................... 2
1.4 The National Health Policy Development Process.................................................................................. 2
Chapter 2: SITUATION ANALYSIS ................................................................................................................... 4
2.1 Geographic, Political and Demographic Features .................................................................................. 4
2.2 Socio-economic Features .................................................................................................................... 65
2.2.1. Economic Performance ............................................................................................................... 65
2.2.2. Employment/Unemployment ........................................................................................................ 6
2.2.3. Poverty ....................................................................................................................................... 76
2.2.4. Education .................................................................................................................................... 76
2.2.5. Water and Sanitation .................................................................................................................. 87
2.2.6. The Environment......................................................................................................................... 87
2.3 Progress in Nigeria’s Overall Health Status ............................................................................................ 8
2.4 Major Causes of the Disease Burden ................................................................................................. 109
2.5 Nigeria’s Health Systems ..................................................................................................................... 11
2.5.1. Governance and Stewardship ...................................................................................................... 11
2.5.2. Health Services............................................................................................................................ 12
2.5.3. Health Financing ......................................................................................................................... 15
2.5.4. Human Resources for Health (HRH) ............................................................................................. 17
2.5.5. Medicines, Vaccines &Other Health Technologies ....................................................................... 20
2.5.6. Health Infrastructure................................................................................................................... 21
2.5.7. The Health Information System (HIS) ........................................................................................... 22
2.5.8. Health Research and Development ............................................................................................. 23
2.5.9. Health Promotion, Community Ownership, and Participation ...................................................... 24

ii
 2.5.10. Partnerships for Health ............................................................................................................. 25
Chapter 3: VISION, MISSION, GOAL, AND GUIDING PRINCIPLES/VALUES .................................................... 26
3.1 The Vision ........................................................................................................................................... 26
3.2 The Mission ........................................................................................................................................ 26
3.3 The Overall Policy Goal ....................................................................................................................... 26
3.4 Social Values and Guiding Principles.................................................................................................... 26
3.4.1. Social Values ............................................................................................................................... 26
3.4.2. Guiding Principles........................................................................................................................ 27
Chapter 4: POLICY OBJECTIVES AND ORIENTATIONS ................................................................................... 28
4.1 Priority Public Health and Other Health Problems ............................................................................... 28
4.1.1. Reproductive, Maternal, Neonatal, Child and Adolescent Health ................................................. 28
4.1.2. Prevention and Control of Communicable Diseases ..................................................................... 29
4.1.3. Prevention and Control of Non-Communicable Diseases (NCDs).................................................. 32
4.1.4. Public Health Emergency Preparedness and Response ................................................................ 34
4.1.5. Other Health Problems ................................................................................................................ 35
4.1.6. Health-related Problems and Issues ............................................................................................ 37
4.2 Health Systems ................................................................................................................................... 42
4.2.1. Governance and Stewardship ...................................................................................................... 42
4.2.2. Health Service Delivery................................................................................................................ 44
4.2.3. Health Financing ......................................................................................................................... 46
4.2.4. Human Resources for Health ....................................................................................................... 48
4.2.5. Medicines, Vaccines, Other Health Technologies ......................................................................... 49
4.2.6. Health Infrastructure................................................................................................................... 52
4.2.7. Health Information System.......................................................................................................... 53
4.2.8. Health Research and Development ............................................................................................. 54
4.2.9. Community Ownership and Participation .................................................................................... 56
4.2.10. Partnerships for Health ............................................................................................................. 56
Chapter 5: THE IMPLEMENTATION FRAMEWORK ........................................................................................ 58
5.1 General Implementation Requirements .............................................................................................. 58
5.2 Stakeholders’ Roles and Responsibilities for the Implementation of the Policy .................................... 59
5.3 The Legal Framework .......................................................................................................................... 70
5.4 Funding of Policy Implementation ....................................................................................................... 72

iii
Chapter 6: MONITORING & EVALUATION .................................................................................................... 74
6.1 The Monitoring & Evaluation Framework ............................................................................................ 74
6.2 Progress Indicators ............................................................................................................................. 75
6.3 Data Management and Feedback.................................................................................................... 7776
Chapter 7: CONCLUSION .......................................................................................................................... 7876
Appendix 1: List of Documents Consulted in the Process of Developing the National Health Policy 2016 .. 7976

iv
List of Abbreviations& Acronyms

AIDS Acquired Immune Deficiency Syndrome

ATM AIDS, Tuberculosis, Malaria

BOF Budget Office of the Federation

CAP Change Agent Programme

CBO Community-based Organization

CDTI Community Direct Treatment Initiative

ComDT Community Direct Treatment

CARMMA Campaign for Accelerated Reduction of Maternal Mortality in Africa

CHEW Community Health Extension Workers

CHO Community Health Officers

CHPB Community Health Practitioners Board

CIDA Canadian International Development Agency

COIA Commission on Information and Accountability for Women and Children’s Health

CSOs Civil Society Organizations

CPIA Country Policy and Institutional Assessment (of The World Bank)

CSM Cerebro-Spinal Meningitis

DFATD Department of Foreign Affairs, Trade and Development (of Canada)

DfID UK Department for International Development

DHIS District Health Information System

DOTS Directly Observed Therapy Short-Course

DPG Development Partners’ Group

DPs Development Partners

v
DRF Drug Revolving Fund

ELSS Extended Life Saving Skills

EU European Union

FCT Federal Capital Territory

FMF Federal Ministry of Finance

FMOH Federal Ministry of Health

GAVI Global Alliance on Vaccines and Immunization

HDCC Health Data Coordinating Committee

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

HNLSS Harmonized Nigerian Living Standards Survey

HPCC Health Partners’ Coordinating Committee

HPRS Health Planning, Research and Statistics

HRH Human Resources for Health

HSF Health Systems Forum

HSRP Health Sector Reform Programme

ICT Information & Communication Technology

IDA Iron Deficiency Anaemia

IDD Iodine Deficiency Disorder

IEC Information, Education, and Communication

IGME Inter-Agency Group on Mortality Estimates

IPs International Partners

IPT Intermittent Preventive Treatment

IMNCHW Integrated Maternal New-born& Child Health Week

vi
IRB Institutional Review Board

ITN Insecticide Treated Net

IUATLD International Union Against Tuberculosis and Lung Disease

JCHEW Junior Community Health Extension Workers

JICA Japan International Cooperation Agency

LGA Local Government Authority

LGAs Local Government Areas

LIC Low Income Country

LSS Life Saving Skills

M&E Monitoring and Evaluation

MDAs Ministries, Departments, and Agencies

MDCN Medical and Dental Council of Nigeria

MDGs Millennium Development Goals

MICS Multiple Indicator Cluster Survey

MMEIG Maternal Mortality Estimation Inter-Agency Group

MNCH Maternal, New-born, and Child Health

MSS Midwives Services Scheme

NARHS National AIDS &Reproductive Health Survey

NAFDAC National Agency for Food and Drug Administration and Control

NCDs Non-Communicable Diseases

NCH National Council on Health

NDHS National Demographic and Health Survey

NHIS National Health Insurance Scheme

NHP National Heath Profiles

vii
NPHCDA National Primary Health Care Development Agency

NSHDP National Strategic Health Development Plan

OOPE Out-of-Pocket Expenditure

OP Operational Plan

PATHS2 Partnership for Transforming Health Systems-2

PHC Primary Health Care

PHCUOR PHC Under One Roof

PPP Public Private Partnership

SDGs Sustainable Development Goals

SERVICOM Service Compact

SHDP Strategic Health Development Plan

SPHCDA State Primary Health Care Development Agency

SMOH State Ministry of Health

SRH Sexual Reproductive Health

SSHDP State Strategic Health Development Plan

STIs Sexually Transmitted Infections

TA Transformation Agenda

TB Tuberculosis

TBL Tuberculosis and Leprosy

TWG Technical Working Group

VAD Vitamin A Deficiency

VCT Voluntary Counselling and Testing

VPD Vaccine Preventable Disease

VVF Vesico Vaginal Fistula

viii
UNFPA United Nations Population Fund

UN IAEG United Nations Inter-Agency Expert Group

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

WHO World Health Organization

ix
Acknowledgement

This National Health Policy (NHP) has emerged following an elaborate consultative process involving all

stakeholders in health, Federal Government Ministries, Departments and Agencies, the National Assembly,

the State Ministries of Health and the FCT Department of Health Services, Academia, Public Health Experts,

Civil Societies and Development Partners. The Federal Ministry of Health and, indeed, the Federal

Government of Nigeria acknowledges its indebtedness to the representatives of these bodies who provided

comments and inputs during the development of this Policy.

We are especially thankful to Professor Eyitayo Lambo, Chairman of the Technical Working Group (TWG) on

the development of the National Health Policy and the other members of the Group who worked tirelessly in

drafting and revising this Policy until this finished product evolved. The ‘Writers’Team’ which gathered all

inputs from various stakeholders and transformed them intocomprehensible and coherent drafts for further

reviews, and the Secretariat for coordinating the entire process effectively - all deserve special mention and

appreciation.

Sincere appreciation goes to the Honourable Minister of Health, Professor Isaac F. Adewole for his

leadership, and to the Honourable Minister of State for Health, Dr.Osagie Ehanire, the Permanent Secretary,

Dr. Mrs. Amina M. B. Shamaki, mni, for their guidance and commitment to the success of this process.

Finally, sincere appreciation is also extended to all development partners for supporting this process,

particularly DFID (through PATHS-2), UNICEF, UNFPA and WHO for the dedicated technical and financial

support they have provided to the process.

Dr.Ngozi R. C. Azodoh,
Director, Health Planning, Research and Statistics.
April, 2016

x
Foreword

Prior to the development of this National Health Policy document, Nigeria had developed and implemented

two National Health Policies in 1988 and 2004 respectively. Both were developed at critical stages in the

evolutionof the Nigeria Health System and had far-reaching impact on improving the performance of the

System. In between these efforts, there were several attempts to develop a holistic approach to addressing

the challenges of the health sector, including the convening of the National Health Summit (in 1995) which

attempted to do a diagnostics of the Health Sector. The 2016 National Health Policy, however, is coming at a

most opportune time, shortly after the enactment of the first National Health Act 2014 for the country and

at a time when there is global re-commitment to a new development framework, the Sustainable

Development Goals (SDGs), and an increasing global support for the attainment of Universal Health

Coverage (UHC).

Over the last two and a half decades, Nigeria has recorded some progress in the performance of its health

system. Progress includes improvements in key indices for ‘major’ communicable diseases (HIV/AIDS, TB and

Malaria), as well as in maternal and child health. Recently, Nigeria has been able to halt the transmission of

the wild poliovirus, eradicate the guinea-worm disease, and successfully controlled the spread of the deadly

Ebola virus disease. The key lesson from these successes is the need for the country to build a resilient health

system that assures access to basic health care services in a sustainable manner.

The Presidential Summit on Universal Health Coverage, convened in March 2014, reiterated the country’s

commitment to achieving UHC and sustainable health development, through the strengthening of Primary

Health Care and providing access to suitable financial risk protection mechanisms. This commitment is in

addition to other development challenges, including the emergence of a sustainable development goals,

target, health risks posed by health emergencies, emerging and re-emerging epidemic diseases, changes in

the epidemiological transition of Nigerians, as well as developments in the political economy affecting health

xi
including the projecteddownward trend in donor aid and available fiscal space for health. The imperative ofa

legislative framework for health necessitated the development of a new National Health Policy, with a view

to providing the appropriate framework that would enhance the relevance of the document to our national

health efforts and make the goals of our health care system more achievable.

This new Policy, therefore, provides the direction necessary to support the achievement of significant

progress in improving the performance of the Nigerian health system. It also lays emphasis on strengthening

primary health care as the bedrock of our national health system, in addition tothe provision of financial risk

protection to all Nigerians, particularly the poor and most vulnerable groups. These important approaches

are at the heart of the change agenda of this Administration. The Policy also gives the reader useful

information, in the form of concise statements, on important ancillary health –related programmes.

In this Policy, we have taken a deeper look at our stakeholder base and recognized their importance in the

successful implementation of the Policy. It is, therefore, our hope that all state and non-state actors,

including the private sector, will closely collaborate with relevant health authorities atthe Federal, State, and

Local Government levels in the implementation of this Policy, considering the general acceptance that

achieving good health is a collective responsibility.

I, therefore,recommend this policy document to all stakeholders in health and health-related sectors.

Professor Isaac Folorunso Adewole, FAS, FSPSP,DSc (Hons)

Honourable Minister of Health
April, 2016.

xii
Executive Summary

Rationale for the Policy

The National Health Policy and Strategy to Achieve Health for All Nigerians launched in 1988, was Nigeria’s

first comprehensive national health policy. This was subsequently revised in 2004. However, it has become

necessary to develop a new national health policy to reflect new realities and trends, including the

unfinished agenda of the Millennium Development Goals (MDGs), the new Sustainable Development Goals

(SDGs), emerging health issues (especially epidemics), the provisions of theNational Health Act 2014, the

new PHC governance reform of bringing PHC Under One Roof (PHCUOR), and Nigeria’s renewed

commitment to universal health coverage. It has also become imperative to develop strategies to respond

adequately to globalization, climate change, and the challenges of insurgency and its impact on the Nigerian

health system. In addition, the country’s experiences in the implementation of the Revised National Health

Policy 2004 and theNational Strategic Health Development Plan (2010-2015) have provided a basis for the

development of a new National Health Policy. This new health policy comes at an opportune time, following

the passage of the National Health Act 2014. The Act,therefore,provides the legal framework for the new

National Health Policy.

Situational Analysis

The situational analysis undertaken was based on examining the functioning of the Nigerian health system

from the perspectives of the strategic thrusts of the NHSDP and the WHO health system building blocks. The

analysis showed that the Nigerian health system is weak and, hence, underperforming across all building

blocks. Health system governance is weak. There is an almost total absence of financial risk protection and

the health system is largely unresponsive. There is inequity in access to services due to variations in socio-

economic status and geographic location. For instance, 11% of births to uneducated mothers occur in health

facilities while 91% of births to mothers with more than secondary education occurs in health facilities; 86%

xiii
of mothers in urban areas receive ANC from skilled providers, compared to only 48% of mothers in rural

areas; and ANC coverage in the North West is 41% compared to 91% in the South East. Other problems

related to health services include: curative-biasof health services delivered at all levels; inefficiencies in the

production of services; unaffordability of services provided by the private sector to the poor; limited

availability of some services, including VCT, PMTCT and ART; low confidence of consumers in the services

provided, especially in public health facilities;absence of a minimum package of health services; lack of

proper coordination between the public and private sectors; and poor referral systems. However, Nigeria has

recorded some important milestones in recent years, such as the eradication of guinea worm, control of the

Ebola Virus Disease outbreak, and the interruption of Wild Polio Virus transmission in the country.

