Resum
Background: Typical of the political structure of the United States of America, Nigeria operates a federal presidential system of government. Political power is shared between the three levels of Federal, State and the Local Governments. The political affairs of the country at these levels are determined by elected politicians from different political parties, with different political and developmental ideologies. This scenario has implications on policy making and implementation especially in the health sector. This paper sought to discuss the type of political structures and institutions and, the effect of these on health policy implementation in selected countries, with emphasis on Nigeria. Current status of financing health care: The National Health Insurance Scheme (NHIS) was launched almost a decade ago but currently covers an estimated four percent of the population, majority of which are in the formal sector. The poor coverage of the scheme in Nigeria has been attributed to the type of political institution and structure it operates. This is evident with examples of some countries in the world; whereas, the scheme in Nigeria was implemented almost at the same time like in neighbouring Ghana, the scheme in Ghana has made a considerable progress. Likewise, prepayment scheme for health in Britain has been in practice for decades, the USA is just currently making progress in the implementation of a nation-wide prepayment scheme despite several years of efforts. It is important to note that Nigeria and the USA has similar political institution and structure different from what Ghana and Britain have in common.
Conclusion: The current low level of coverage of the NHIS in Nigeria is largely due to the type of adopted political institution and structure. The implications of this on the health status of the people and national development cannot be over-emphasized.
Keywords: Health status, NHIS, political institution, political structure, presidential system
Résumé
Contexte: Type de la structure politique des États-Unis d’Amérique, le Nigéria opère un système présidentiel de gouvernement fédéral. Le pouvoir politique est partagé entre les trois niveaux de gouvernement Fédéral, d’État et Local. Les affaires politiques du pays à ces niveaux sont déterminées par les élus politiciens de différents partis politiques, avec différentes idéologies politiques et de développement. Ce scénario a des implications sur l’élaboration et la mise en œuvre des politiques en particulier dans le secteur de la santé. Cet article visait à discuter les types de structures et institutions politiques et, l’effet de ceux-ci sur la mise en œuvre de politique de la santé dans certains pays, en mettant l’accent sur le Nigeria. État actuel des financements de soin de santé: Le projet national d’assurance de santé (NHIS) a été lancé il ya près d’une décennie, mais couvre actuellement environ quatre pour cent de la population, dont la majorité sont dans le secteur formel. La faible couverture du régime au Nigeria a été attribuée au type d’institution et structure politique il opère. Cela est évident avec exemples de certains pays dans le monde; cependant, le régime au Nigeria a été mis en œuvre presque au même temps que le Ghana voisin, le projet a fait un progrès considérable au Ghana. De même, le système de prépaiement pour la santé en Grande-Bretagne a été en pratique depuis des décennies, les Etats-Unis font juste actuellement des progrès dans la mise en œuvre d’un système de prépaiement national, malgré plusieurs années d’efforts. Il est important de noter que le Nigeria et les Etats-Unis ont une institution et structure politique similaire différente de ce que le Ghana et la Grande-Bretagne ont en commun.
Conclusion: Le faible niveau actuel de couverture du projet NHIS au Nigeria est en grande partie dû au type d’institution et structure politique adoptée. Les implications de cette situation sur l’état de santé de la population et le développement national ne peuvent pas être surestimées.
Mots-clés: état de santé, NHIS, institution politique, structure politique, système presidential
Correspondence: Dr. D.A. Adewole, Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan. Nigeria. E-mail: ayodadewole@yahoo. com
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