Developing integrated and decentralised health systems

Nana Enyimayew and Andrew Mckenzie, 2008

Institutional weaknesses in the Nigerian health system are undermining efforts to improve services. Health services remain fragmented among multiple health providers which include local government, state, federal, faith-based and private for-profit organisations. Overlap in service provision between private and public sectors has resulted in wasteful duplication. Many health programmes are organised along vertical lines resulting in poor integration and limited coordination between them. In addition to poor structure, the public health sector faces shortages of staff, equipment and supplies while health facilities need rehabilitating. As a result, the quality of health services in Nigeria is often low. Communities have little confidence in the system and utilisation is poor.

This paper looks at how the Partnership for Transforming Health Systems (PATHS) programme supported several Nigerian states in addressing these difficulties. Developing an integrated health system was a cornerstone of the reform strategy. It also explores the importance of encouraging each state to consider models and approaches appropriate to its own context: no single size fits all states in Nigeria.

Produced as part of the Partnership for Transforming Health Systems (PATHS) programme.