The Policy Development Process

The process for developing the new National Health Policy(NHP) was initiated by the FMOH through

consensus-building among stakeholders. A Technical Working Group (TWG) comprising some officials of the

FMOH and its Agencies, and representatives of development partners, the private health sector, Civil Society

Organisations (CSOs), the Regulatory Bodies, and Ministries of Health from the States/FCT and the Academia

was constituted. The first meeting of the TWG was held in January 2015 in Calabar to review the 2004 NHP

and progress made with its implementation. Also, emerging health challenges were discussed and a new

health policy theme was proposed. The theme adopted for the NHP 2016 was “Promoting the Health of

Nigerians to Accelerate Socioeconomic Development”. The Calabar meeting ended with the production of a

sub-zero draft of the policy. The second meeting of the TWG in Enugu State in February 2016, resulted in the

development of a standard draft of the policy.

Vision, Mission and Policy Goal

Vision: Universal Health Coverage (UHC) for all Nigerians

xiv
Mission: To provide stakeholders in health with a comprehensive framework for harnessing all resources for

health development towards the achievement of Universal Health Coverage as encapsulated in the National

Health Act 2014, in tandem with the Sustainable Development Goals (SDGs)

Overall Policy Goal: To strengthen Nigeria’s health system, particularly the primary health care sub-system,

to deliver effective, efficient, equitable, accessible, affordable, acceptable and comprehensive health care

services to all Nigerians

Policy Thrusts

There are ten (10) policy thrusts in the policy. They were derived from the NSHDP thrusts and the WHO

health systems building blocks. They are: Governance, Health Service Delivery,Health Financing, Human

Resources for Health, Medicines, Vaccines, Commodities and Health Technologies, Health Infrastructure,

Health Information System, Health Research and Development, Community Ownership/ Participation,and

Partnerships for Health.

Policy Directions

Policy objectives and directions (actions) were developed for the 10 policy thrusts. These are activities to

ensure that the Nigerian health system would be significantly strengthened to improve the health status and

wellbeing of all Nigerians. Many of the actions would require inter-sectoral and multi-sectoral collaborations.

The faithful implementation of the actions should lead to the achievement of the health-related SDGs and

UHC.

Roles and Responsibilities

These have been identified and spelt out for 52 actors that will be involved in the implementation of the

policy (The full list of the 52 actors is provided in sub-section 5.2 of this policy document). The faithful

adherence of the stated roles and responsibilities by all the health system actors will not only mainstream

xv
health in all sectors within the Nigerian economic space, but will also assure adequate resourcing and

achievement of the health-related SDGs, with emphasis on the achievement of UHC in the country.

Policy Implementation, Monitoring and Evaluation (M&E)

The new National Health Policyshall be implemented through the development and implementation of a

series of National Strategic Health Development Plans, each covering a period of 5 years.

A simple M&E framework has been proposed to help track progress in the implementation of the Policy,

compared to 2015 baseline values. Specific indicators for monitoring progress will be fully specified in the

National Strategic Health Development Plans. Governments at all levels and other stakeholders will be

involved in the monitoring and evaluation of the implementation of theNational Health Policy.

Conclusion

It is imperative for the federal, state and local governments to implement the Policy. Hence, it is expected

that all states and LGAs shall adapt the policy to their contexts and develop their corresponding strategic

health development plans for the implementation of the new Policy.

xvi
Chapter 1 INTRODUCTION

1.1 Justification for Developing a New National Health Policy

The National Health Policy and Strategy to Achieve Health for All Nigerians, launchedin 1988, was

Nigeria’sfirst comprehensive national health policy. This was subsequently revised in 2004. However,it has

become necessary to develop a newnational health policy to reflect new realities and trends, including the

unfinished agenda of the Millennium Development Goals (MDGs), the new Sustainable Development Goals

(SDGs), emerging health issues, especially epidemics, the provisions of the National Health Act 2014, the new

PHC governance reform of bringing PHC Under One Roof (PHCUOR), and Nigeria’s renewed commitment to

universal health coverage.It has also become imperative to develop strategies to respond adequately to

globalization, climate change, the challenge of insurgency and its impact on the Nigerian health system.

In addition, the country’s experiences in the implementation of the Revised National Health Policy, 2004 and

the National Strategic Health Development Plan (2010-2015) have provided a basis for the development of a

new National Health Policy.

1.2 The National Context for Health Development

TheNational Health Policy is situated within the national development agenda, including the Vision 20:2020

which articulates Nigeria’s economic growth and development strategies for the period between 2009 and

2020.For the health sector, the Vision 20:2020 proposed to enhance access to quality and affordable health

care through the establishment of at least one general hospital in each of the 774 LGAs1.

TheRevised National Health Policy2004was operationalized through the National Health Sector Reform

Programme(2004-2007) and subsequently through the National Strategic Health Development Plan (2010-

2015) and the annual operational plans. Since then, Nigeria’s desire to offer affordable and accessible health

1
Nigeria Vision 20:2020

1
care services to all Nigerians has led to efforts to revitalize primary health care delivery. This new health

policy comes at an opportune time following the passage of the National Health Act, 2014. The Act,

therefore, provides the legal framework for the new National Health Policy.

1.3 The Global Context for Health Development

Nigeria is a signatory to several global initiatives and agenda on health and development, including the

Millennium Development Goals (MDGs) and the new Sustainable Development Goals (SDGs). The thrust of

the third goal of the SDGs is to ensure healthy lives and promote well-being for all at all ages. This also aligns

with the Nigerian Vision 20:2020 goal.

Human capital development is a sine qua nonfor sustainable economic development, hence Nigeria also buys

into the Rio Political Declaration on Social Determinants of Health(2011) in which governments resolved to

take appropriate action on the social determinants of health in order to create vibrant, inclusive, equitable,

economically productive and healthy societies.

There has been a global commitment to universal health coverage, the principles of Alma Ata, and the

Ouagadougou Declaration on primary health care. The new NationalHealth Policy is meant to guide the

country in the implementation of the above global declarations for the realization of good health and well-

being for all Nigerians.

1.4 The National Health Policy Development Process

The process of developing the new National Health Policy was initiated by the FMOH, through consensus-

building among stakeholders. A Technical Working Group (TWG) comprising some officials of the FMOH and

its Agencies, and representatives of development partners, the private health sector, Civil Society

Organisations (CSOs), the Regulatory Bodies, and Ministries of Health from the States/FCT and the Academia

was constituted. The first meeting of the TWG was held in January 2015 in Calabar to review the 2004

National Health Policy and the progress made with its implementation. Also, emerging health challenges

2
were discussed and a new Health Policy Theme was proposed. The theme adopted for the National Health

Policy 2016 was “Promoting the Health of Nigerians to Accelerate Socioeconomic Development”. The

Calabar meeting ended with the production of a sub-zero draft of the Policy. The second meeting of the TWG

in Enugu State in February 2016,which had six participating states,resulted in the development of the

standard draft of the Policy.

3
Chapter 2 SITUATION ANALYSIS

2.1 Geographic, Political and Demographic Features

Nigeria is located in Western Africa on the Gulf of Guinea and has a total area of 923,768 km2

(356,669 square miles), making it the world's 32nd-largest country. Its territorial borders are defined by the

Republics of Niger and Chad in the north, the Republic of Cameroon in the east, the Republic of Benin in the

west and the Atlantic Ocean in the south. Nigeria lies between latitudes 4°16’ and 13°N53’, and longitudes 2°

and 15°E. The main rivers are the Niger and the Benue, which converge at Lokoja and empty into the Niger

Delta.The climate of Nigeria is tropical, with wet and dry seasons associated with the movement of the Inter-

tropical Convergence Zone,north and south of the Equator.

Nigeria runs a federal political system. It has 36 states, 774 Local Government Areas and the Federal Capital

Territory, with Abuja as the national capital. There are currently no clearly defined roles and responsibilities

with regard to the provision and financing of health among the three tiers of government.

Nigeria is the most populous country in Africa, with a 2014 projected population of 182,867,631 based on a

growth rate of 3.2% per annum.

4
 Females Nigeria2015 Males
100+
95-99
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4

Population (in millions) Age Population (in millions)

Gro
Figure 1: Nigeria Population Structure (Source: United Nations, Department of Economic and Social Affairs, Population Division
(2015). World Population Prospects: The 2015 Revision.)

The population structure is characterized by a predominantly young population, with a median age of 18.2

years. The total dependency ratio is high at 89.2% with, a youth dependency ratio of 84%.

The total fertility rate has dropped slightly from 5.7 live births per 1000 covering age 15-49 years in 2008 to

5.5 in 2013. This may be related to the low contraceptive prevalence which had stayed static from 15% in

2008 and 15.1% in 2013 for all methods of contraception. Considering this low uptake of contraception and a

persistent youth bulge, harnessing Nigeria’s demographic dividend will depend on the extent to which the

scale-up of contraceptives is implemented.

The proportion of the population living in urban areas has increased to 46.9% in 2014,from 34.8% in year

2000,with an urbanization growth rate of 3.75%2. This could result in increased pressure on social amenities

and facilities in cities.

2
United Nations Population Division website. Accessed 8 February 2016

5
2.2 Socio-economic Features

2.2.1. Economic Performance

Nigeria’s GDP grew from NGN 54.6 trillion in 2010 to NGN 80 trillion 3 ($502 billion) in 2013, making Nigeria

the largest economy in Africa. The economy grew at a rate of 4.5 – 5% between 2010 and 2013 and by 6% in

2014. While Nigeria’s economy is still largely dependent on oil revenues, the growth in GDP was driven

largely by growth in the non-oil sectors.

However, with declining oil revenues and ongoing security challenges in the North-East, the gross foreign

and fiscal reserves declined steadily from 2014. The overall economic growth in 2015 was only 2.98%, and

projected to increase to 3.7% in 2016. Current government efforts are aimed at increasing revenues in the

short term, through improving efficiency in government spending, broadening the tax base, and through

borrowing. The economic outlook in Nigeria is optimistic in the medium term, with economic growth

projected to rise to about 5.4% annually, from 2017 to 2019. This is expected to result from investments in

non-oil sectors especially in power, works, and housing4,5 commencing in 2016.

2.2.2. Employment/Unemployment

The labour force population of Nigeria was estimated at 75.9 million in the third quarter of 2015, with an

unemployed population of 20.7 million. The unemployment rate is currently estimated at 9.9%, with an

underemployment rate of 17.4%6. Unemployment is highest in the age group of 15-34 years and higher in

urban than in rural areas. Underemployment, on the other hand, is more prevalent in the rural areas. The

trend analysis indicates an overall increase in unemployment from 5% in 2010 to 9.9% in 2015.

3
GDP at current basic prices. National Bureau of Statistics. GDP Rebasing - final estimates.
4
Federal Government of Nigeria, Budget Speech, 2016.
5
The Nigerian economy: the past, present and the future. NBS 2016.
6 rd
National Bureau of Statistics ‘Unemployment report, 3 Quarter, 2015.

6
 2.2.3. Poverty

Nigeria’s economic growth and diversification have not translated into a significant decline in poverty levels.

Based on the Harmonized Nigeria Living Standards Survey (HNLSS) of 2010, 69% of the population are

estimated to be living below the poverty level, translating to 112.7 million persons. The poverty level varies

widely across the geopolitical zones of the country, with higher levels in the northern parts of the country

compared to the south, and in rural areas compared to urban areas. The South-West has the lowest poverty

rate while the North-West has the highest poverty rate by all poverty measures7.

2.2.4. Education

About half of the women and three-quarters of the men in Nigeria are literate. Literacy is higher among

women and men in urban areas than those in rural areas.

Nearly 4 in 10 women (38%) and 21% of men have never attended school. Only 17% of women and men

have attended primary school. 45% of women and 62% of men have attended secondary school or higher.

Women and men in urban areas are more likely to achieve higher levels of education than those living in

rural areas. Younger women are more likely than older women to have attended school.

Women in urban areas of Nigeria have a median of 10.2 years of schooling, compared to rural women who

have a median of zero years of schooling. Sixty-nine percent (69%) of women in the North-West Zone have

never attended school, compared to 5% of women in the South-South and South-East Zones. Forty-five

percent (45%) of men in the North-East Zone have never been to school, compared to 1% in the South-South

and South-East Zones8.

7
National Bureau of Statistics, Nigerian Poverty Profile, 2010.
8
NDHS 2013. National Population Commission.

7
 2.2.5. Water and Sanitation

Sixty-one percent (61%) of households in Nigeria have access to an improved source of drinking water.

“Improved sources” include: piped water within a dwelling places; public water tapor borehole; a protected

well; spring water; bottled water; and rainwater. The most common source of drinking water is a tube well

or a borehole (37%). A higher proportion of urban households (76%) have access to an improved source of

drinking water, compared to rural households (49%).

Thirty percent (30%) of households have an improved toilet facility not shared with other households, and

25% use a shared facility. Forty-five percent (45%) of households use a non-improved toilet facility. Twenty-

nine percent (29%) of households have no toilet facility; rural households are more likely than urban

households to have no toilet facility (40% versus 16%)9. Households in urban areas have higher access to

improved sanitation than rural areas.

These figures suggest that Nigeria did not meet its MDG target of at least 63% having improved sanitation

facilities and at least 75% of the population having access to improved drinking water by 2015.

2.2.6. The Environment

There has been increasing environmental degradation in Nigeria as a result of both human activity and

natural phenomena. Climate change, with its attendant increased temperatures, intense heat waves, more

extreme rainfall and increased flooding, have the combined potential of intensifying existing challenges of

communicable diseases, food insecurity and poverty, if pro-active action is not taken.

2.3 Progress in Nigeria’s Overall Health Status

Nigeria has recorded progress in some of its health indicators, such as in infant and under-five mortality

rates, while other areas showed slow progress or have worsened over the years.

