Aligning policymaking in decentralized health systems: Evaluation of strategies to prevent and control non-communicable diseases in Nigeria.

Autor:	Ajisegiri WS; The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia., Abimbola S; The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia.; School of Public Health, University of Sydney, Sydney, Australia., Tesema AG; The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia.; School of Public Health, Mekelle University, Mekelle, Ethiopia., Odusanya OO; Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Nigeria., Ojji DB; Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.; University of Abuja, Abuja, Nigeria., Peiris D; The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia., Joshi R; The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia.; The George Institute for Global Health, New Delhi, India.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2021 Nov 10; Vol. 1 (11), pp. e0000050. Date of Electronic Publication: 2021 Nov 10 (Print Publication: 2021).
DOI:	10.1371/journal.pgph.0000050
Abstrakt:	Noncommunicable diseases (NCDs) are leading causes of death globally and in Nigeria they account for 29% of total deaths. Nigeria's health system is decentralized. Fragmentation in governance in federalised countries with decentralised health systems is a well-recognised challenge to coherent national health policymaking. The policy response to the rising NCD burden therefore requires strategic intent by national and sub-national governments. This study aimed to understand the implementation of NCD policies in Nigeria, the role of decentralisation of those policies, and to consider the implications for achieving national NCD targets. We conducted a policy analysis combined with key informant interviews to determine to what extent NCD policies and strategies align with Nigeria's decentralised health system; and the structure and process within which implementation occurs across the various tiers of government. Four inter-related findings emerged: NCD national policies are 'top down' in focus and lack attention to decentralisation to subnational and frontline care delivery levels of the health system; there are defective coordination mechanisms for NCD programmes which are underpinned by weak regional organisational structures; financing for NCDs are administratively burdensome and fragmented; and frontline NCD service delivery for NCDs are not effectively being integrated with other essential PHC services. Despite considerable progress being made with development of national NCD policies, greater attention on their implementation at subnational levels is needed to achieve more effective service delivery and progress against national NCD targets. We recommend strengthening subnational coordination mechanisms, greater accountability frameworks, increased and more efficient funding, and greater attention to integrated PHC service delivery models. The use of an effective bottom-up approach, with consideration for decentralization, should also be engaged at all stages of policy formulation. Competing Interests: The authors declare no competing interest. (Copyright: © 2021 Ajisegiri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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