The JLN and Nigeria
Nigeria’s health sector
Health care in Nigeria is financed through diverse sources that include tax revenue, out-of-pocket payments, health insurance and donor funding. The mechanism for financing the health care system remains a critical factor for reaching UHC. As Nigeria focuses on achieving UHC through primary health care, implementing effective and efficient ways of financing health care services and identifying best practices from across the globe, the JLN is an important learning platform for the country.
Nigeria became a member of the JLN in 2011, with several organizations and the National Health Insurance Scheme (NHIS) taking the lead. The engagement/participation has since expanded to include 37 organizations as of September 2017.
Early JLN experience
2011-2015 served as a learning phase for the JLN in Nigeria. Modupe Ogundimu of the NHIS and Co-Convener of the JLN Steering Group commended NHIS as “The vehicle through which JLN came to Nigeria” in 2011. Many of the lessons learned during this period contributed to the successes the program has experienced. Results achieved during the gestation phase include Nigeria’s active representation at Steering Group meetings, as well as participation in more than 10 joint learning events. These events produced three tools and contributed to the drafting of country priority initiatives.
However, given that the CCG members are full-time employees with limited time to carry out activities for the network, implementing a program that aims to impact millions of people required dedicated personnel for consistent coordination. The World Bank recruited and seconded a learning coordinator in 2015 to support the JLN Nigeria CCG to ensure effective coordination, management and documentation of activities.
Stronger CCG and alignment with the JLN
The JLN in Nigeria now has a strengthened, active and well-represented CCG with basic structure and systems, including an active work plan that tracks progress and features a strategic framework and illustrative results model that led to an increased focus on achieving results. The Nigerian JLN secretariat is moving formally to the Federal Ministry of Health and has expanded to a tripartite core coordination team that includes the National Primary Health Care Development Agency, NHIS and the Federal Ministry of Health, with the requisite approval and support of all the principal managers and chief executives of these agencies, including the minister of health.
Additionally, the JLN in Nigeria has integrated wider UHC stakeholders through various technical and legislative working groups on health care financing. This group has grown from eight people in 2011 to over 80 registered members on the JLN’s online member portal in 2017. With the structure recently put in place by key stakeholders, the CCG meetings and discussions are back on schedule and CCG members are actively utilizing both online and in-person platforms for their deliberations.
Catalyzing change and sustainable outcomes
One of the country-level successes of the JLN in Nigeria is that it informed the design of the nation’s Health Financing Policy and Strategy, which has been widely adopted and validated by health stakeholders in Nigeria. In developing the strategy, Nigeria worked directly with the country leads and, on some occasions, met during and after joint learning exchanges. Further, the World Bank facilitated a training on the leadership required to achieve UHC, which contributed to the synergy and effective collaboration among various stakeholders. These learning opportunities also led to the expansion of the JLN to the sub-national level and the birth of the recently launched legislative learning network for UHC.
Currently, Nigeria is reviewing the NHIS Act, legislation aimed at reducing financial hardship experienced by over 90 percent of citizens who pay out of pocket for health care services. The review is enriched by lessons and inputs from other JLN countries whose evidence of what has worked for them can be adapted. Extending the joint learning network to include the legislative arm means that Nigeria now has many legislators who appreciate UHC goals and are committed to providing the required impetus for easy passage of future health care reform bills.
Looking forward with the JLN
JLN Nigeria has the continued support of its Minister of Health, Professor Isaac Adewole, who views the JLN as an important platform for practitioner-to-practitioner learning for UHC. With this support, Nigeria is emboldened and equipped to reach out to other countries and to use evidence from other JLN countries to improve health care outcomes for its teeming population in 36 states and the federal capital territory as it advances its UHC agenda through primary health care.