Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria.

BACKGROUND: The National Health Insurance Scheme (NHIS) in Nigeria was launched in 2005 as part of efforts by the federal government to achieve universal coverage using financial risk protection mechanisms. However, only 4% of the population, and mainly federal government employees, are currently covered by health insurance and this is primarily through the Formal Sector Social Health Insurance Programme (FSSHIP) of the NHIS. This study aimed to understand why different state (sub-national) governments decided whether or not to adopt the FSSHIP for their employees. METHODS: This study used a comparative case study approach. Data were collected through document reviews and 48 in-depth interviews with policy makers, programme managers, health providers, and civil servant leaders. RESULTS: Although the programme's benefits seemed acceptable to state policy makers and the intended beneficiaries (employees), the feasibility of employer contributions, concerns about transparency in the NHIS and the role of states in the FSSHIP, the roles of policy champions such as state governors and resistance by employees to making contributions, all influenced the decision of state governments on adoption. Overall, the power of state governments over state-level health reforms, attributed to the prevailing system of government that allows states to deliberate on certain national-level policies, enhanced by the NHIS legislation that made adoption voluntary, enabled states to adopt or not to adopt the program. CONCLUSIONS: The study demonstrates and supports observations that even when the content of a programme is generally acceptable, context, actor roles, and the wider implications of programme design on actor interests can explain decision on policy adoption. Policy implementers involved in scaling-up the NHIS programme need to consider the prevailing contextual factors, and effectively engage policy champions to overcome known challenges in order to encourage adoption by sub-national governments. Policy makers and implementers in countries scaling-up health insurance coverage should, early enough, develop strategies to overcome political challenges inherent in the path to scaling-up, to avoid delay or stunting of the process. They should also consider the potential pitfalls of reforms that first focus on civil servants, especially when the use of public funds potentially compromises coverage for other citizens

The Politics of Intergovernmental Relations: Assessing the Many Phases and Challenges of Nigeria’s Judicial System

The judiciary is an important organ of government as it functions as a counterbalancing institution in states. Notwithstanding the nature of the political system in place, either democratic or nondemocratic, the judiciary plays the essential role of interpreting the extant laws and adjudicating between competing interests whether domiciled in individuals, groups, institutions of government or the various arms of government. The stabilising role of the judiciary in modern governance is exemplified by its ingrained function of checking the excesses of individuals, groups and government institutions through the application of state laws. Since Nigeria’s independence, its judiciary has been discharging its constitutional responsibilities. The journey of the Nigerian judiciary has been quite explosive, considering that it traversed both the jackboot of military authoritarianism and democratic governance in diverse forms, with each presenting its own peculiar bouquet of challenges. This chapter examines the various phases and attendant challenges that the Nigerian judiciary has passed through. It chronicles its many challenges and triumphs as well as low points. In sum, the Nigerian judiciary has acquitted itself admirably in dealing with such challenges as judicial independence, judicial accountability and crisis of condence occasioned by judicial recklessness and corruption. However, Nigeria’s judicial system still has room for further improvement in order to continue to command the respect of the citizens and thus, deserve such epithets as “the last hope of the common man”, “the bulwark of the people’s liberty”, “the defender of the rights of the people” and “the bastion of constitutional democracy,” among others, which demonstrate public acceptance and confidence