NATIONAL HEALTH POLICY Olabisi O Outline Overview of

NATIONAL HEALTH POLICY Olabisi O

Outline • Overview of policy • Policy process • Essential issues for policy process • Policy making process • Nigeria Health Policy

Overview of the Policy v statement of intent for achieving an objective. v Deliberate statement aimed at achieving specific objective v. They are formulated by the Government in order to provide a guideline in attaining certain objectives for the benefit of the people.

Importance of policy v to solve existing challenges/problems in any society vused as a tool to safeguard and ensure better services to members of the society.

Reasons formulating a Policy v Reforms (socio-economic, technological advancements, etc) within and outside the country.

Essential issues for policy process • identifying the prerequisites of a successful policy process • identifying the main actors and their roles • determining the main steps in the policy process

Prerequisites Alignment with other national processes ü Bringing coherence to a set of tested and approved employment interventions ü Achieve internationally-set objectives to which the country has adhered e. g. SDGs

Prerequisite Cont. Building partnerships - The need to identify the actors with whom to establish partnerships such as sectoral ministries, MDAs ministries and agencies, the Central Bank, finance ministries and national planning agencies

Prerequisite Cont. Broad and sustained political commitment - A clear and strong political commitment emanating from the highest Government levels is key to ensuring sustainability.

Prerequisite Cont. An inclusive and accountable process - A good policy development process requires broad based dialogue implementation. for successful - Dialogue at every step, from the situation analysis that leads to policy choices, all the way to the validation of the policy implementation, and later its evaluation

Dialogue Process 1. National /Sectoral level: Identification of the main challenges, options, validated of selected priorities and ways of implementing them a. Social partners( employers organizations and trade union)

National/sectorial cont. b. Other ministries especially govt economic team and sectoral ministries c. Civil society groups such as women or youth organizations. Can be achieved through: Working groups, tripartite workshops, tripartite conference

Dialogue process cont. 2. Regional level: ministries of employment and a. regional branches b. Regional social partners c. Other decentralized government agencies d. Regional civil society groups such as women and youth organization

• Can be achieved through workshop, focus group discussions.

Dialogue process 3. Local level Animated by regional branches of ministry in charge of employment involving local communities, NGOs active at the local level, specific project that have an employment impact, beneficiaries -Can be achieved through village meeting, focus groups, discussions, interviews

POLICY PROCESS MAKING

Process • • Preparation phase Issue identification Formulation phase Validation, adoption and communication phase Programming and budgeting phase Implementation steering and monitoring phase Evaluation phase

The preparation phase Defining the policy’s development goal

The preparation cont. Organizational framework for the policy process. - Identification of stakeholders and the modalities of their interventions - A steering committee with members from government structures (Ministry of Finance, education, Infrastructure, etc. ), and from trade unions and employers’ organizations, so as to ensure policy coherence, ownership, and sustainability

The preparation cont • A national technical team of technical experts in the Ministry in charge of Employment or consultant with a clear mandate and clear responsibilities designated to accompany the whole policy cycle.

The preparation cont • Responsibilities of the technical team • For organizing a broad social dialogue all along the policy development process • For supervising the consultants doing the diagnostic work (if any); • for drafting the policy;

Responsibilities of the technical team cont. • For drafting the legal texts necessary to formally adopt the policy; • For participating in the national budget preparation process and arbitrations; • for communicating about the policy development exercise to citizens.

The issue identification phase • what are the emerging policy concerns? Situation analysis (diagnosis phase). • to produce a statement of issues which identifies the opportunities and constraints of the labour market through research, and broadbased consultations • to collect all the stakeholders’ views on the challenges they face and, in the case of social partners, on their constituents’ demands.

The formulation phase • Prioritization of policy issues • Generation of policy options, • Presentation of the rationale justification for their choice. and

Formulation Steps • Which issues/policy concerns to address • Which policy options to use to tackle the selected employment problems. • Choose policy interventions informed by a set of criteria or indicators, such as employment targets, fiscal space, complementarily or substitution of policies, etc.

