Governance Coordination, Financing Reform, and Equity-Targeted Interventions as Structural Determinants of Health System Performance in Southwest Nigeria: A Convergent Mixed-Methods Study

IF 2.5 4区医学 Q3 HEALTH POLICY & SERVICES

International Journal of Health Planning and Management Pub Date : 2026-09-08 Epub Date: 2026-07-24 DOI:10.1002/hpm.70107

Babatunde Folorunso Kolajo, Johnson Olusola Olaosebikan, Henry Inegbedion

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Abstract

Background

Improving health system performance in decentralised settings requires coordinated governance structures, sustainable financing mechanisms, and targeted equity policies. However, empirical evidence on how these institutional mechanisms interact to influence service delivery, financial protection, and equitable access remains limited in many low- and middle-income countries.

Methods

This study examined the determinants of health system performance in Southwest Nigeria using cross-sectional survey data collected from health sector stakeholders. Robust ordinary least squares regression models with heteroskedasticity-consistent standard errors were estimated to assess the relationships between governance coordination, financing reform implementation, equity-targeted interventions, and three performance outcomes: service delivery effectiveness, financial access protection, and equitable access to care. State fixed effects and stakeholder and organizational controls were included in all models.

Results

Governance coordination demonstrated a significant positive association with service delivery effectiveness in the baseline model (β = 0.295, p < 0.01). Financing reform implementation was strongly associated with improved financial access protection (β = 0.311, p < 0.01), while equity-targeted interventions exhibited the strongest and most consistent relationship with equitable access outcomes (β = 0.335, p < 0.01). Expanded institutional models revealed that public trust was positively associated with multiple performance indicators, whereas corruption displayed a negative relationship with financial protection and service delivery outcomes.

Conclusion

The findings suggest that health system performance improvements are driven by the combined effects of governance coordination, pooled financing mechanisms, and equity-focused policy interventions operating within supportive institutional environments. Strengthening intergovernmental coordination, expanding financial risk-pooling arrangements, and prioritising targeted equity policies may substantially enhance progress towards universal health coverage in decentralised health systems.

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治理协调、融资改革和以公平为目标的干预措施是尼日利亚西南部卫生系统绩效的结构性决定因素：一项融合混合方法研究。

背景：在分散环境中改善卫生系统绩效需要协调的治理结构、可持续的融资机制和有针对性的公平政策。然而，在许多低收入和中等收入国家，关于这些体制机制如何相互作用以影响服务提供、财政保护和公平获取的经验证据仍然有限。方法：本研究使用从卫生部门利益相关者收集的横断面调查数据，检查了尼日利亚西南部卫生系统绩效的决定因素。估计具有异方差一致标准误差的稳健普通最小二乘回归模型，以评估治理协调、融资改革实施、以公平为目标的干预措施与三个绩效结果之间的关系：服务提供有效性、金融获取保护和公平获得医疗服务。所有模型都包括状态固定效应、利益相关者和组织控制。结果：在基线模型中，治理协调与服务提供效率呈显著正相关（β = 0.295, p）。结论：研究结果表明，卫生系统绩效的改善是由治理协调、集中融资机制和在支持性制度环境中运作的以公平为重点的政策干预的综合效应驱动的。加强政府间协调，扩大财政风险分担安排，并优先考虑有针对性的公平政策，可能会大大促进在分散的卫生系统中实现全民健康覆盖的进展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Health Planning and Management Multiple-

CiteScore

4.50

自引率

3.70%

发文量

197

期刊介绍： Policy making and implementation, planning and management are widely recognized as central to effective health systems and services and to better health. Globalization, and the economic circumstances facing groups of countries worldwide, meanwhile present a great challenge for health planning and management. The aim of this quarterly journal is to offer a forum for publications which direct attention to major issues in health policy, planning and management. The intention is to maintain a balance between theory and practice, from a variety of disciplines, fields and perspectives. The Journal is explicitly international and multidisciplinary in scope and appeal: articles about policy, planning and management in countries at various stages of political, social, cultural and economic development are welcomed, as are those directed at the different levels (national, regional, local) of the health sector. Manuscripts are invited from a spectrum of different disciplines e.g., (the social sciences, management and medicine) as long as they advance our knowledge and understanding of the health sector. The Journal is therefore global, and eclectic.