POLITICS OF HEALTHCARE REFORM IN AFRICA: INSIGHTS FROM RURAL NIGERIA

POLITICS OF HEALTHCARE REFORM IN AFRICA

  • Afeez Folorunsho Lawal Al-Hikmah University, Ilorin, Nigeria
Keywords: healthcare reform, health policy, policy transfer, community-based health insurance, policy design, policy failure

Abstract

Healthcare reform is largely a political process which requires a careful analysis for better understanding. The process is often characterized by politics of domination and influence by various actors on the policy scene. This study examines the power relations that shaped the design and implementation of a Community-Based Health Insurance programme in Nigeria. Health policy triangle developed by Walt and Gilson serves as the analytical tool. Using a qualitative method of data collection, this study sheds light on the recent trends in health policy transfer to Africa from the global North and reveals the underlying politics in the design and implementation of a CBHI programme in rural Kwara. Specifically, we highlight the process through which the policy was proposed and accepted. Also, our study shows the political underpinnings of the design and implementation of the policy. Finally, we argue for a need to repurpose the role of the state (i.e. government) towards achieving meaningful development and to gainfully improve social services provisioning, especially in the healthcare sector. Given the importance of healthcare to the well-being of the people, productivity and national development, this study contributes to understanding the issues ‘behind the scenes’ in relation to policy design and implementation.

Downloads

Download data is not yet available.

