Strengthening the Primary Care Delivery System: A Catalytic Investment Toward Achieving Universal Health Coverage in Nigeria

A Framework for Implementation Conclusion References Nigeria, with its current population estimated at 184 million people (accounting for 20% of the African population), has 36 states and 774 local government areas (LGAs). The country operates a presidential system of governance. Health care provision is a responsibility of all three tiers of government, with federal government primarily responsible for tertiary health care, state government responsible for secondary care, and local government authority responsible for primary health care. Over the years, successive governments have not paid desired attention to primary health care as a gateway to accessing health care delivery in the country. Nigeria devolved primary health care services to the LGAs in the late 1980s, but the local government structure had little capacity for governance and resource mobilization, with weak absorptive capacity to manage allocated resources and take on an implementation role. In 1992, the National Primary Healthcare Development Agency was established to represent the federal government’s support to primary health care with a mandate to provide technical assistance to states for primary health care development, planning, management, monitoring and evaluation, and mobilization of national and international resources. Management of Nigeria’s primary health care system has been fragmented with the involvement of different stakeholder institutions. This has included federal institutions— the Federal Ministry of Health and National Primary Healthcare Development Agency—and state and local government platforms: the State Ministry of Health, Local Government Service Commission, Local Government Council, and Local Government Health Department/Local Government Primary Health Care Authority individually responsible for provision of services, recruitment, retention and deployment of staff, mobilization and allocation of funds, development of support Received 18 July 2016; revised 2 September 2016; accepted 2 September 2016. *Correspondence to: Isaac F. Adewole; Email: ifadewole@yahoo.co.uk Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/khsr.