Employing strategic alliances and unconventional advocacy strategies for health reforms in Nigeria

The Nigerian health system performs poorly even when compared to countries with lower GDP and per capita expenditure on health. Healthcare expenses are largely out-of-pocket and limit access to services as majority of citizens live below the global poverty line. Despite the high cost of care, the health system is poorly managed and lacks the legal framework to ensure effective provision of basic quality care to its citizens.

In order to facilitate the achievement of the country’s health-related goals and ensure sustainable and effective management of health funding, a National Health Bill that will provide a legal framework for the health system was sent to the National Assembly in 2004. After over seven years of protracted hearing and debate about the bill, stakeholders began advocating for its passage with the National Assembly. These engagements were largely non complementary, uncoordinated and ineffective. In 2010, the Partnership for Transforming Health System spear headed the formation of the Health Sector Reform Coalition, an alliance which engaged both Houses of the National Assembly and the Executive through unconventional advocacy mechanisms by working with proxy advocacy agents, building momentum through media channels, and employing multi-layered platforms to educate citizens and other stakeholders on the health bill provisions

These efforts triggered a series of responses on the part of government and culminated into the President’s assent to the Health Bill in October 2014. The Health Act provides a sustainable funding stream, including an annual federal grant of at least 1% of the consolidated revenue fund, and provides a framework for regulating, developing and managing the health sector.

The experience of the coalition underscores the importance of strategic alliances and unconventional advocacy strategies in facilitating health reforms.