9
NDHS 2013. National Population Commission.

8
 Table 1: Progress on overarching health indicators in Nigeria

Indicator 2003 2008 2013

“Trends in child mortality(Per 1000 live births)”

Neonatal mortality 48 40 37
Infant mortality 100 75 69
Post neonatal mortality 52 35 31
Child mortality 112 88 64
Under-five mortality 201 157 128
Trends in maternal mortality About 1000/100,000 (WHO/UNICEF) 545/100,000 576/100,000
Source: NDHS 2003, 2008, 2013

The average life expectancy at birth has increased from 46 in 2008 to 52.62 in 2013 10. The Under-5 mortality

rate declined from 201 deaths per 1,000 live births in 2003 to 128 deaths in 2013, a decline of 31 percent,

while the infant mortality rate declined from 100 deaths per 1,000 live births in 2003 to 69 in 2013.At the

current mortality levels, one in every 15 Nigerian children die in their first year, and one in every eight do not

survive to their fifth birthday. The neonatal mortality rate, at 37 deaths per 1,000 live births, has not

declined to the same extent as the infant and under-five mortality rates11.

Twelve percent of women and men are likely to die between the ages of 15 and 50. These probabilities have

decreased since 2008 by 23 percent for women and 27 percent for men. Maternal deaths account for 32

percent of all deaths among women in the age group 15-49. The maternal mortality ratio was 576 maternal

deaths per 100,000 live births for the seven-year period preceding the survey reported in Table 1. The

lifetime risk of maternal death indicates that the death of 1 in 30 women in Nigeria will be related to

pregnancy or childbearing12.

Inequalities in health outcomes also exist between rural and urban areas, between the northern and

southern regions of the country, and across income groups. Childhood mortality rates are higher in rural

areas than in urban areas, and higher in the northern zones than in the southern zones. Also, childhood

mortality is positively correlated with the wealth quintile, as well as with the level of mothers’ education.

10
NDHS 2013. National Population Commission
11
NDHS 2013. National Population Commission.
12
NDHS 2013. National Population Commission

9
Thirty-seven percent of children under age 5 are stunted, 18 percent are wasted, and 29 percent are

underweight. The proportion of stunted children declined from 41 percent in 2008 to 37 percent in 2013.

2.4 Major Causes of the Disease Burden

Nigeria still has a high prevalence of communicable diseases and an increasing burden of non-communicable

diseases.

Communicable diseases account for 66% of the total burden of morbidity.These diseases include malaria,

acute respiratory infections (ARI), measles, diarrhoea, tuberculosis, HIV/AIDs and neglected tropical diseases

(filariasis, onchocerciasis, trachoma, worm infestation, schistosomiasis, leprosy etc.) Although the incidence

of HIV/AIDs is currently on the decline,the absolute number of affected persons still places a huge morbidity

burden on Nigeria’s resources.The emergence of resistant strains of bacteria tends to complicate

intervention efforts, as well as management costs.

Malaria remains an important cause of morbidity and mortality in Nigeria and it accounted for 32 percent of

the global estimate of 655,000 malaria deaths in 2010 (World Health Organization, 2012). An estimated 97

percent of the country’s estimated population of 160 million residents are at risk of malaria. Children under

age 5 and pregnant women are the groups most vulnerable to illness and death from malaria infection in

Nigeria.The outbreaks of epidemic-prone diseases, such as Ebola Virus Disease (EBV), Lassa fever and

Avianinfluenza in recent years, has added to the burden of communicable diseases in the country. While the

surveillance system and response mechanisms have been able to detect and control these outbreaks, there

is still room to strengthen them.The neglected tropical diseases (filariasis, onchocerciasis, trachoma, worm

infestation, schistosomiasis, leprosy etc.) also continue to be a major public health problem.

10
With the continuing epidemiological and demographic transition of the Nigerian population, the burden of

non-communicable diseases remainsa major challenge. Consequently, morbidity and mortality associated

with diseases such as cardiovascular disorders, diabetes mellitus, cancers, and chronic obstructive lung

disease are on the increase. Furthermore, there has been an increase in injuries and disability, mental health

disorders and other psycho-social problems as a result of violenceand social unrest. Malnutrition and

nutrition-related diseases still constitute a formidable public health problem in Nigeria;they remain the

underlying cause of 53% of under-five mortality in the country. Many malnourished children have

irreversible damage, including lower cognitive development, which will result in life-long disadvantage.

Pregnancy and birth-related complications constitute other major drivers of the increasing burden of

diseases. The maternal mortality rate in the country is still high (576/100,000 live births) and the major direct

causes remain severe bleeding, abortion, sepsis, obstructed labour, and hypertension in pregnancy. Although

the childhood mortality indicators, such as infant and under-five mortality rates, have improved, the rates

are still unacceptably high compared to other countries in the region13. The major causes of childhood

mortality include malaria, pneumonia, diarrhoea, HIV/AIDs, and vaccine-preventable diseases―all

complicated by malnutrition.

2.5 Nigeria’s Health Systems

2.5.1. Governance and Stewardship

Nigeria is governed by the provisions of the 1999 Constitution. Unfortunately, it does not lay emphasis on

health and fails to clearly indicate the roles and responsibilities of the three tiers of Government in health

systems management and delivery.The National Health Act 2014 is the first legislative framework for the

13
NDHS2013. National Population Commission

11
health system, though it has not properly addressed the gaps in the Constitution. The country has several

sub-sectoral policies and plans, including the Reproductive Health Policy, the National Human Resources for

Health (HRH)Policy and Plan, the National Health Promotion Policy, the Health Financing Policy,and the

National Strategic Plan of Action for Nutrition, amongst others.

There is an existing framework for the oversight of programme implementation, starting with the National

Council on Health, at the highest level. There are various national coordination platforms, including the

Health Partners Coordinating Committee, chaired by the Minister of Health, the Development Partners

Group for Health, and different thematic technical Groups and Task Teams. However,poor coordination and

harmonization of these groups leads to duplication of functions and waste of scarce resources.

There is lack of transparency in the budgetary process. While the federal budget appropriation is published,

information on the state budget appropriations is not usually publicly available. In addition, budget

execution is also not made public.

Other challenges related to leadership and governance include: inadequate political will and commitment to

health, as evidenced by low budgetary allocation to health; constant change in leadership of the FMOH and

the SMOHs; high level of corruption and fraud; inadequate level of accountability and transparency;

ineffective coordination among the three levels of government,as well as between the private and public

sectors; lack of effective mechanisms for engaging consumers in policy and plan development and

implementation;and weak donor coordination and harmonization of donor aid.

2.5.2. Health Services

In Nigeria, health services are delivered through primary, secondary and tertiary health facilities by both the

public and private sectors. Although primary health care is the fulcrum of the Nigerian health system, the

provision,financing and management of primary health care services, as well as secondary health care

services, leaves much to be desired.

12
The availability of health facilities does not translate into the availability of qualityhealthcare services.

Certain services are not generally available to a large percentage of the population. There is consistent

disruption of health care services, due to incessant industrial action by all cadres of health care providers in

public facilities. Even though the private sector has played a vital role in making health services available,

there is still poor integration of the private sector in the Nigerian health system.

Many health facilities are situated far away from the people, especially in rural and hard-to-reach areas. The

most common barriers to accessing health services by the population are the cost of services, distance to the

health facility, and the attitude of health workers14.

The quality of health services is generally poor and does not instil confidence in the people. This has led to

some people seeking care outside the country, or bypassing the primary and secondary health facilities to

seek health care at tertiary health institutions. Competence in the diagnosis and management of clinical

illnesses is disproportionate, while adherence to clinical guidelines is low15. Even where quality may be high,

the perception of service users may not correlate with the actual quality of care delivered. These may be due

to the poor attitude of health workers, lack of clarity of standards and protocols, as well as inadequate

implementation of these guidelines and other regulations (SDI, 2014). While State Ministries of Health

(SMOH) issue licences to ensure that facilities comply with standards, the monitoring of quality of services

provided by the private sector is limited16. There is no institutional framework for regulating quality and

standards. While the National Health Act2014 provides that health facilities are required to obtain a

certificate of standards, the requirements for this certificate are not specified in the Act. Regulations that

would provide these requirements have also not yet been enacted.

Service coverage is still low, showing little progress in the past ten years. This can be seen in Table2.

14
NDHS2013. National population Commission
15
SDI 2014
16
Nigeria Health systems assessment 2008.

13
Table 2: Coverage Levels of Some Key MNCH Services in Nigeria

Indicator 2003 2008 2013

Percentage of married women aged 15-49 who are currently using 13 15 15
contraceptives (any method)
Antenatal care attendance by skilled provider during pregnancy for 58 58 61
most recent births
Delivery in a health facility 33 35 36
Delivery assisted by skilled provider 35 39 38
Trends in vaccination coverage
BCG 48 50 51
DPT3 21 35 38
Polio 3 29 39 54
Measles 36 41 42
All 13 23 25
None 27 29 21
Source: NDHS 2003, 2008, 2013

There is inequity in access to services due to socio-economic status and geographic location. For instance,

11% of births to uneducated mothers occur in health facilities while 91% of births to mothers with more than

secondary education occurs in health facilities; 86% of mothers in urban areas receive ANC from skilled

providers, compared to only 48% of mothers in rural areas; while antenatal care (ANC) coverage in the North

West is 41%, compared to 91% in the South East.

Nigeria has achieved some significant milestones in recent years with the eradication of guinea worm,

control of the Ebola Virus Disease outbreak and the interruption of Wild Polio Virus (WPV) transmission in

the country. The Federal Ministry of Health is leveraging the platform deployed to achieve these milestones

in strengthening the delivery of health care. Earmarking 5% of the Basic Health Care Provision Fund for

emergency medical treatment is useful in ensuring that all accident victims are attended to.

Other problems related to health services include: curative-skewdness of health services delivered at all

levels; inefficiencies in the production of services; non-provision of a minimum package of health services,

and poor referral systems.

14
 2.5.3. Health Financing

The health financing functions comprise revenue-generation, revenue-pooling and purchasing. At the federal

level, the total allocation from the Federal Budget to health rose from 3.9% to 6% between 2010 and 2012,

but decreased again to 4% in 2013. There is paucity of data on state budgetary allocations to health. Key

health financing for Nigeria compared to the Africa’s regional average are shown in Figures 2-5.17

3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nigeria Regional Average

Figure 2. General Government health expenditure as a proportion of GDP

12
10
8
6
4
2
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nigeria Regional Average

Figure 3. General government expenditure on health (GGHE) as a proportion of general government expenditure (GGE)

17
Global Health Expenditure Database. WHO. http://apps.who.int/nha/database/ViewData/Indicators/en. Accessed 23
Feb 2016.

15
 200

150

100

50

0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nigeria Regional Average

Figure 4. Total health expenditure per capita in US$ exchange rate

There is an opportunity for domestic resource mobilization with regards to increasing the number of private

sector players in health. Overall, out-of-pocket expenditure (OOPE), as a proportion of total health

expenditure, remained high for the same period, ranging from 73.8% in 2006 to 70% in 2009. The high level

in OOPE poses a barrier to accessing health services, thereby fuelling the inequity in health outcomes18.

80
70
60
50
40
30
20
10
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nigeria Regional Average

Figure 5. Out-of-pocket expenditure on health (OOPE) as a proportion of total health expenditure (THE)

Less than 5% of the population is currently covered by any form of prepayment schemes, such as health

insurance. Only Federal Government workers are currently enrolled in social health insurance and civil

servants from most states are yet to be enrolled. Also, the enrolled Federal Government workers have not

begun to pay their employee contributions to health insurance. At the current level and trends of health

financing, Nigeria will not achieve universal health coverage.

18
NDHS 2013. National Population Commission.

16
Benefit packages are fragmented across various schemes and the purchasing of health services is neither

efficient nor strategic. Resource allocation is not based on evidence. Though the National Health Act 2014

has made provisions for a Basic Health Care Fund, accountability is a challenge as there is weak institutional

capacity in public financial management and expenditure tracking at all levels of government.

Meanwhile, the Federal Ministry of Health has commenced the implementation of the recommendation of

experts from the Presidential Declaration on UHC by establishing a central coordination platform in the

FMOH, as well as facilitating reforms in the NHIS.

Health financing challenges include gross under-funding of health, inadequate public health funding, low

external funding, with the little external funding not being in tandem with national priorities, incomplete and

unreliable data on health financing, allocative and technical inefficiencies in health spending, very limited

coverage with risk pooling mechanisms, and poor private sector investments in health.

2.5.4. Human Resources for Health (HRH)

There were 27 accredited medical schools in 2012, 78% of which are in the southern part of the country.

Every year, about 2,300 students graduate from the 27 accredited schools of medicine. In 2012, there were

56 accredited colleges/schools of health technology offering training programmes for Community Health

Extension Workers (CHEWs) and Junior Community Health Extension Worker (JCHEWs), and 14 Community

Health Officer (CHO) training institutions. Only 76 schools of nursing and midwifery were accredited in 2012,

out of the total of 89 nursing schools recorded in 2009. Thus, 13 schools of nursing and midwifery lost

accreditation between 2009 and 2012, due to lack of appropriate infrastructure and under-qualified tutors,

thereby impacting negatively on the country’s ability to produce adequate numbers of health workers in the

17
medium to long term. This also points to a reduction in the quality of training provided to health workers in

the country.

Nigeria has one of the largest stocks of human resources for health in Africa.Table 3 shows the profile for

human resources in Nigeria in 2012.

Table 3: Summary of the Health Workforce Profile for Nigeria, 2012

Registered Health worker cadre Number Population ratio per Sub-Saharan African
100,000 population ratio per
19
100,000
Medical Doctors 65,759 38.9 15
Nurses and Midwives 249,566 148 72
Pharmacists 16,979 10 NA

Community Health Officers (CHOs) 5,986 3.5 NA

Community Health Extension 42,938 25.3 NA

Worker (CHEWs)
Junior Community Health 28,458 16.8 NA
Extension Workers (JCHEWs)
Radiographers 1,286 0.76 NA

Medical Laboratory Scientists 19,225 11.3 NA

Physiotherapists 2,818 1.7 NA

Source: National HRH profile 2013

Impressive as these absolute figures may be, Nigeria still suffers from inadequate numbers of various

categories of health workers. A greater problem is the maldistribution of the existing health workers

between the rural and urban areas and among geo-political regions (Table 4).

