The impact of political institution and structure on health policy making and implementation: Nigeria as a case study.

Abstract

Background: Typical of the political structure o f the United States of America, Nigeria operate s a federal presidential system of government. Political power is shared between the three levels of Federal, State and the Local Governments. The political affairs of the country at these levels are determined by elected politicians from different political parties, with different political and developmental ideologies. This scenario has implications on policy making and implementation especially in the health sector. This paper sought to discuss the type of political structures and institutions and, the effect of these on health policy implementation in selected countries, with emphasis on Nigeria. Current status of financing health care: T h e National Health Insurance Scheme (NHIS ) w a s launched almost a decade ago but currently covers an estimated four percent of the population, majority of which are in the formal sector. T h e poor coverage of the scheme in Nigeria has been attributed to the type of political institution and structure it operates. This is evident with example s of some countries in the world ; whereas, the scheme in Nigeria w a s implemented almost at the same time like in neighboring Ghana , the scheme in Ghana has made a considerable progress. Likewise , prepayment scheme for health in Britain has been in practice for decades, the USA is just currently making progress in the implementation of a nation-wide prepayment scheme despite several years of efforts. It is important to note that Nigeria and the USA has similar political institution and structure different from what Ghana and Britain have in common. Conclusion: T h e current low level of coverage o f the NHIS in Nigeria is largely due to the type of adopted political institution and structure . T h e implications of this on the health status of the people and national development t cannot be over - emphasized.