References

Acharya, A. & Ranson, M.K. (2005). Health care financing for the poor: community-based health
insurance schemes in Gujarat. Economic and Political Weekly, 40(38):4141-4150.
Adésínà. J.O. (2020). Policy merchandising and social assistance in Africa: don’t call dog monkey
for me. Development and Change, 51(3):561-582.
Adésínà, J.O. (2015). Return to a wider vision of social policy: re-reading theory and history. South
African Review of Sociology, 46(3):99-119.
Adésínà, J.O. (2008). Transformative social policy in a post neoliberal African context: enhancing
social citizenship. Paper presented at the RC19 Stockholm 2008 Annual Conference (The future of social citizenship: politics, institutions and outcomes). Stockholm, 4‐6 September.
Alegbeleye, B.J. & Mohammed R.K. (2020). Challenges of healthcare delivery in the context of
COVID-19 pandemic in Sub-Saharan Africa. Iberoamerican Journal of Medicine, 02:100-109.
Amsterdam Institute for Global Health and Development (2015). The impact of access to quality
healthcare in Africa: research findings on health insurance fund supported programs. Available online at: https://www.aighd.org/wp-content/uploads/2017/11/The-Impact-of-Access-to-Quality-Healthcare-in-Africa-Research-findings-on-Health-Insurance-Fund-supported-programs.pdf (Accessed 14 March 2020).
Amsterdam Institute for Global Health and Development. (2017). Access to better healthcare in
Africa: new findings from research on PharmAccess Group supported programs. Available online at: https://www.aighd.org/wp-content/uploads/2017/12/172015-BETTER-HEALTHCARE-BW-03-LR-3.pdf (Accessed 13 March 2020).
Amsterdam Institute of International Development. (2013). A short term impact evaluation of the
health insurance fund program in central Kwara State, Nigeria. Available online at: https://www.pharmaccess.org/update/a-short-term-impact-evaluation-of-the-health-insurance-fund-program-in-central-kwara-state-nigeria/ (Accessed July 12 2018).
Andrianaivosoa, L.M.D. (2016). Family planning policies in Sub-Saharan Africa: failure of policy
transfer. Oregon State University: Unpublished Master’s Thesis.
Baum, F. (2007). Health for all now! Reviving the spirit of alma ata in the twenty-first century: an
introduction to alma ata declaration. Social Medicine, 2(1):34-41.
Béland, D. & Ridde, V. (2016). Ideas and Policy Implementation: understanding the resistance
against free healthcare in Africa. Global Health Governance, 10(3):9-23.
Benatar, S.R., Gill, S. & Bakker, I. (2009). Making progress in global health: the need for new
paradigms. International Affairs, 85(2):347-371.
Bender, K., Keller, S. & Willing, H. (2014). The role of international policy transfer and diffusion
for policy change in social protection – a review of the state of the art. Available online at: https://www.h-brs.de/files/izne/policy_diffusion_1.pdf (Accessed 23 August 2020).
Bennett, F. (1979). Primary health care and developing countries. Soc Sci Med, 13(A):505-514.
Bond, P. (2007). The sociopolitical structure of accumulation and social policy in Southern Africa,
in Adésínà, J. (ed.), Social Policy in Sub-Saharan African Context: In Search of Inclusive Development. Basingstoke: Palgrave Macmillan.
Boston Consulting Group. (2015). Health insurance fund evaluation report. Available online at:
https://www.government.nl/documents/reports/2015/04/30/health-insurance-fund-evaluation-report (Accessed 12 March 2020).
Brals, D. (2019). Maternal and child health in sub-Saharan Africa within the context of a health
system intervention. Available online at: https://pure.uva.nl/ws/files/43144646/5.pdf (Accessed 15 May 2020).
Braveman, P., Arkin, E., Orleans, T., Proctor, D. & Plough, A. (2017). What is health equity? And
what difference does a definition make? Princeton, New Jersey, USA: Robert Wood Johnson Foundation.
Campos, P.A. and Reich, M.R., (2019). Political analysis for health policy implementation. Health
Systems & Reform, 5(3):224-235.
Cook, S., Zhang, S. & Yi, I. (2013). Health and development: challenges and pathways to HiAP in
low-income countries, in Leppo, K., Ollila, E., Peña, S., Wismar, M. & Cook, S. (eds.) Health in All Policies Seizing opportunities, implementing policies. Finland: Ministry of Social Affairs and Health.
Dolowitz, D.P. & Marsh, D. (2000). Learning from Abroad: The role of policy transfer in
contemporary policy-making. International Journal of Policy and Administration, 13(1):5–24.
Dolowitz, D.P. & Marsh, D. (2012). The future of policy transfer research. Political Studies Review,
10:339–345.psr_274 3
Duggal, R., Nandraj, S. & Vadair, A. (1995). Special Statistics-10: Health Expenditure across States:
Part I. Economic and Political Weekly, April 15:834-844.
Ekman, B. (2004). Community-based health insurance in low income countries: a systematic review
of the evidences. Health Policy Plan, 19:249-270.
Foli, R., Béland, D. & Fenwick, T.B. (2018). How instrument constituencies shape policy transfer:
a case study from Ghana. Policy and Society, 37:1, 108-124.
Fox, A.M. and Reich, M.R. (2015). The politics of universal health coverage in low- and middle-
income countries: a framework for evaluation and action. Journal of Health Politics, Policy and Law, 40(5):1019-1057.
Gilson, I. & Muramatsu, K. (2020). Trade and COVID-19 Guidance Note: health services trade and
the covid-19 pandemic. Available online at: http://documents.worldbank.org/curated/en/804331588657997511/pdf/Health-Services-Trade-and-the-COVID-19-Pandemic.pdf (Accessed June 2020).
Gunn, J.M., Palmer, V.J., Naccarella, L., Kokanovic, R., Pope, C.J., Lathlean, J. & Stange, K.C.
(2008). The promise and pitfalls of generalism in achieving the alma-ata vision of health for all. Med J Aust, 189(2):110-112.
Gustafsson-Wright, E. & Schellekens, O. (2013). Achieving universal health coverage in Nigeria.
One state at a time: a public-private partnership community-based health insurance model. Washington DC: Brookings.
Hanafi, S. (2020). Global sociology revisited: Toward new directions. Current Sociology, 68(1):3–
21.
Health Insurance Fund. (2012). Afon Community Health Program. Progress Report 1 January – 30
June 2012. Netherlands: Amsterdam. Health Insurance Fund.
Hussain, Z.I. & Cornelius, N. (2009). The use of domination and legitimation in information systems implementation. Information Systems Journal, 19:197–224.
Isouard, G. (2010). National health reform success: it's all about leadership and management.
Australian Quarterly, 82:(3)21-24.
John, J.H. & Taylor, R. (2003). Health for all beyond 2000: the demise of alma-ata declaration and