Table 4: Disparity in the Distribution of Various Cadres Health Workers among Geopolitical Zones

Health Workers Total North Central North North South South South
Number % East% West% East% South% West%
Doctors 52408 9.73 4.06 8.35 19.59 14.37 43.9
Nurses 128,918 16.4 11.65 13.52 15.29 27.75 15.35
Radiographers 840 14.3 3.66 5.97 15.0 18.3 43

19
WHO, 2006

18
Pharmacists 13,199 19.94 3.8 7.79 11.74 12.39 44
Physiotherapists 1,473 10.8 2.73 8.32 8.58 7.93 62
Medical Lab Scientist 12,703 6.82 1.72 3.6 35.26 23.89 29
Environmental & Pub 4,280 9.39 11.27 18.94 12.36 15.69 32.08
HW
Health Records Officers 1,187 13.34 4.85 11.6 14.64 29.9 26
Dental Technologists 505 14.08 5.92 5.92 12.96 16.62 44.5
Dental Therapists 1,102 13.19 10.29 21.86 10.19 12.99 31.5
Pharmacy Technicians 5,483 6.17 9.12 18 8.58 11.8 46
Source: Professional Regulatory Agencies, 2008

There are at present 14 professional regulatory bodies charged with the responsibility of regulating and

maintaining standards of training and practice for various health professionals in Nigeria. These include, but

are not limited to, the Medical and Dental Council of Nigeria, the Pharmacists Council of Nigeria,the Nursing

& Midwifery Council, the Community Health Practitioners Board, and the Medical Laboratory Science

Council,etc. However, they are limited by weak structures and poor institutional capacities to carry out their

statutory function of effective monitoring of health professionals and the accreditation of training institution

programmes in their areas of jurisdiction.

The Federal Ministry of Health has established a national health workforce registry, although it is not yet

fully functional and the registry’s dataare not regularly updated. Currently, the regulatory bodies maintain

records of the health workers in their jurisdiction, but the records arealso often not up to date and are,

thus,inadequate for planning. The National Health Acthas earmarked 10% of the Basic Health Care Provision

Fund for the development of human resources for primary health care. The Actalso specifies the rights of

health care personnel.

Some of the other major challenges of HRH include: poor management of HRH (including retention,

remuneration, supervisory and logistics support); apoor working environment; limited opportunities for

continuing education;migration to “greener pastures”; professional rivalry; divided/ conflict of interests of

health staff; and frequent strike actions.

19
 2.5.5.Medicines, Vaccines &Other Health Technologies

Nigeria has made appreciable progress in improving her capacity for local manufacturing of medicines and

health commoditiesas four Nigerian pharmaceutical companies have received WHO certification for Good

Manufacturing Practices (GMP). However, this isstill inadequate considering the need and there is still a high

dependence on importation. In addition, the country is unable to make progress in the local production of

active pharmaceutical ingredients. There are no locally manufactured products that are WHO pre-qualified

yet.

The National Agency for Food and Drug Administration and Control (NAFDAC)is the regulatory body

responsible for ensuring the quality of food, drugs and other regulated products which are manufactured,

exported, imported, advertised and used in Nigeria. While NAFDAC has made significant efforts to check the

prevalence of fake and substandard medicines and products, the challenge still exists. To strengthen the

regulatory capacity of NAFDAC, its drug quality control laboratory is being upgraded to achieve WHO pre-

qualification standards.

There are fragmented systems and inefficient processes for the procurement, storage and distribution of

medicines, vaccines, health commodities and technologies, including a reliable “cold chain” for the vaccines.

Other challenges include poor implementation of guidelines, few training opportunities, and a poor pool of

necessary skills for supply-chain management, among providers. These deficiencies often lead to drugs and

other health commodities being frequently out of stock. It is expected that the provision of 20% of the Basic

Health Care Provision Fund for essential drugs will address this gap.

In order to mitigate the above-mentioned challenges, the National Product Supply Chain Management

Programme, under the Department of Food and Drug Services of the FMOH, was set up to coordinate all

activities related to the supply of medicines and other health products of the FMoH. While this programme

20
has made significant progress in streamlining supply management efforts at the national level, more still

needs to be done to strengthen the capacity at state and primary health care levels, leveraging on the recent

ratification of the National Quality Assurance Policy for Medicines and other Health Products (2016) and the

Nigeria Supply Chain Policy for Pharmaceuticals and other Healthcare Products (2016).

There is shortage of biomedical engineers and poor institutional capacity for the maintenance of equipment

and medical devices. Maintenance specifications are often not included, or not followed up, in the

procurement contracts. There are no comprehensive maintenance standards and plans as well as spare parts

and maintenance funds. Other problems related to medicines, vaccines include low spending on

pharmaceuticals, vaccines and proportion of health expenditure, high prices of medicines, and irrational use

of medicines.

2.5.6.Health Infrastructure

As at December 2011, there were 34,173 health facilities across 36 States and the FCT: 30,098 (88%) are

primary health care (PHC) facilities, 3992(12%) are secondary level facilities, while 83 (1%) are tertiary level

facilities. More than 66% of the facilities are public (government) owned20.

Table 5: Number of Health Facilities by Type (2011)

Primary Secondary Tertiary Total

Public 21,808 969 73 22,850

Private 8,290 3,023 10 11,323
Total 30,098 3,992 83 34,173
Source: National Health Facility List, 2011

Physical structures, such as buildings and other physical facilities, such as pipe borne water, good access

roads, electricity and transportation are deficient in most locations. Also, technological equipment meant for

20
National Health Facility List 2011. FMOH

21
hospital use, such as surgical equipment, computers, power generating plants, and consumables are

inadequate. Poor location of healthcare facilities leads to under-utilization of healthcare services.

There is a poorfacility managementand maintenance culture and a lack of standardization for health

infrastructure.Although there is GIS system on health facilities in Nigeria there is urgent need for its

standardization and harmonization.

In order to ensure an optimum quality health infrastructure for primary health care, the National Health

Acthas specified 15% of the Basic Health Care Provision Fund to make available predictable financing

obligations for the provision and maintenance of health infrastructure.

2.5.7. The Health Information System (HIS)

Nigeria developed its national health information policy and strategy in 2014 and has a roadmap to

strengthen the health information system across the country.

There is fragmentation in the data systems, due to the emergence of vertical programmes and their parallel

systems. The FMOH has established its national health management information software (DHIS2) for

routine health information.However, progress in integrating the various versions of the software by disease

programmes and partners is slow. The review and harmonization of the data reporting tools was carried out

in 2013,but the level of compliance and implementation is still low with varying reporting rates across the

states. The overall completion rate of the national DHIS 2 database is just over 60%.

TheIntegrated Disease Surveillance and Response (IDSR) system has been successful in detecting outbreaks,

but the response capacity is still inadequate. There are still challenges with the quality of data, with the use

of various values for selected indicators.

Routine analysis of data and the provision of a timely feedback mechanism areinadequate. As a result,

efforts in data use for policy making are deficient although there has been more success in translating the

22
results of surveys into policy. The quality of data is still sub-optimal, and data quality assessments are neither

regularly nor consistently conducted. There are often large variations in the values of indicators from

different data sources.

Other challenges related to theHealth Information System include: a very weak capacity for the HIS at the

sub-state level in regard to its operation at the LGAs, the provision of facilities, untimely production/

reporting of routine data, inadequate use of available data for planning and decision making, limited

information from the private sector, and little or no operational research activities. Funds allocation by

Federal and State Governments to the health information system is inadequate and unable to meet the

needs. This has made Federal Government unable to take the lead in directing partners on the landscape,

causing more fragmentation.

2.5.8. Health Research and Development

There is a National Health Research Policy and Priorities that has been developed by the FMOH since 2014.

There are research structures, such as research institutes (the Nigeria Institute of Medical Research and the

National Institute for Pharmaceutical Research and Development),as well as training institutions supporting

learning and dissemination of research products in health. However, research is still underfunded in most

institutions.

Currently, the various research institutions and health programmes are left to develop their research

priorities. There is paucity of targeted research studies that address the country’s health policy needs. There

is limited collation, dissemination and use of available evidence from research for decision-making.The

capacity of the FMOH and the State Ministries of Health to promote and lead health research activities is

very weak.

There is a mechanism for the regulation of research whereby NAFDAC regulates clinical trials, in line with the

principles of Good Clinical Practice.The National Health Research Ethics Committee (NHREC), along with

23
identical Committees at state and institutional levels, provide ethical oversight for all health research

studies. The collaboration between NAFDAC and the national NHREC has been successful, so far.The most

recent example of success is the establishment of a Nigeria Clinical Trials Registry. The collaboration has

however been through informal mechanisms, which need to be formalised. Furthermore, the NHREC has not

been able to monitor and provide adequate guidelines to the state and institutional HRECs, due to

underfunding and challenges with its operational structure,especially in regard to the provision of dedicated

professional staff, a formal office space for its operations,and a dedicated budget line.

2.5.9. Health Promotion, Community Ownership and Participation

There are various health promotion units at both federal and state levels. However, they often lack effective

leadership for health promotion. According to the National Health Promotion Policy 2006, there is little

understanding of the concepts of health promotion, consumer rights, the need for multi-sectoral action, and

the promotion of a supportive environment for behavioural changes in health care. In addition, there are

few frameworks and guidelines for systematic planning and management of health education

interventions21.

There is a framework for the development of, and engagement with, community structures, such as Ward

Development Committees, the Village Development Committees, and Health Facility Committees. These

committees are responsible for demand-creation, monitoring of health services, community mobilization,

and participation in programme implementation, among others functions. However, they are often not

empowered and are, therefore, unable to carry out their mandate within the community. Despite the

existence of these structures, communities are not adequately involved in the design and planning of health

interventions and are often not in a position to hold government and service providers accountable.

21
National health promotion policy 2006. Federal Ministry of Health

24
However, where the committees are supported, they have proved to be instrumental in increasing demand

for services22.

2.5.10. Partnerships for Health

Nigeria signed up to the Global Compact of the International Health Partnerships and related initiatives in

2008, and signed up to acomplementary country compact,with its development partners, in 2010.

Nigeria developed a Public-Private-Partnership Policy for Healthin 2005. It was designed to promote and

sustain equity, efficiency, accessibility and quality in health care provision, through a collaborative

relationship between the public and private sectors. The policy is currently under review. Despite this,

private sector engagement remains weak as there are very few incentives for private sector engagement in

health services delivery.However, there are new developments to improve public-private partnerships,

including the provisions of the National Health Act 2014 and the Infrastructure, Concession and Regulatory

Commission.

Although platforms for partnership coordination exist, laxity persists in ensuring donor alignment to national

priorities and programmes.In recent years, there has been an increased effort to include other stakeholders,

such as the private sector and civil society in policy and planning processes for health care delivery. There

has been progress in multi-sectoral collaboration as exemplified by the comprehensive response to

epidemics and disasters andthe HIV programme in Nigeria. However, greater effort is needed to strengthen

this inter-sectoral collaboration, considering that many of the determinants of health outcomes are outside

the health sector.

22
NPHCDA assessment of WDCs

25
Chapter 3 :THE VISION, THE MISSION, THE GOAL AND GUIDING PRINCIPLES/VALUES

3.1 The Vision

Universal Health Coverage (UHC) for all Nigerians

3.2 The Mission

To provide stakeholdersin health with a comprehensive framework for harnessing all resources for health

development towards the achievement of Universal Health Coverage as encapsulated in theNational Health

Act,in tandem with the Sustainable Development Goals (SDGs)

3.3 Overall Policy Goal

To strengthen Nigeria’s Health System,particularly the primary health care sub-system, to deliver quality

effective, efficient, equitable, accessible, affordable, acceptable and comprehensive health care services to

all Nigerians

3.4 Social Values and Guiding Principles

The Nigerian Health Policy will be guided by the principles and values as stated below.

3.4.1. Social Values

 A right to the highest attainable level of health as a fundamental right of every Nigerian,including

access to timely, acceptable and affordable health care of highest quality and international best

practice;

 Maintenance of professional ethics through observance of human dignity, human rights,

confidentiality and cultural sensitivity;

 Shared responsibilities and mutual accountability of both the client and the provider in health

promotion, health-seeking, and service provision;

26
 Gender equity and responsiveness, cultural sensitivity and social accountability to be taken into

account by all actors in the health system;

 Sustained political commitment to health through ensuring adequate resource allocation to health

and commitment to national and international declarations and;

 Equity in access and use of services.

3.4.2. Guiding Principles

 PHC shall be the bedrock of the national health system;

 The attainment of universal health coverage shall be the basic philosophy and strategy for national

health development;

 All health actors shall ensure the provision and use of health services that are gender-sensitive,

evidence-based, responsive, pro- poor and sustainable, with a focus on outcomes;

 Government shall ensure quality health care at all levels;

 Government shall provide policy support and funding and take active measures to involve all

private health care actors and other stakeholders;

 Promotion of inter-sectoral action for health and effective partnerships among all relevant

stakeholders for health development by mainstreaming ‘Health-in-All’policies and;

 Focus on the poor and the vulnerable in all health interventions.

27
Chapter 4 :POLICY OBJECTIVES AND ORIENTATIONS

4.1 Priority Public Health and Other Health Problems

4.1.1. Reproductive, Maternal, Neonatal, Child and Adolescent Health

The Goal

To reduce maternal, neonatal, child and adolescent morbidity and mortality in Nigeria, and promote universal

access to comprehensive sexual and reproductive health services for adolescents and adults throughout their

life cycle

Objectives

 To reduce maternal morbidity and mortality;

 To reduce childhood mortality and ensure optimal growth, protection and development for all new-

bornsand children under-five;

 To promote the healthy growth and development of school-aged children;

 To improve access to adolescent health information and services and;

 To ensure the awareness of, and access to, comprehensive reproductive health services.

Policy Orientation/Initiatives

 Promote the optimal health of the child through implementation of child survival strategies;

 Reduce the risks associated with pregnancy and childbirth through promotion of comprehensive

obstetrics care at all levels;

 Promotethe provision of essential care services for the new-born as well as prevention and

management of babies with other special needs;

 Promote mechanisms to ensure access to quality reproductive health services;

28
  Promote integration ofreproductive, maternal, neonatal and child and adolescent health (RMNCAH)

services and programs along the continuum of care;

 Promote the provision of services that address the needs of school-aged children and;

 Promote the enactment and implementation of legislation for mitigation of harmful cultural

practices including female genital mutilation.