The validation phase After drafting, it must be submitted for the validation • This is to obtain a national consensus on the policy Possible Avenues -regional workshops; national stakeholders in a tripartite and/or ; national workshop • After validation, the national technical team should incorporate the comments received and finalize the policy document •

Adoption • Formalization and executive force: all the authority necessary for it to be taken serious and given the credibility by the actors. Means of formalization -Government official adoption - Issuing a statement, decree, conversion into a Law, or other - Integration into the National Development Framework

- Adoption Through • mass media, • training workshops • oral tradition through village theater or • The distribution of gadgets and T-shirts, • Websites, Social media, facebook etc

Communication • Selling the Policy to the people -To internalize the Policy and its contents to all those who are concerned, and - To make them understand its meaning as a comprehensive and new mode of action to deal with employment challenges.

The programming and budgeting phase -Specify the necessary conditions for ownership and authority - Itemize interventions in an operational manner and establish the authority and ownership of the policy. - Define the plan which is going to allow the organization and progress for the implementation of the Policy

The programming and budgeting phase cont. • Give information about the process, methods and conditions • Formulate the requirements relating to the strengthening of the financial capacities technical and

The implementation phase Basic principles underlying implementation are: • 1. internalization of the objectives of the Policy by all concerned actors. • 2. convergence of their efforts and their monitoring. • 3. Dialogue and cooperation as a mode of organization of the implementation.

Key elements to ensure implementation of the policy • Operationalize the tripartite, interministerial coordination mechanism • Operationalize the monitoring evaluation framework. and • Financial resources must be brought to bear within a continuing annual stream of budget cycles.

The evaluation phase • Have the initiative achieved its objectives? • what were the effects, and • are any policy changes needed? Measures of Evaluation: Using social science research methods, including qualitative and quantitative techniques, to examine the effects of policies.

NIGERIA HEALTH POLICY • It describes the goals, structure, strategy and policy direction of the health care delivery system in Nigeria. • It defines the roles and responsibilities of the three tiers of government without neglecting the non-governmental actors

NHP cont. • Its long-term goal is to provide the entire population with adequate access not only to primary health care but also to secondary and tertiary services through a well-functioning referral system. • The first Nigeria comprehensive national health policy and strategy to Achieve Health for All Nigerians was launched in 1988.

NHP cont. • This was subsequently revised in 2004 • The recent Nigeria health policy was signed on April, 2016 by minister of health: Isaac Adewole

NHP cont. It 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

Rationale for New Health Policy • 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 epidemics), health issues (especially

Rationale for New Health Policy cont - the new PHC governance reform of bringing PHC Under One Roof (PHCUOR), - Nigeria’s renewed commitment universal health coverage. to - globalization, climate change, and the challenges of insurgency and its impact on the Nigerian health system.

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(NGO Health Service Delivery Project) and the WHO health system building blocks.

Situational analysis cont. • 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 socioeconomic status and geographic location

Situational cont. • 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

Situational cont. • absence of a minimum package of health services; • lack of proper coordination between the public and private sectors; • and poor referral systems

The Policy Development Process • The process for developing the new National Health Policy(NHP) was initiated by the FMOH through consensus-building among stakeholders.

The Policy Development Process • 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

NHP • Vision: Universal Health Coverage (UHC) for all Nigerians • 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)

NHP: Overall Policy Goal: • To strengthen Nigeria’s health system, particularly the primary health care subsystem, 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 - Governance, -Health Service Delivery,

Policy thrust cont -Human Resources for Health, -Medicines, Vaccines, Commodities and Health Technologies, -Health Infrastructure,

Policy thrust cont -Health Information System, - Health Research Development, - Community Participation, and Ownership/ - Partnerships for Health.

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Further reading • Kojo Appiah-Kubi (2015) Policy Process Making. DRUSSA-ISSER Executive Training on ‘Influencing Policy’ • FMOH(2016) National Health Policy. Promoting the Health of Nigerians to Accelerate Socio-economic Development