IDEAS home Printed from https://ideas.repec.org/a/bla/ijhplm/v37y2022i6p3192-3204.html
   My bibliography  Save this article

How (not) to promote sub‐national ownership of national initiatives in decentralised health systems: The free maternal and child health programme in Nigeria, 2008–2015

Author

Listed:
  • Uchenna Ezenwaka
  • Seye Abimbola
  • Obinna Onwujekwe

Abstract

Background Promoting the sub‐national ownership of national health initiatives is essential for efforts to achieve national health goals in federal systems where sub‐national governments are semi‐autonomous. Between 2008 and 2015, Nigerian government implemented a pilot free maternal and child health (MCH) programme in selected states to improve MCH by reducing physical and financial barriers of access to services. This study was conducted to better understand why the programme was neither adopted nor scaled‐up by sub‐national governments after pilot phase. Methods We conducted a qualitative evaluation of the programme in Imo and Niger States, with data from programme documents, in‐depth interviews (45) and focus group discussions (16) at State and community levels. Data was analysed using manual thematic coding approach. Result Our analysis indicates that the programme design had two mutually dependent goals, which were also in tension with one another: 1. To ensure programme performance, the designers sought to shield its implementation from sub‐national government politics and bureaucracy; and 2. To gain the buy‐in of the same sub‐national government politicians and bureaucrats, the designers sought to demonstrate programme performance. The potential for community advocacy for sub‐national adoption and scale‐up was not considered in the design. Therefore, limited involvement of sub‐national governments in the programme design limited sub‐national ownership during implementation. And limited oversight of implementation by sub‐national government policymakers limited programme performance. Conclusion Efforts to promote sub‐national ownership of national initiatives in decentralised health systems should prioritise inclusiveness in design, implementation, and oversight, and well‐resourced community advocacy to sub‐national governments for adoption and scale‐up.

Suggested Citation

  • Uchenna Ezenwaka & Seye Abimbola & Obinna Onwujekwe, 2022. "How (not) to promote sub‐national ownership of national initiatives in decentralised health systems: The free maternal and child health programme in Nigeria, 2008–2015," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(6), pages 3192-3204, November.
    • Handle: RePEc:bla:ijhplm:v:37:y:2022:i:6:p:3192-3204
    DOI: 10.1002/hpm.3548
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hpm.3548
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hpm.3548?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ijhplm:v:37:y:2022:i:6:p:3192-3204. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0749-6753 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.