4.1.2. Prevention and Control of Communicable Diseases

The Goal

To significantly reduce the burden of communicable diseases in Nigeria in line with the targets of theThird

Sustainable Development Goal

Objectives

 To foster behavioural change, reduce stigma and improve access to quality care and support

services for persons living with HIV/AIDS

 To promote an integrated approach to control of communicable diseases

 To reduce the malaria burden to pre-elimination levels and bring malaria-related mortality to zero

by 2030

 To improve and sustain routine immunization (RI) coverage of all antigens to 90% by the year 2020

in line with the national vision

 To achieve the eradication of Polio in Nigeria

 To reduce the incidence of vaccine-preventable diseases through appropriate strategies

 To achieve reduction in the tuberculosis prevalence rate and the tuberculosis mortality rate in

Nigeria by ensuring universal access to high-quality, client-centred TB/Leprosy diagnosis and

treatment services

29
  To eliminate neglected tropical diseases, achieve global targets and significantly improve the life

expectancy and quality of life of Nigerians

Policy Orientations/ Initiatives

HIV/AIDS

 Provideuniversal access to comprehensive and quality HIV prevention, treatment, care and support

services through a multi-sectoral approach

 Facilitate multi-sectoral interventions that will ensure an end to AIDS by 2030

 Support effective measures that will ensure that90% of all people living with HIVinfection will know

their status, 90% of all people diagnosed with HIV infection will receive sustained antiretroviral

therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression

Malaria

 Reduce malaria transmission through vector control as part of an Integrated Vector Management

strategy (IVM)

 Ensure prompt parasitological diagnosis and appropriate treatment of clinical cases at all levels and

in all sectors of health care with special attention to management of severe malaria cases

 Reduce the burden of malaria in pregnancy through implementation of prevention and treatment

strategies and ensuring universal availability of IPTp

 Promote the local production of quality artemisinin-based combination therapy (ACT) to make

antimalarial drugs widely affordable

 Improve access to antimalarial commodities and encourage innovation for malaria control and

elimination

30
Tuberculosis and Leprosy

 Implement comprehensive strategies for case notification, management and control of

tuberculosisand leprosy in the general population in line with the global road map

 Increase access to high-quality integrated services for all people co-infected with tuberculosis and

HIV

 Improve access to diagnosis and treatment of multi-drug resistant tuberculosis

 Improve access to diagnosis and treatment of paucibacillary and multibacillary leprosy

Neglected Tropical Diseases

 Strengthenintegrated vector management for targeted neglected tropical diseases

 Strengthen capacity for management and control of targeted neglected tropical diseases at all levels

 Promote research and development for neglected tropical diseases

 Improve coverage of preventive chemotherapy for neglected tropical diseases

Immunization and Vaccine-preventable Diseases

 Promote efforts to further ensure ownership of the immunization program by Governments,

communities, and other stakeholders at all levels

 Promote mutual accountability for routine immunization to ensure that all stakeholders clearly

understand their expected roles and responsibilities in the system, and fully buy into the national

strategy

 Ensure vaccine security for appropriate routine immunization coverage

 Establish standards for injection safety and disposal, cold chain equipment and inventory

requirement for immunization service delivery

 Promote equity inaccess and utilization of services across all communities

 Coordinate and sustain all efforts to ensure the eradication of Polio by 2017

31
 4.1.3. Prevention and Control of Non-Communicable Diseases(NCDs)

T heGoal

To significantly reduce the burden of non-communicable diseases in Nigeria in line with the targets of the

Third Sustainable Development Goal

Objectives

 To integrate the prevention and control of non-communicable diseases into the national strategic health

development plan and into relevant policies across all tiers of government

 To ensure the acquisition of up-to-date evidence on non-communicable diseases in Nigeria

 To reduce the burden of NCDs by engaging agencies and stakeholders that provide services impacting on

the social determinants of health

 To provide an appropriate framework for research on the prevention and control of NCDs

 To strengthen partnerships with stakeholders and development partners

 To monitor and evaluate the progress made at all levels of NCDs prevention and control

Policy Orientations/Initiatives

Overall

 Promote healthy lifestylesacross all levels of the population in Nigeriato address risk factors of non-

communicable diseases

 Integrate NCDs management into primary health care services

 Strengthen the evidence base,including up-to-date evidence on the burden of NCDs in Nigeria,to

inform the appropriate design of programs to address non-communicable diseases

 Implement the provisions of the National Tobacco Control Act 2015

 Promote multi-sectoral collaboration and partnerships for the prevention and control of NCDs

32
Cardiovascular Diseases (CVDs)

 Promote screening for early detection of hypertension, stroke, heart attack and risk factors

 Strengthen capacity for the detection and management of cardiovascular diseases

 Establish centres for rehabilitation of clients with long-term sequelae of CVDs

Diabetes Mellitus

 Promote screening for early detection of diabetes and risk factors

 Build capacity on the detection and management of diabetes mellitus

 Establish rehabilitation centres for management of long-term complications of Diabetes Mellitus

Cancers

 Promote strategies for routine screening and early detection of cancers in relevant age groups

 Strengthen the existing cancer treatment centres for management of patients

 Improve the quality of life of cancer patients and provision of palliative care

 Strengthen the cancer registries across the country

 Develop innovative financing mechanisms for cancer patients

Sickle Cell Disorder(SCDs)

 Institute universal screening and genetic counselling for the general populace

 Strengthen the structures and capabilities for management of SCDs

 Promote research on innovative methods of management of SCDsto improve the quality of life and

life expectancy of people with SCDs

Injuries / Emergencies

 Integrate injury surveillance, detection, management and control into existing national strategies

and plans

 Promote strategies for the prevention and management of occupational injuries

33
  Promote awareness of legislationand build capacity to respond to all forms of violence in Nigeria,

including gender-based violence and violence against children

 Establish trauma carecentres at all levels of care

 Build capacity of health systems in support of injury-prevention and control

 Develop mechanisms to ensure that the provisions of the National Health Act 2014, with regards to

emergency patients care, are fully implemented

 Establish a national emergency ambulance service

4.1.4. Public Health Emergency Preparedness and Response

The Goal

To reduce the burden of public health emergencies

The Objective

To strengthen the national alert and response capacity for public health emergencies, including epidemics,

humanitarian crises and natural disasters

Policy Orientations/ Initiatives

 Develop and maintain the capabilities of stakeholders for regular risk analysis, including vulnerability

and risk assessment

 Develop and implement health emergency and disaster preparedness plans and risk-specific

contingency plans, including pre-positioned emergency medical stocks and supplies

 Implement strategies to mitigate the health impacts of disasters and environmental health issues

 Strengthen health emergency management capacityand emergency coordination mechanisms at all

levels

34
  Strengthen the capacity of the surveillance and response systems in line with the International

Health Regulations (IHR) of 2005

 Upgrade health infrastructure and security systems in public health institutions that handle

biological agents of public health importance

4.1.5. Other Health Problems

4.1.5.1. Mental Health

The Goal

To promote the mental health and wellbeing of all Nigerians

Objectives

 To reduce the burden of mental illnesses and promote the maintenance of sound mental health of

Nigerians in general

Policy Orientation / Initiatives

 Develop and promote measures that will prevent mental illness and maintain sound mental health of

Nigerians in general

 Develop and ensure the provision of standard comprehensive care for sufferers of mental illness and

disorders

 Ensure the implementation of the national mental health policy in general

 Improve public health education and awareness of mental health, mental illness and mental

disorders

 Develop and implement strategies to reduce stigma and eliminate discrimination against persons

with mental illnesses and disorders

 Strengthen participation in, and implementation of, signed regionaland international conventions

that relate to mental health

35
  Strengthen multi-sectoral collaboration for the promotion of sound mental health in Nigeria

 Strengthen the evidence base for mental health in Nigeria

4.1.5.2. Oral Health

The Goal

To achieve optimum oral health for all Nigerians

Objectives

 To ensure effective integration of oral health into existing national health programs

 To reduce the burden of oral health problem and its associated complications among the population

Policy Orientations/ Initiatives

 Promote effective integration of oral health services into primary health care

 Promote awareness of the importance of oral healthamong Nigerians

 Build capacity for the provision of oral health services at all levels

 Promote research in oral health care

4.1.5.3. Eye Health

The Goal

To promote and improve the eye care services for Nigerians

Objectives

 To reduce the burden of eye diseases in the country

 To ensure access to eye health care services to all Nigerians

Orientations/Initiatives

 Integrate eye care services into the existing national health programs

 Build capacity foreye care services delivery at all levels

36
  Improve public awareness of eye health

 Strengthen the evidence base for eye health problems and care

4.1.5.4. Disabilities

The Goal

To ensure attainment of well-being that would enable people living with disabilities (PLWDs) achieve

economically productive lives.

Objectives

 To reduce the burden of disabilities in the country

 To ensure easy access to health services by persons living with disabilities

 To reduce morbidity and mortality and sequel associated with disabilities

 To improve the quality of life for people living with disabilities

Policy Orientation/initiatives

 Integrate disability-related interventions into existing national health programs

 Institute measures to ensure access to health services by persons living with disabilities

 Promote measures to reduce stigma against people living with disabilities

 Strengthen the evidence base on disabilities in Nigeria

4.1.6. Health-related Problems and Issues

4.1.6.1. Nutrition

The Goal

Improve the nutritional status throughout the lifecycle of Nigerians, with a particular focus on

vulnerable groups, especially women of reproductive age and children under five years of age

37
The Objective

Reduce the burden of nutritional disorders among the general population

Policy Orientations/ Initiatives:

 Promote awareness on nutritional disorders

 Strengthen institutional capacity on prevention, management and control of nutritional disorders

 Enhance a multi-sectoral approach to addressing malnutrition and obesity in Nigeria

 Encourage broader private sector engagement to promote innovative delivery of nutrition programs

 Promote the generation of evidence on nutrition status and coverage of nutrition interventions,

including operational research

 Promote and facilitate community participation in nutrition interventions

4.1.6.2. Food Safety

The Goal:

Reduce the burden of food-borne diseases/illnesses among the general population

The Objective:

To significantly improve the food safety structure in the country

Policy Orientations/Initiatives:

 Modernise the Nigerian food safety regulatory framework in line with International best practices

 Minimise the incidence of risks associated with physical, chemical and biological hazards in foods

and water

 Strengthen institutional capacity for food safety

38
  Establish an effective information and communication mechanism for the food safety system.

4.1.6.3. Water and Sanitation

The Goal

Reduce the disease burden resulting from unsafe drinking water and poor sanitation

The Objective

To promote universal access to safe drinking water and acceptable sanitation

Policy Orientations/Initiatives

 Promote the provision of adequate and safe water and appropriate sanitary facilities in urban and

rural areas through multi-sectoral collaboration, public-private partnerships and effective

community engagement

 Develop and implement quality standards for safe potable drinking water

 Develop and implement a national framework for water quality monitoring and surveillance

strategies

 Promote awareness on the risks linked with the consumption of unwholesome water

4.1.6.4. The Environment,Chemical Productsand Medical Waste

The Goal

Ensure proper healthcare waste management and protect human health from environmental and chemical

hazards and the effects of climate change

39
Objectives

 To reduce exposure to chemical hazards and poisons.

 To improve environmental management and manage the health impact of climate change

 To improve the management of medical waste and reduce harm to the population

Policy Orientations/Initiatives

 Promote awareness on the impact of climate change on public health, public education and

preventive options

 Strengthen capacity to enforce environmental and occupational health policies and legislation

 Strengthen capacity for effective health care waste management at all levels of the health system

 Develop and implement guidelines for healthcare waste management at all levels

 Strengthen capacity to appropriately respond to health effects of climate change

 Strengthen collaboration with other relevant government authorities and stakeholders on health

care waste management and interventions to mitigate the impacts of environmental and chemical

hazards and the effects of climate change

 Strengthen the implementation of national guidelines for establishment of poison information

control and management centres in Nigeria

 Establish a national surveillance system for chemical waste

4.1.6.5. Health Promotion

The Goal

To reduce the overall burden of disease through behaviour and lifestyle changes

The Objective

To enable individuals acquire information, knowledge, attitudes and skills as well as change attitudes and

behaviours to facilitate the making of healthy choices

40
Policy Orientations/Initiatives

 Promote awareness on the rights and responsibilities of consumers

 Mobilize the potentials of the mass media for health promotion

 Strengthen partnerships and multi-sectoral collaboration for health promotion

 Strengthen capacity in health promotion, including channelling of resourcesat all levels

 Promote the inclusion of health promotion in school curricula at all levels

 Promote the inclusion of health promotion in workplace health programs

4.1.6.6. Gender Issues

The Goal

To ensure access to gender-sensitive health services irrespective of sexual orientation

Objectives

Tomainstream gender responsiveness in all national health programs

Policy Orientations/Initiatives

 Promote gender mainstreaming in all health policies and plans

 Promote gender education and capacity building, thereby ensuring technical expertise and a positive

gender culture

 Promote the empowerment of women through equitable access to needed health services

4.1.6.7. Medical Tourism

The Goal

 To make Nigeria a preferred regional medical tourist destinationand reverse the current trend for

outward medical tourism

41
Objectives

 To develop world-class medical services in Nigeria, in line with global best practices

 To make healthcare a major contributor to the GDP

Policy Orientations/Initiatives

 Upgrade health infrastructure and technologies in at least one tertiary hospital in each geopolitical

zone

 Supportcapacity development of health personnel on cutting edge health technologies and

procedures

 Provide incentives for private sector investment and foreign direct investment in healthcare services

in Nigeria

 Expand the National Health Insurance Scheme (NHIS) in terms of population as well as service

coverage

 Develop appropriate guidelines for the implementation of the provisions of the National Health Act

2014 on medical tourism

 Institute mechanisms for effective regulation/ accreditation/quality control of Nigerian healthcare

facilities to meet international standards

4.2 Health Systems

4.2.1. Governance and Stewardship

The Goal

To provide effective leadership and an enabling policy environment that ensures adequate oversight and

accountability for the delivery of quality health care and development in the National Health System

42
Objectives

 To effectively use the platform in the health sector for the provision of strategic governance and

oversight

 To provide clear policy orientation for health development

 To facilitate the implementation of legislative and regulatory frameworks for health development,

including the National Health Act 2014

 To strengthen accountability, transparency and responsiveness of the national health system