primary health care in developing countries. The Medical Journal of Australia, 178(1):17-20.
Le, T.M., Morley, C., Hill, P.S., Bui, Q.T., & Dunne, M.P. (2019). The evolution of domestic
violence prevention and control in Vietnam from 2003 to 2018: a case study of policy development and implementation within the health system. International Journal of Mental Health Systems, 13(41):1-16.
Magashula, O. (2010). Foreword, in Prichard, W., Citizen-state relations: improving governance
through tax reform. Paris: Organisation for Economic Cooperation and Development.
Maluka, S., Chitaka, D., Dungumaro, E., Masawe, C., Rao, K. & Shroff, Z. (2018). Contracting-out
primary health care services in Tanzania towards UHC: how policy processes and context influence policy design and implementation. International Journal for Equity in Health, 17(118):1-13.
McKee, M. & Mackenbach, J. (2013). Conditions for successful health policies, in Mackenbach, J.
P. & McKee, M. (eds). Successes and failures of health policy in Europe four decades of divergent trends and converging challenges. England: Open University Press.
Mehtar, S., Preiser, W., Lakhe, N.A., Bousso, A., TamFum, J.J.M., Kallay, O., Seydi, M., Zumla, A.
& Nachega, J.B. (2020). Limiting the spread of COVID-19 in Africa: one size mitigation strategies do not fit all countries. The Lancet Global Health. Available online at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30212-6/fulltext (Accessed 2 June 2020).
Mkandawire, T. (2007). Foreword, in Jimi Adésínà (ed.), Social Policy in Sub-Saharan African
Context: In Search of Inclusive Development. Basingstoke: Palgrave Macmillan.
Mkandawire, T. (2015). Neopatrimonialism and the political economy of economic performance
in Africa critical reflections. World Politics, 67(3), 563–612.
Mthethwa, R.M. (2012). Critical dimensions for policy implementation. African Journal of Public
Affairs,5(2):36-47.
Myint C.Y., Pavlova, M., Thein, K.N.N. & Groot, W. (2019). A systematic review of the health
financing mechanisms in the Association of Southeast Asian Nations countries and the People’s Republic of China: Lessons for the move towards universal health coverage. PLoS ONE 14(6):1-18.
Onwujekwe, O., Onoka, C., Uzochukwu, B., Okoli, C., Obikeze, E. & Eze, S. (2009). Is
community- based health insurance an equitable strategy for paying for health care? Experience from southeast Nigeria. Health Policy, 92:96-102.
Ouma, M. and Adésínà, J. (2019). Solutions, exclusion and influence: Exploring power relations
in the adoption of social protection policies in Kenya. Critical Social Policy, 39(3):376-395.
PharmAccess Group. (2016). Progress report 2016. Available online at:
https://www.pharmaccess.org/wp-content/uploads/2017/04/PharmAccess-Progress-Report-2016.pdf (Accessed 13 March 2019).
Romero, M.J. & Gideon, J. (2019). Public Private Partnerships and universal healthcare in Latin
America – at what cost? Available online at: https://d3n8a8pro7vhmx.cloudfront.net/eurodad/pages/524/attachments/original/1591802662/public-private-partnerships-and-universal-health-care-in-latin-america-at-what-cost-.pdf?1591802662 (Accessed 20 August 2020).
Sarwar. M.B. (2018). The political economy of cash transfer programmes in Brazil, Pakistan and
the Philippines when do governments ‘leave no one behind’? ODI Working Paper 543. Available online at: https://www.odi.org/sites/odi.org.uk/files/resource-documents/12567.pdf (Accessed 6 June 2020).
Signe, L. (2017). Why do development policies often fail in Africa? Perspectives on the World
Development Report. Available online at: https://africaupclose.wilsoncenter.org/why-do-development-policies-often-fail-in-africa-perspectives-on-the-world-development-report-2017/ (Accessed 31 August 2020).
Stone, D. (2001). Learning lessons, policy transfer and the international diffusion of policy ideas.
Centre for Study of Globalisation and Regionalisation. Working Paper No. 69/01. University of Warwick.
Storeng, K.T., Palmer, J., Daire, J. & Kloster, M.O. (2019). Behind the scenes: the international
NGOs’ influence on reproductive health policy in Malawi and South Sudan. Global Public Health, 14(4):555-569.
Tabor, S. R. (2005). Community-based health insurance social protection policy. Social Protection
Discussion Paper Series No 0503, Washington: World Bank.
Taegtmeyer, M., Martineau, T., Namwebya, J.H., Ikahu, A., Ngare, C.W., Sakwa, J., Lalloo, D.G.,
Theobald, S. (2011). A qualitative exploration of human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis. BMC Public Health, 11(812):1-10.
Tidjani, M.A. (2009). Between autonomy and dependence: “policy transfer” dynamics in Sub-
Saharan Africa. Paper presented at the NORRAG Conference on Policy transfer or policy learning: Interactions between international and national skills development approaches for policy making. Geneva, 25-26 June.
Uzochukwu, B.S.C., Onwujekwe, O.E., Eze, S., Ezuma, N., Obikeze, E.N. & Onoka, C.A.
(2009). Community based health insurance scheme in Anambra State, Nigeria: an analysis of policy development, implementation and equity effects. CREHS Policy Brief. UK: Department for International Development.
Uzochukwu, B.S.C., Onwujekwe, O.E., Eze, S., Ezuma, N., Obikeze, E.N. & Onoka, C.A. (2010).
Implementing community-based health insurance in Anambra State, Nigeria. CREHS Policy Brief. UK: Department for International Development.
Walt, G. & Gilson, L. (1994). Reforming the health sector in developing countries: the central role
of policy analysis. Health Policy and Planning, 9(4):353-370.
Walt, G., Shiffman, J., Schneider, H., Murray, S.F., Brugha, R. & Gilson, L. (2008). Doing health
policy analysis: methodological and conceptual reflections and challenges. Health Policy and Planning, 23(308-317).
Wang, H., Wang, S. & Yu, K. (2020). COVID-19 infection epidemic: the medical management
strategies in Heilongjiang Province, China. Critical Care, 24(107):1-4.
WHO (2020). WHO Coronavirus Disease (COVID-19) Dashboard. Available online at:
https://covid19.who.int/ (Accessed 10 September 2020).
WHO Regional Office for Africa (2020). COVID-19 Africa numbers at a glance. Available online
at: https://www.afro.who.int/health-topics/coronavirus-covid-19 (Accessed 10 September 2020).
World Bank (2020). Physicians (per 1,000 people) – Nigeria. Available online at: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=NG
(Accessed 18 August 2020).
Published
2024-05-19
How to Cite
Lawal, A. (2024) “POLITICS OF HEALTHCARE REFORM IN AFRICA: INSIGHTS FROM RURAL NIGERIA”, Berumpun: International Journal of Social, Politics, and Humanities, 7(1), pp. 26-38. doi: 10.33019/berumpun.v7i1.144.
Section
Research Articles