SOAS Research Online

Abstract

This PhD study seeks to generate novel insights into how social policy, here in the context of health, has taken form in Nigeria. At the global level, healthcare has been an area of social policy which has received much attention, with African Governments and national and international organisations promoting Universal Health Coverage (UHC) as an important social policy goal. Nigeria offers an interesting case study as it is in the midst of translating its 2014 National Health Act into practice. The Act provides the legal basis for efforts aimed at enabling all Nigerians to access healthcare without financial hardship. Part and parcel of the new law was the establishment of a novel health financing mechanism, the Basic Health Care Provision Fund, put into place to provide sustainable, predominantly public resources for the fast-tracking of UHC. Adopting Fine’s “Systems of Provision” (SoP) approach with its emphasis on assessing country- and system-specific structures, I highlight the complexity of health policymaking and implementation in the Nigerian context. I illustrate how a broad range of various agents – which include Federal, State and Local Governments, health professionals, communities, the civil society, the private sector and international organisations – have impacted the final text of the NHAct (to different degrees) and influence the on-going operationalisation of the BHCPF. My research underscores how the combination of Nigeria’s federal structure, the dominance of the private sector, the widespread disenchantment with the Government in Nigeria as well as competing views and priorities of international organisations continue to influence Nigeria’s perspective in terms of attaining UHC. It also demonstrates how the trajectory of neoliberalism shapes the notion of what universal and integrated social policy is and should entail. In order to generate such insights, material gathered during fieldwork has been triangulated with information gained from various types of documents, including the academic literature as well as strategic, legal and policy documents, action plans, advocacy material of civil society organisations and budget and household survey data.