Policy Orientation/ Initiatives

 Ensure the effective positioning and functioning of the National Council on Health for the provision Formatted: Strikethrough

of strategic oversight and guidance of the health sector

 Develop and implement the national strategic plan for the implementation of the National Health

Policy 2016 with the involvement of all major stakeholders

 Strengthen the coordination of all health stakeholders for the effective implementation of health

programs

 Strengthen the capacity for leadership, management and administration of the health sector

 Establish multi-sectoral collaboration mechanisms to promote synergy and leverage capacity to

address the social determinants of health

 Put mechanisms in place at all levels to enforce compliance with relevant legislation and regulations

 Ensure efficient resource allocation to identified national health priorities Formatted: Strikethrough

 Develop mechanisms for additional resource mobilization for health

 Institute a comprehensive accountability framework that promotes effective monitoring and

evaluation of health sector performance, system audit, a feedback system, due process in

procurement and independent verification

43
  Set up mechanisms that will foster closer working relationships between the Ministries of Health and

the Ministries of Finance at both federal and state levels

4.2.2. Health Service Delivery

The Goal

Provide and ensure access to, and use of, high quality and equitable health care services, especially at the

primary health care level, by all Nigerians

Objectives

 To provide a minimum health care service package for all Nigerians at all levels

 To strengthen governance and accountability of service delivery units to improve the management

of health facilities

 To enhance demand-creation for health care services and health system responsiveness to client

needs

 To strengthen referral systems

 To ensure the provision of adequate and safe blood for appropriate treatment of patients at all times

 To strengthen traditional medicines/care as a component of the national health system and improve

partnership with traditional medicine practitioners in health care delivery

 To ensure timely, accessible, affordable, and reliable laboratory and radiological investigations for

enhancing accurate diagnosis

 To improve the quality of health services and ensure patient safety at all levels of the health system

Policy Orientations/Initiatives

 Ensure availability of required and appropriate health services(preventive, promotive, curative and

rehabilitative) at each level of care, including the community, primary, secondary and tertiary levels

44
  Strengthen the capacity for the management of health service delivery at all levels

 Promote strategies to improve the quality of health care provided to the population

 Strengthen effective implementation of the SERVICOM charter and other strategies for improving

clinical governance

 Facilitate collaboration with private sector and other non-state health care providers to expand

health service coverage

 Develop and implement a robust and integrated referral mechanism systems in both private and

public health care systems and especially in the emergency transport services

 Implement strategies to create demand for health services and educate the population on their

rights in health service delivery

 Promote delivery approaches that respond to the needs of communities

 Develop and implement measures to standardize and integrate traditional medicine practice into the

national health care delivery system

 Strengthen the National Blood Transfusion Service and step up advocacy for voluntary and non-

remunerated blood donation for improved service

 Strengthen and expand the capacity for quality laboratory and radiological services to meet the

demands of the population

 Entrench routine systems for monitoring the quality of service delivery mechanisms at all levels

 Ensure that there is at least one fully functional primary health care centre per Wardand one fully

functional secondary hospital in each Local Government Area

4.2.2.1 Primary Health Care

Primary Health Care shall remain the basic philosophy and central focus for the national health

development. Its overall policy objectives shall be to:

 Design health services which can reach the majority of the people

45
  Prevent and treat the disease problems which are responsible for much morbidity, disability and

mortality

The overall policy directives for primary health care shall include:

 The strengthening of primary health care of management through a unified governance system at

the state and LGA levels

 The promotion of equitable distribution and access to services through the Ward Health System

 The promotion of delivery of a Minimum Health Care Package

 The promotion of community participation in the planning, management, monitoring and evaluation

of the local health system through the committee system (village, ward, development committees

etc.)

 The involvement of health-related sectors in primary health care development

4.2.3. Health Financing

The Goal

Ensure adequate and sustainable funding that will be efficiently and equitably used to provide quality health

services and ensure financial risk protection in access to health services for all Nigerians, particularly the

poor and most vulnerable

Objectives

 To strengthen the institutional environment for sustainable financing and ensure accountability in

the health sector

 To guarantee financial access to a minimum package of health services through mandatory health

insurance for all Nigerians

 To strengthen domestic mobilisation of adequate resources to sustain funding for health

46
  To ensure value for money in purchasing cost-effective services essential for achieving the health-

related SDGs and national priorities

 To bolster health investments for economic growth and development.

Policy Orientations/ Initiatives

 Develop and implement mechanisms for enhancing a more effective communication, collaboration

and working relationships between Ministriesof Health and Ministries of Finance for increased

health funding

 Advocate for increased budgetary allocation to health at all levels

 Facilitate sustainable budgetary provisions for the implementation of the Basic Health Care Provision

Fund as provided for in the National Health Act 2014

 Explore additional sources of domestic resource mobilization, including earmarked taxes on alcohol

and tobacco, an aviation levy, a percentage of VAT, GSM contributions, health bonds, etc.

 Promote the revision of the 1999 NHIS Act to, among other things, make health insurance

mandatory for all Nigerians and make the NHIS a regulatory body and not an implementer

 Streamline and harmonize the various risk pools in health insurance into a single pool at the federal

level and in each state

 Eliminate inefficiencies and improve accountability for health resources

 Promote strategic purchasing mechanisms, including outcome-focused provider payment

mechanisms and focus on high impact, cost-effective interventions

 Provide macro-economic support systems that will provide incentives for the private sector to

significantly invest in health

 Update Nigeria’s National Health Account and its Sub-Accounts and institutionalize routine

expenditure-tracking through annual national and sub-national health accounts estimation and

public expenditure-tracking

47
  Promote the updating and the implementation of a sustainable health care financing policy and

strategies at all levels

 Promote the development and implementation of performance-based financing schemes

 Develop mechanisms that provide evidence of economic returns on health investments

 Develop a national platform for ensuring that evidence drives financial decision-making

 Strengthen the financial management capacity of officials of Ministry of Health

4.2.4. Human Resources for Health

The Goal

To provide appropriate and adequate human resources for healthcare at all levels of the health system

Objectives

 To strengthen the institutional framework for human resources planning, production,

recruitment, distribution, management and practices in the health sector

 To ensure clarity in the roles and responsibilities of actors at all levels on human resources for

health planning, production and management

Policy Orientations/Initiatives

 Strengthen the utilization of evidence-based planning and projection of the HRH, including medium

and long-term planning for health

 Improve the production of human resources for health,including the training of specialised health

worker cadres through the completion and implementation of a national HRH policy and strategic

plan and their adaptation by the state governments

 Foster effective collaboration with the regulatory bodies in both the education and health sectors

 Promote reform onthe performance management systems for all cadres of health workers

48
  Institute measures that promote equitable distribution and retention of human resources for health

at all levels of the health system, including improving the conditions of service especially in rural

settings

 Strengthen the capacity of professional regulatory bodies to ensure compliance with the ethical

standards and norms for health care delivery

 Strengthen the HRH information system

 Develop and implement mechanisms to minimize rivalries between professional health workers and

also minimize industrial unrest (strikes)

 Develop and implement measures to address the post-graduate specialty training challenges in

health care

 Develop and implement measures to reduce the existing “conflict of interest” problem of medical/

health workers

 Ensure the effective and efficient use of 10% of the Basic Health Care Provision Fund for the

development of human resources for primary health care

4.2.5. Medicines, Vaccines, Other Health Technologies

The Goal

To ensure that quality medicines, vaccines, commodities and other technologies are available, affordable

and accessible to all Nigerians

Objectives

 To build and maintain an integrated and effective system at all levels that ensures availability of

good quality medicines, vaccines, health commodities and other technologies at all timesin

accordance with international standards

49
  To establish effective structures that ensure accessibility of medicines, vaccines, commodities and

other technologies at all levels and at all times

 To create an enabling environment that ensure affordability of medicines, vaccines, commodities

and other technologies at all times

 To create appropriate mechanisms/structures that will enable proper regulation, management and

administration of medicines, vaccines, commodities and other technologies

 To develop and facilitate the use of Traditional Medicine in Nigeria in the official healthcare system;

and also harness its economic benefits

Policy Orientation/Goals

 Revise, update and implement the National Drug Policy, the National Essential Medicines List, the

Nigeria Supply Chain Policy for Pharmaceuticals and other Healthcare Products, and the National

Quality Assurance Policy for Medicines and other Health Products

 Promote the local production of high quality medicines, vaccines, therapeutic foods, commodities

and other health technologies

 Facilitate public/private partnerships in the production of medicines and vaccines

 Support more local drug manufacturers to attain the WHO pre-qualification status

 Strengthen existing systems for effective monitoring, surveillance and evaluation in the whole

logistics channelfor health care delivery

 Strengthen relevant regulatory bodies(NAFDAC and SON) to reduce the supply of fake and

substandard medicines, vaccines, commodities and other technologies for health care delivery

50
 Strengthen a unified supply management system for medicines, vaccines, commodities and other

technologies with a functional logistics management information system (LMIS) and leverage

benefits of pooled procurement and economies of scale

 Facilitate adequate expansion/upgrading of all medical stores and cold chain storage facilities at all

levels for the purpose of effective storage and proper distribution of drugs, vaccines and

commodities

 Facilitate proper education of health workers on the rational use of drugs to minimise the incidence

of drugs resistance

 Strengthen the pharmacovigilance processes for early detection and reporting of adverse drug

reactions

 Implement strategies to ensure availability and accessibility of controlled medicines for therapeutic

use

 Implement a Traditional Medicine Policy in order to integrate the practice of traditional medicine

into the healthcare delivery system

 Implement a systematic approach to improve the use of traditional medicines and herbs and support

research on local medicinal plants for priority diseases

 Ensure the appropriation and use of the 20% allocation from the Basic Health Care Provision Fund

for the provision of essential drugs, vaccines and consumables

51
 4.2.6. Health Infrastructure

The Goal

To have an adequate and a well distributed network of health care infrastructure that meets quality and

safety standards

Objectives

 To improve availability and distribution of functional health facilities across the country to ensure

equitable access to health services, especially in underserved areas

 To ensurecompliance with quality standards and requirements for facilities and biomedical

equipment

 To ensure effective maintenance of health equipment and infrastructure at all levels

Policy Orientations/ Initiatives

 Ensure the efficientutilization of the 15% allocation from the Basic Health Care Provision Fund for

the maintenance of health infrastructure, equipment and transport for eligible primary care

facilities, in line with the National Health Act 2014

 Promote adherence to all quality requirements and standards for equipment and safety for all the

various categories of health facilities

 Strengthen the implementation of the issuance of,and compliance with, the Certificate of Standards

in line with the National Health Act 2014

 Ensure the classification of health establishments according to the National Health Act 2014 to

guarantee efficiency and equitable access to health services

 Promote multi-sectoral and public-private partnership for infrastructural development and

maintenance

52
  Resuscitate and strengthen schools of biomedical engineering to produce the required personnel

and to manage and maintain medical equipment

 Integrate the principles of service contracts and technology transfer/training/maintenance

agreements as part of the contracting conditions for the purchase of equipment and complex

medical services

4.2.7. Health Information System

The Goal

To institutionalize an integrated and sustainable health information system for decision-making at all levels

in Nigeria

Objectives

 To provide timely reliable and accurate data that will inform policy making, evidence-based decisions

and resource allocation for improved health care at all levels

 To develop and strengthen the national e-health system

Policy Orientations/Initiatives

 Ensure adequate resource allocation (finance, human resources and logistics support) for health

information system at all levels

 Strengthen mechanisms to ensure accuracy, timeliness and completeness of health data-reporting

from both public and private health facilities

 Build capacity on routine data-collection, analysis and interpretation for decision making

 Strengthen coordination mechanisms and platforms for effective collaboration, harmonization and

integration of data-collection, reporting and management systems of both state and non-state

actors to ensure adequate and complete information for decision making in health care delivery

53
  Strengthen mechanisms for translating health evidence into policy, decision making and resource

allocation

 Collaborate with relevant agencies to strengthen civil registration and vital statistics systems

 Strengthen and integrate existing surveillance systemsand registries into the overall health

information system

 Strengthen data infrastructure,including ICT infrastructure at all levels

 Strengthen mechanisms to ensure data protection, confidentiality and security, in line with the

provisions of the National Health Act 2014

 Establish a national health observatory for appropriate knowledge management

 Develop and implement mechanisms to ensure collaboration, harmonisation and integration of data-

collection, analysis, storage and dissemination of activities of state and non-state actors to ensure

adequate and complete information for decision making in the health sector

 Strengthen the mechanisms to ensure accuracy, timeliness, and completeness of health information

from the general population and from health facilities

4.2.8. Health Research and Development

The Goal

To have robust research and development systems at all levels that generate reliable health data that is

responsive to the decision making needs of the health system

Objectives

 To provide a coordination and regulatory framework for health research and development by all

relevant stakeholders,in line with the National Health Act 2014

 To advocate and solicit for mobilization of adequate funding for health research and

development,including the establishment of a National Health Research and Innovation Fund

54
  To establish a framework for the effective utilisation of research findings for evidence-based decision

making

Policy Orientations/Initiatives

 Ensure the implementation of the National Health Research Policy and Priorities 2014

 Facilitate the development and operationalization of a national research agenda, including

basic/translational research and product development, as well as health systems/policy

implementation research

 Facilitate adequate resource allocation for research and surveys at all levels, in line with agreed

International Declarations especially the Algiers Declaration on Health Research1

 Strengthen the national health research institutes (the National Institute of Medical Research and

the National Institute of Pharmaceutical Research and Development) to contribute to evidence-

based decision making

 Build professional and institutional capacity for health research and development at all levels

 Establish new and strengthen existinginstitutions and systems for the promotion, regulation and

ethical oversight of essential national health research

 Facilitatea mechanism for the collation and archiving of health-related research findings for

improved knowledge management

 Promotethe process of translating research findings into policies, strategies, practice and utilization

 Strengthen the Department of HealthPlanning, Research and Statistics at the Federal and State levels

in regards to their research functions to commission and harness research findings for decision

making in health.

55
 4.2.9. Community Participation and Ownership

The Goal

 To strengthen and sustain active community participation and ownership in health planning,

implementation, monitoring and evaluation

Objectives

 To empower communities for active participation in planning, monitoring and evaluation and
decision making for effective implementation of the health policy.

 To strengthen communities on the use of M&E reports for resource mobilization and
utilization for improved health outcomes.

