Health and the Legislature: The Case of Nigeria

Health Politics—Engagement, Alignment, and Mobilization of Political Will and Legislative Functions How Legislatures’ Strengthened Engagement Is Working in Nigeria Next Steps: Growing the Economy to Strengthen Health Care References What can political actors do to strengthen the health system and, conversely, how can ministries of health ensure that the political actors do that? Politics and health are intertwined: Obamacare and the National Health Service were major issues in the most recent US and UK elections, with each party promising to increase access to quality health care. In Nigeria, too, politicians at all levels of government promise their constituents better access. Nonetheless, over a quarter of the 201,000 sub-Saharan African women who die in childbirth are Nigerian, only 15% of the 407,000 Nigerians with tuberculosis have been identified, and immunization rates vary from 10% to 80% across Nigerian states. The country’s health system is financially and managerially overwhelmed by various disease burdens. Despite the great need for public resources, the budget allocation to health has fallen every year, from 6.2% of the total budget in 2015 to a proposed 3.9% for 2018. This forces Nigerians to pay for their own care, which is often of mediocre quality and risks pushing many of them further into poverty. Though weaknesses in health financing and governance are known contributors to the current state of Nigeria’s health system, this commentary looks beyond the health sector to discuss what an underutilized yet critical group of non-health actors—specifically, the legislature—can do to improve the functioning of the health system. A country health system that fulfills its responsibilities to citizens cannot function in isolation—it needs good governance in terms of policy making, appropriations, oversight, and accountability mechanisms. That is, democratically elected governments/legislatures must pass informed policies and laws that govern the health system and allocate adequate resources to a ministry of health. The responsibility of oversight—ensuring that those resources are spent efficiently and effectively on the elected government’s priorities—belongs to the arms of government that can call ministries or associations to account. Failure of a health system in a democracy should have consequences through accountability mechanisms both within government, such as elections, and outside of government,