A review of corruption and accountability issues in Nigeria’s COVID-19 response: Implications for health systems governance

By: Prince Agwu, Nma Ekenna, Uche Obi, Tochukwu Orjiakor, Aloysius Odii, Enyi Etiaba, Benjamin Uzochukwu, Obinna Onwujekwe

Flexible and urgent health spending during public health emergencies distorts procurement processes and potentially encourages corrupt practices in health systems. This can erode public confidence, resulting to poor compliance to health safety measures during public health crisis. Thus, anticorruption in health, and in pandemic responses is key. COVID-19 related articles (reports from various government bodies and CSOs) on resource mobilization, appropriation, public perceptions towards accountability and anticorruption, were reviewed. Findings were organised under three themes: i) mobilized resources for COVID-19, ii) evidence of corruption or anticorruption in spending them and iii) implications for health systems governance.

About N36.3b ($US93.5m) was raised through 295 donations to federal and state governments, to combat the virus. Additionally, Nigeria appropriated N10b ($27m) to epi-centres and the disease control agency in the country. Whilst information on available resources are freely available, that on expenditure has been opaque, which has generated heated concerns. Lack of evidence of optimal utilization of resources under the frames of accountability and anticorruption has aroused public concerns and trust in the actual existence of a pandemic. Diminished health worker motivation connects with industrial actions.

CSOs need to be actively engaged in driving government to show accountability, through partnering with multilateral organisations and donors to increase pressure on government to be accountable with resources mapped out for pandemic responses. Health workforce groups and Associations also need to actively engage government and demand accountability. Finally, conversations on corruption and accountability issues that affect health systems should be encouraged.

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Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance

By: Uche Shalom Obi,  Osondu Ogbuoji,  Wenhui Mao,  Minahil Shahid,  Obinna Onwujekwe, Gavin Yamey

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies.

We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

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