 To strengthen effective community systems on the use of M&E to reflect gender and cultural
issues for improved health outcomes.
Policy Orientations /Initiatives

 Strengthen systems for effective community health promotion

 Strengthen the functionality of the community health systems,such as ward development

committees, village development committees, health facility management committees,etc., across

the country

 Institute community dialogue through effective use of the information, education and

communication (IEC) methodology, especially in local languages

 Establish mechanisms for ensuring community participation in decision making at all levels

4.2.10. Partnerships for Health

The Goal

 To promote effective partnerships among the public, and private sectors and other stakeholders for

optimum resourcemobilization and usetowards universal health coverage for all Nigerians

56
Objectives

 To identify areas of need for collaboration and partnerships among actors in the health system

 To promote partnerships for the purpose of supporting capacity building, innovation and

sustainability in health financing, provisioning, utilization and quality assurance and improvement

 To ensure that formal, systematic and innovative mechanisms are developed and used, involving all

public and non-state actors in the development and sustenance of the health sector

 To promote both inter and intra-sectoral collaboration in the health sector

Policy Orientations/Initiatives

 Facilitate effective intra and inter-sectoral partnership and collaboration at all levels for the

implementation of priority health programs, in line with the provisions of the National Health Act

2014

 Promote Public-Private Partnership in health development by revising and implementing the existing

policy on public-private partnership in health and the corresponding strategic plan

 Establish partnerships with community, faith-based institutions, and traditional medicine

practitioners for improved healthcare service delivery

 Strengthen collaboration with development partners for effective healthcaredelivery

57
Chapter 5 : IMPLEMENTATION FRAMEWORK

5.1 General Implementation Requirements

a. Dissemination of the Policy

i. The Federal Ministry of Health shall ensure widespread dissemination of thisPolicy and

other related instruments, through various relevant channels

b. State-level Adaptation

i. All states shall be encouraged to adapt and disseminate thisPolicy

ii. Reports on progress in adaptation shall be submitted to the Federal Ministry of Health

and presented to the National Council on Health

iii. State governments shall strengthen the local governments to function for effective

provision of primary health care

c. Strategic Plans

i. The Federal Ministry of Health shall develop a National Strategic Health Development

Plan, in line with the National Health Policy 2016

ii. Annual and mid-term reviews of the implementation of the Strategic Plan shall be

undertaken by FMOH and all stakeholders with reports presented to the National

Council on Health andthis will be followed by dissemination

d. Medium-term Expenditure Framework

e. The Federal Ministry of Health shall interact regularly with Federal Ministry of Finance and

Federal Ministry of Budget and National Planning on the development of the Medium Term

Expenditure Framework (or other alternative medium-term instruments)Operational Plans

58
 i. The Federal Ministry of Health, the State Ministries of Health,and the LGA Departments

of Health shall develop operational plans, based on the Strategic Plan on an annual basis

ii. Reviews of the implementation of the Policy’s annual operational plansshall be

institutionalized at all levels and the reports widely disseminated

5.2 Stakeholders’ Roles and Responsibilities for the Implementation of the

Policy
S/N Stakeholders Roles and responsibilities
1. The Office of the  Shall ensure that all public sector Ministries, Departments and Agencies
President
(MDAs) and the private sector faithfully implement the provisions of the

National Health Policy

 Shall establish a presidential health multi-sectoral collaborative platform

for implementing ‘Health-in–All’ policiesfor achievement of the health-

related SDG targets

 Shall establish and implement a framework for achieving the SDGs in

Nigeria, with adequate provision of funding for achieving the health-

related SDG targets

 Shall ensure that relevantaspects of the National Health Policy are

reflected in the revised Nigerian constitution (e.g., clear definition of

roles and responsibilities of the various government levels in the

provision and financing of health services in Nigeria)

2 The Office of the  Shall ensure the careful implementation of the National Health Policy
Minister of Health
 Shall ensure that all states and LGAs adopt and adapt the National Health

Policy to suite their contexts

 Shall ensure that the private sector and community groups participate

fully in decision making and implementation of the NHP

 Shall convenequarterly meetings of the presidential health multi-sectoral

59
S/N Stakeholders Roles and responsibilities
collaboration for implementing ‘Health-in-All’ policies

 Shall ensure improved evidence-based planning, budgeting, resourcing

and effective (efficient and equitable) use of health resources to achieve

the goals and objectives of the NHP

• Shall ensure that the National Health Policy implements and enforces the

key provisions of the National Health Act (2014) and other relevant

health legislations

3. National Council of  Shall advocate and ensure the adoption of the NHP 2016 by all the states
States
 Shall ensure adequate national resourcing for full implementation of the

NHP 2016

4. National Economic  Shall advocate and ensure the adoption of the NHP 2016 by all the states
Council
 Shall ensure adequate national resourcing for full implementation of the

NHP 2016

 Shall create and implement a framework for monitoring and

strengthening the implementation of the NHP 2016

5. Federal Executive  Shall take the lead in entrenching and mainstreaming of health in all
Council
sectors

 Shall speedily approve the NHP

 Shall review resource envelopes for MDAs and increase the envelope for

health

 Shall review quarterly reports of meetings of the presidential platform on

multi-sectoralcollaboration for implementing ‘Health-in-All’ policies

6. The National Assembly  Shall ensure that relevant aspects of the National Health Policy are

reflected in the revised Nigerian constitution, e.g., definition of roles and

responsibilities for each level of government

60
S/N Stakeholders Roles and responsibilities
 Shall facilitate the passage of relevant publicly and privately-sponsored

health legislations

 Shall ensure that adequate resources are appropriated and disbursed in a

timely manner to ensure that health activities/interventions are carried

out as planned

 Shall undertake regular oversight activities to ensure that money

disbursed are effectively and efficiently used for the purposes intended

7. The Federal Ministry of  Shall ensure widespread dissemination of this Policy and other related
Health
instruments, through various channels

 Shall develop a National Strategic Health Development Plan, in line with

the new National Health Policy 2016

 Shall estimate the full costs for implementing the Strategic Plan.

 Shall undertake annual and mid-term reviews of the implementation of

the Strategic Plan and reports of the reviews presented to the National

Council on Health for wide dissemination

 Shall ensure timely release and disbursement of allocated or

appropriated funds to achieve the goals and objectives of the new NHP

2016

 Shall ensure that appropriate budget expenditure reporting and budget

tracking mechanisms are put in place at all levels to track the use of

resources for the new NHP

 Shall institutionalize the processes of national and sub-national health

accounts,medium and long-term expenditure frameworks, and

appropriate review processes to involve the Federal and State Ministries

of Finance and other relevant agencies/bodies

 Shall mobilize additional resources from external and domestic sources

61
S/N Stakeholders Roles and responsibilities
for achieving the goals and objectives of the NHP (especially the goal of

UHC)

 Shall ensure sector-wide monitoring and evaluation of the status of

implementation of the NHP health policies

 Shall coordinate a national multi-sectoral committee on ‘Health-in-

All’policies

 Shall provide evidence-based achievements of the NHP objectives, through

routine research and data analysis, which will also inform policy reviews and

formulation of new policies when necessary (through regular joint annual

reviews and other mechanisms)

8. Office of the State  Shall be encouraged to adapt and disseminate the policy for the state
Governor
 Shall undertake other responsibilities at the state level as stated by the

Office of the President

9. The State Houses of  Shall mirror the roles and responsibilities of the National Assembly at the
Assembly
state level

10. State Ministries of  Shall mirror the roles and responsibilities of the FMOH at the state level.
Health
11. National Council on  Shall ensure that a strong National Health System is established on the
Health
basis of the NHP 2016

 Shall be responsible for offering advice to the Federal Government of

Nigeria, through the Minister of Health, on matters relating to the

development of national guidelines on health and the implementation of

the NHP at both state and national levels

 Shall ensure that all the goals and objectives of the NHP 2016 are

implemented across the country

 Shall monitor progress on the adoption and adaptation of the NHP 2016

62
S/N Stakeholders Roles and responsibilities
in all states and LGAs

 Shall monitor the implementation of the NHP 2016

12. State Councils on Health  Shallensure the development of a State Health Policy

 Shallmobilize and involve all LGAs within each state to adopt/adapt and

implement the NHP 2016

 Shallmirror the NCH at the state level in other matters

13 National Health  Shalltake the lead in ensuring that every Nigerian is covered by a
Insurance Scheme
prepayment/health insurance scheme

14. National Primary  Shallmobilize domestic and external resources for the development of
Healthcare Development
Agency primary health care in the country

 Shall support capacity building for primary health care, through

orientation and continuing health education programs across all levels of

primary healthcare providers

 Shallprovide free vaccines and coordinate the immunization vaccines

procurement initiative

 Shall issue operational guidelines for the VHCs, WDCs, etc.

 Shall provide annual reports on the status of primary health care

implementation nationwide

15 State Primary Healthcare  Shall mirror the roles of NPHCDA at the state level
Development Agencies
 Shallcoordinate and empower the LGAs within the states in

strengthening PHC implementation along the lines of the NHP 2016 at

the LGA level

16. Local Government Area  Shallappropriate specific budget items for health, with at least 15% of
Councils
LGA budgets allocated to healthcare delivery

 Shall ensure timely release and disbursement of allocated or

63
S/N Stakeholders Roles and responsibilities
appropriated funds for health required to achieve the goals and

objectives of NHP 2016

 Shall ensure that budget expenditure reporting and tracking mechanisms

are established at all levels to track the use of resources for NHP

 Shall institutionalize the process of national and sub-national health

accounts as well asa medium and long-term expenditure framework

 Shall support capacity building for the local government primary health

care through orientation and continuing health education programs

across all levels of primary healthcare providers

17. Federal Ministry of  Shallincrease the resource envelope to the health sector and ensure that,
Finance
progressively, at least 15% of national budget is allocated for health

 Shallsupport the FMOH in mobilizing the health sector pool of funds,

including at least 1% of the consolidated revenue funds and resources

from other sources as stipulated in the National Health Act 2014.

 Shall ensure timely releases and disbursements of allocated or

appropriated funds for health required to achieve the goals and

objectives of the NHP 2016

 Shall establish budget expenditure reporting and tracking mechanisms at

all levels to track the use of resources for the NHP

 Shall institutionalize the process of national and sub-national health

accounts as well as a medium and long-term expenditure framework

18. State Ministries of  Shallsupport the SMOH in mobilizing the health sector pool of funds and
Finance
resources from all sources at the state level

 Shallmirror FMOF at the state level in other functions

19. Federal Ministry of  Shallensure the increase of resource allocation to the Federal Ministry of
Planning and Budget
Health for the full implementation of the NHP 2016

64
S/N Stakeholders Roles and responsibilities
 Shallsupport a the FMOH in formulating and preparing long-term,

medium-term and short-term development plans for implementing the

NHP

 Shallmonitor the implementation of the NHP by the FMOH and other

health system actors

 Shall coordinate Donor Assistance for Health (DAH) at the federal Level

20. State Planning and  Shallmirror the Federal Ministry of Planning and Budget at the state level
Budget Offices
21. Federal Ministry of  Shallmainstream health in the agriculture sector
Agriculture
 Shallcollaborate in implementing the food security and safety aspects of

the NHP

 Shallbe actively involvedas participant in the multi-sectoralforumon

implementing the ‘Health-in-All’ policies and mechanism

21. State Ministries of  Ditto at the state level

Agriculture

22. Federal Ministry of  Shallmainstream health in the education sector

Education
 Shallcollaborate in implementing health promotion, especially health

education and school-health, aspects of the NHP

 Shallbe actively involved and participate in the multi-sectoral forum on

implementing the ‘Health-in-All’ policies and mechanisms

23. State Ministries of  Ditto at the state level

Education

24. Federal Ministry of  Shallmainstream health in all women affairs

Women Affairs
 Shallcollaborate in implementing the gender health equity aspects of the

NHP

 Shallbe actively involvedas participants in the multi-sectoral forum on

implementing the ‘Health-in-All’ policies and mechanisms

65
S/N Stakeholders Roles and responsibilities
25. State Ministries of Ditto at the state level
Women Affairs
26. Federal Ministry of  Shall collaborate with the Ministry of Health and other line ministries to
Environment
implement environmental management programs to reduce

environment-related health risks and vector control activities as

contained in the NHP

 Shall be actively involvedas participants in the multi-sectoral forum on

implementing the ‘Health-in-All’ policies and mechanisms

27. Federal Ministry of  Shall disseminate all information about the NHP to all Nigerians within
Information
and outside the country

28 State Ministries of Ditto

Information
29. Ministry of Defence  Shall harmonize the health strategies for defence staff, in line with the

NHP

 Shall be actively involvedas participants in the multi-sectoral forum on

implementing the ‘Health-in-All’ policies and mechanisms

30. State Ministries of  Shall collaborate with the State Ministries of Health and other line

Environment ministries to implement environmental management programs to reduce

environmental-related health risks

 Shall be actively involvedas participants in the multi-sectoral forum on

implementing the ‘Health-in-All’ policies and mechanisms

31. NAFDAC  Shall conduct appropriate tests and ensure compliance with standard

specifications designated and approved for the effective control of quality of

food, drugs, cosmetics, medical devices, bottled water, and chemicals

32. NIMR  Shall conduct research into diseases of public importance in the country

 Shall develop human and infrastructural capacities for clinical and

66
S/N Stakeholders Roles and responsibilities
biomedical research, in collaboration with medical schools, universities

and other health-related institutions, in and outside Nigeria

 Shall ensure that the results of health research that it generates are

disseminated widely and used for decision making in the country

33 NIPRD  Shall collaborate with the FMOH to undertake development work on

drugs and biological products including vaccines and pharmaceutical raw

materials from indigenous natural resources

 Shall promote and sponsor the local development and production of

drugs, vaccines, pharmaceutical machines, and accessories

 Shall ensure that the results of health research that it generates are

disseminated widely and used for decision making in the country

34. National Arbovirus  Shall conduct appropriate research on arboviruses for detection and
Research Institute
control of disease breakouts, especially epidemics

 Shall ensure that the results of health research that it generates are

disseminated widely and used for decision making in the country

35. Professional  Shall ensure that the services they provide are of high quality and ethical
Associations
standards in the spirit of inter-professional collaboration and in

conformity with the National Health Act 2014 and the National Health

Policy

36. Professional Regulatory  Shall regulate the practice of health professionals across all cadres of
Bodies
health practice in Nigeria

