Social Accountability in Nigeria's Health Sector

Social accountability as a means of promoting good governance for access to drugs in the health sector in Nigeria

Summary:

Governance of primary, secondary and tertiary facilities in Nigeria includes participation (through Town Hall style meetings) by local community members in Ward/Health Facility Committees (HFCs) and Hospital Boards. This is intended to make facilities more accountable and responsive to the local communities they serve.

We believe that if we can understand the linkages between facility governance structures and town hall meetings we can shed light upon how social accountability systems reduce the space for corrupt activities and help strengthen health sector governance. We anticipate we will find differences in how these mechanisms operate at each level of the health system (primary, secondary, tertiary) and these will impact on the responsiveness of providers to issues raised at town hall meetings.

The corruption issue:

Access to affordable medicines in Tanzania, Nigeria and Bangladesh is known to be poor. There are many reasons, but among them is the presence of corruption at all levels of the supply chain. Each country has nascent mechanisms in place to provide a degree of social accountability, mechanisms that, if effective, should reduce the space for corrupt behaviours (and from incompetence and inefficiency that compound the problem). Yet these mechanisms are often weak.

Theory of change:

  • IF we can strengthen Local Health Facility Committees with wider representation of the communities that they serve through the established Town Hall style meetings, and implement score cards or similar real time monitoring systems to track the performance of different health facilities in terms of accessible and appropriate drug supply chains
  • THEN we will be able to improve access to essential medicines by reducing corrupt practices that lead to over-pricing of state-procured drugs and inefficient procurement procedures in state facilities
  • BECAUSE increased accountability will remove a major barrier to the dependable supply of affordable medicines

Research methods:

The research will combine qualitative and quantitative methods such as: focused literature/document reviews, consensus building techniques, qualitative and key informant interviews and focus group discussions, retrospective and prospective analysis of public hearings, questions will be incorporated in the quantitative provider survey of 400 households. In Nigeria the study will be conducted in the South-east region and also in the Federal Capital, Abuja.

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