 Shall institute and routinely conduct continuing medical education and

update courses for all cadres of health professionals

37. Academia and Research  Shall participate in research and development for health care delivery

 Shall support capacity development for health service delivery

67
S/N Stakeholders Roles and responsibilities
 Shall provide technical assistance in advancing health programs

38. Media (Print and  Shall support demand creation for health services
Electronic)
 Shall support health promotion and awareness creation for health care

39. The Private Sector  Shall contribute to health service delivery within the national health

policy framework in compliance with national standards and guidelines

 Shall invest in healthcare

 Shall at all times comply with the provisions of the National Health Policy

40 Civil Society  Shall act as an instrument for ensuring accountability and monitoring

health service provisions

 Shall create demand for health services and mobilize communities in the

achievement of health goals

 Shall contribute to strengthen health services delivery

41. Community Groups  Shall participate in determining community health needs and

planning/implementation, as well as in interventions to address such

needs

42 Healthcare Providers  Shall collaborate with all relevant authorities in health to ensure mutual

accountability

 Individuals, families, caregivers and communities shall be involved in the

planning, implementation and evaluation of health services

43. Clients/Consumers  Shall take appropriate actions to contribute to their own health

(individuals, families and

communities)

44. Trade Unions  They shall work with government to realize the health outcomes of their

members

45. Development Partners  Shall collaborate with government in aligning their support and activities

68
S/N Stakeholders Roles and responsibilities
in the health sector

 Shall effectively engage with government to ensure adequate

participation in health development

 Shall provide appropriate technical assistance in advancing health

programs

 Shall support capacity development for health service delivery

46. Traditional Medical  Shall ensure adherence to appropriate guidelines for traditional medicine
Practitioners
practice

 Shall ensure effective use of referral systems inorthodox medical care

47. Religious Organizations  Shall work with the FMOH to ensure that health services are in

consonance with the provisions of the National Health Policy

 Shall work closely with the communities to ensure appropriate

participation in the planning and implementing health programs

48. Ministry of Labour and  Shall be concerned with ensuring cordial working relationships between
Productivity
staff and employees

49. National Emergency  Shall work with the FMOH and other relevant stakeholders to coordinate
Management Agency
efficient and effective disaster prevention, preparedness, mitigation and

appropriate responses in Nigeria

50 Ministry of Water  Shall provide safe and potable drinking water for all Nigerians
Resources
 Shall participate actively in inter-sectoral actions for health

51 The Governor’s Forum  Shall include discussions on health issues of national interest in their

agenda and take common positions

52 Committee of Speakers  Shall include discussions on health of national interest in their meetings
(of Houses of Assembly)

69
5.3 The Legal Framework

The legal framework is critical for the implementation of the National Health Policy. To this end:

• Stakeholders in the health sector shall advocate for a review of the Constitution of the Federal

Republic Nigeria, 1999, as amended, to make health an enforceable right in Nigeria and to include a

clear division of responsibilities for health among the three tiers of government in the Constitution.

• The National Health Policy shall be oriented to implement the provisions of the National Health Act

2014 and other relevant legislation.

• Provision shall be made to revise, update and enact new health legislation as relevant, including but

not limited to the following:

• National Primary Health Care Development Act

• National Health Insurance Scheme (Amendment) Bill

• University Teaching Hospital Acts

• The Federal Medical Centres Bill

• Acts Governing Professional Regulatory Bodies

• Mental Health Bill

• The Elderly Care Bill

• Labour, Safety, Health and Welfare Bill

• Nigerian Centre for Disease Control Bill

• The Public Health Act

• The Vaccination Act

• Yellow Fever and Infectious Diseases (Vaccination) Act

• Quarantine Act

70
• States shall be encouraged to enact relevant laws to provide a legal framework for state health

systems, in line with the National Health Act 2014, including the various State Primary Health Care

Development Agency Bills and State Health Insurance Laws.

71
5.4 Funding of Policy Implementation

a. Funding:

a) Governments at all levels shall earmark and allocate at least 15% of their annual budgets

(in line with the Abuja target) for the implementation of the National Health Policy

b) The Federal Government shall allocate at least 1% of the Consolidated Revenue Fund for

the establishment of the Basic Health Care Provision Fund, as provided for in the

National Health Act 2014

c) To ensure accountability, development partners shall sign a compact for the

implementation of the National Health Policy and the National Health Strategic Plan,in

line with the provisions of the Paris Declaration on Aid Effectiveness and the Busan

Partnership for Effective Development Co-operation

d) Stakeholders, especially civil society organisations, shall advocate in the executive and

the legislative arms of governmentat all levels on the need to increase allocations to

health to meet 15% of the total budget as per Abuja Declaration

e) Government shall encourage private sector participation in the implementation of the

National Health Policy, including investment in health

b. Disbursement:

a) There shall be timely release and disbursement of allocated or appropriated funds for

health

b) Budget expenditure reporting and tracking mechanisms shall be established at all levels

72
 c) Construction and updating of national and sub-national health accounts shall be

institutionalised23

23
In April 2001, heads of state of African Union countries met and pledged, as part of a broader “Abuja
Declaration” document, to set a target of allocating at least 15% of their annual budget to improve the
health sector (the Abuja Target). At the same time, they urged donor countries to "fulfil the yet to be met
target of 0.7% of their GNP as official Development Assistance (ODA) to developing countries".

African Summit on HIV, TB and other Related Infections Diseases. The Abuja Declaration on HIV/AIDS,
Tuberculosis and other related Infectious Diseases. 24-27 April, 2001.

73
Chapter 6 : MONITORING & EVALUATION

6.1 The Monitoring & Evaluation (M&E) Framework

The National Health Policy 2016 is the primary policy document providing long-term direction for health

development in Nigeria for the period 2016-2030. The National Health Policy will be operationalized and

implemented through three cycles of National Strategic Health Development Plans (NSHDP 2016 – 2020,

NSHDP 2021– 2025 and NSHDP 2026– 2030)and Annual Operational Plans drawn up by the FMOH, Health

Agencies, SMOHs, State Primary Health Care Boards (SPHCB), relevant health institutions at all levels, and

the LGA Health Authorities (HAs). The implementation shall be monitored using a comprehensive monitoring

and evaluation framework, based on the objectives and targets set out in the policy and the NSHDP.

Monitoring & Evaluation Framework for National Health Policy

Policy Directions Na onal Health Policy 2016

Strategies
Na onal Strategic Health Development
Plans

Federal State LGA

Strategies Strategies Strategies

Medium resources Medium Term Expenditure

allocation at all levels Frameworks

Priority activities based Annual Work Plans

on available resources

Stakeholders commitments to Performance Monitoring

achieving priority activities

The Mechanism for the monitoring and evaluation of the policy shall be through quarterly M/E activities to

be undertaken by the states and the LGAs of health programmes, based on the set goals, objectives and

74
targets. The mechanism for M&E shall also be effected through Joint Annual Reviews (JAR) to be coordinated

by the FMOH. In the last year of each cycle of the Strategic Plan, evaluation of the plan shall be undertaken

as well as development of a new Strategic Plan. The Policy will be reviewed periodically.

National Strategic Health Development Plans shall be used to identify priority investment areas while

Operational Plans shall be developed for specific decision-making levels of health care systemsand units,

such as at the levels of States and the Local Government Areas that are able to plan and raise resources for

defined services. In this context, it should be noted that referral services are critical delivery units at both

State and National levels.

National Strategic Health Development Plans shall provide information and guidance on the annual targets

and budgeting processes. The budgeting process and framework, therefore,shall be based on agreed priority

investments in the respective investment plans. During the budgeting process, the priorities for investment

should be directly derived from the National Strategic Health Development Plans. The policy orientations

would constitute the sector programs in the budget around which priorities and budgets would be defined.

The defined priorities and budgets constitute the guidelines for the elaboration of Annual Work Plans—the

priority activities for implementation in the short term, based on the resources available.

6.2 Progress Indicators

Progress indicators shall be based on the respective domain areas and set objectives. Targets used for

monitoring performance of the implementation of the health policy shall be based on values for Sub-Sahara

Africa (SSA). These targets shall be measured clearly indicating absolute achievements and variations across

the states of the Federation.

75
 Table 6: Performance Monitoring Matrix

SN Goal/Thrust Key performance 2015 Key performance Key performance Key performance
indicator baseline Indicators Indicators Indicators
levels Short term Medium term Long term
(2016 to 2020) (2021 to 2025) (2026 to 2030)

Overarching goal of the policy

Ensure Life expectancy at

Universal Health birth (in years)

Coverage and Annual crude death

healthy lives for rate (per 1,000

all Nigerians people

Infant mortality rate

Under-five mortality

rate

Maternal mortality

ratio

Prevalence of

children under five

years of age who are

underweight

Mortality due to

cardiovascular

diseases

Prevalence of

children under five

years of age who are

stunted

76
6.3Data management and feedback

Monitoring and evaluation of progress on policy implementation shall require data collection, collation and

analysis on governance and leadership, the burden of diseases, health services, health financing, human

resources for health, medicines, vaccines & other health technologies, health infrastructure and equipment

and other areas as defined in the NSHDP.The required data can be acquired through special surveys or the

acquisition of routine data fromDHIS2.

Feedback on progress of policy implementation shall be carried out through the generation and

dissemination of periodic reports, annual review meetings at national, zonal & state levels.

77
Chapter 7 : CONCLUSION

The National Health Policy 2016 has established solid and evidence-based mechanisms and directions for

Nigeria to significantly improve the health status of all its citizens to enable them lead fully healthy and

fulfilling lives. The policy is geared towards ensuring that Nigeria successfully implementscurrent national

and global priorities such as the Sustainable Development Goals, Universal Health Coverage, Vision 20.2020.

It will also provide an operational platform for the National Health Act 2014.

The policy was developed with the active participation of diverse health system actors, including people

from both the public and private sectors. The policy directions were guided by evidence generated from the

situational analysis of the health sectorin Nigeria. They were also guided by the strategic thrusts that have

been suggested by the international community on how to successfully implements several health sector

priorities.

It is now imperative for the federal, state and local governments to implement the policy. It is expected that

all states and LGAs shall adapt the policy to their contexts. This will lead to the development of State Health

Policies and LGA Health Policies. These will be followed by the development of implementation plans for the

policies by all levels of government, in partnership with non-governmental actors such as development

partners and the private sector.

The roles and responsibilities of all the health system actors in implementing the policy have been spelt out

in the document. The faithful performanceof the stated roles and responsibilities by all the health system

actors will not only mainstream health in all sectors within the Nigerian economy space, it will also assure

adequate resourcing and achievement of the health-related SDGs, and the attainment of UHC.

78
Appendix 1 List of Documents Consulted in the Process of the Development

of the National Health Policy 2016

1. Constitution of Federal Republic of Nigeria (1999): Decree no. 24, Federal Republic of Nigeria

2. Federal Ministry of Health Report: First National B Prevalence Survey, 2012.

3. Federal Ministry of Health Saving New-born Lives in Nigeria: NEWBORN HEALTH in the context of the
Integrated Maternal, New-born and Child Health Strategy, Revised 2nd edition, 2011.

4. Federal Ministry of Health,The National Quality Assurance Policy, 2016.

5. Federal Ministry of Health,The Nigeria Supply Chain Policy for Pharmaceuticals and other Health
Products, 2016.

6. Federal Ministry of Health. National Child Health Policy, April, 2006.

7. Integrated Maternal, New-born and Child Health Strategy: Department of Family Health, Federal
Ministry of Health, Nigeria. Revised 2011.

8. National Agency for the Control of AIDS. National Strategic Framework for HIV/AIDS II. NACA,
December, 2009.

9. National Blood Transfusion Service. FMOH, December, 2006.

10. National Health Act (2014). Federal Republic of Nigeria, Official Gazette No. 145 Vol. 101 Notice No.
208.

11. National Health Promotion Policy. FMOH, February, 2006.

12. National Malaria Strategic Plan 2014-2020 (2014). Federal Ministry of Health, Federal Republic of
Nigeria.

13. National Oral Health Policy. FMOH, November, 2006.

14. National Policy on Human Resources for Health. FMOH, 2008.

15. National Policy on Public Private Partnership for Health in Nigeria. FMOH, November, 2005.

16. National Policy on the Health & Development of Adolescents & Young People in Nigeria, FMOH,
2007.

17. National Primary Health Care Development Agency: Integrating Primary Health Care Governance in
Nigeria (PHC under One Roof): Implementation Manual, FMOH, August, 2013.

79
18. National Primary Health Care Development Agency: Minimum Standards for Primary Health Care in
Nigeria. NPHCDA.

19. National Primary Health Care Development Agency: National Routine Immunisation Strategic Plan,
(2013-2015). NPHCDA, 2013.

20. National Reproduction Health Policy: 1st Revision. Federal Ministry of Health, 2008.

21. National Strategic Health Development Plan (NSHDP) 2010-2015. November, 2010.

22. National Strategic Plan of Action for Nutrition: NSPAN, 2014-2019. FMOH, 2014

23. Nigeria Demographic Health Survey (2003). National Population Commission, Federal Republic of
Nigeria, Abuja, Nigeria. ICF Macro Calverton, Maryland, USA. June, 2014.

24. Nigeria Demographic Health Survey (2003). National Population Commission, Federal Republic of
Nigeria, Abuja. ICF Macro Calverton, Maryland, USA. November, 2004.

25. Nigeria Demographic Health Survey (2008). National Population Commission, Federal Republic of
Nigeria, Abuja. ICF Macro Calverton, Maryland, USA. November, 2009.

26. Nigeria Health Information System Policy. FMOH, September, 2014.

27. Nigeria Health Sector Reform Program: Strategic Thrusts with a Logical Framework and Plans of
Action, 2004-2007. FMOH, 2004.

28. Obasanjo, O., Mabogunje, A., and Okebukola, P., (2016). Towards a new dawn for the health sector
in Nigeria: (Ed) Centre for Human Security Abeokuta, Olusegun Obasanjo Presidential Library,
Abeokuta, Nigeria.

29. The National Strategic Plan for Tuberculosis Control: Towards Universal Access to Prevention,
Diagnosis and Treatment, 2015-2020. National Tuberculosis and Leprosy Control Programme,
Department of Public Health, Federal Ministry of Health, Nigeria, July, 2014.

80