By Ijeoma Okedo-Alex, Ifeyinwa Akamike, Gladys Olisaekee, Chinyere Okeke, Chigozie Uneke
In Nigeria, domestic funding for health policy and systems research (HPSR) is inadequate and basically non-existent. Although a national health research agenda exists in the country, it lacks funding for its implementation as only 0.08 per cent of the national health expenditure at the federal level is allocated to research. There is hardly any domestic funding for research at the sub-national level, with very poor private investment in health research and development. Most funding for HPSR comes from donors to individuals and institutions in Nigeria.
Since HPSR started gaining ground in Nigeria in 2009, researchers have had to rely on external grants and scholarships to be able to carry out research in this area. Sources of funding for research (HPSR inclusive) in Nigeria include the Tertiary Education Trust Fund (TETFUND) and grants from private foundations/organizations, however domestic funding remains inadequate to address the myriad of health system needs in the country. Prioritizing funding for HPSR is vital to strengthening the health system and achieving sustainable development.
In a bid to identify advocacy strategies and relevant stakeholders to increase domestic funding for HPSR in Nigeria, Health Systems Global (HSG), through its Africa Regional Network, organized a one-day sub-national convening in partnership with the African Institute for Health Policy and Health Systems (AIHPS), also supported by K2P Centre, American University of Beirut (AHPSR/WHO-BIRD Project). The convening, the first of its kind in Nigeria, was in response to a call for convening proposals by Africa HSG regional network in line with the subthemes for the Sixth Global Symposium on Health Systems Research (HSR2020) and the HSG Africa priority areas. This convening addressed the first HSR2020 sub-theme – ‘Engaging political forces’ – and advocating for increased domestic funding for research, which is one of the priority areas for the HSG Africa network.
The event – held on 4 August 2020 at the San Diego hotel, Abakaliki in Nigeria’s southeast region – brought together policymakers (career policymakers, political policymakers and parliamentarians), global health practitioners, health professionals, NGO representatives and HPSR researchers from Enugu and Ebonyi States in Nigeria’s Southeast. The convening included capacity-building sessions, panel sessions, group work and breakout sessions on stakeholder identification and analysis, innovative platforms and strategic opportunities for advocacy on increased domestic funding for HPSR in Nigeria.
Speaking against the backdrop of ways to improve domestic funding for HPSR, Dr Sunday Nwangele, Commissioner for Donors and Grants in Ebonyi State (formerly Commissioner for Health), said “There is need for governments to have HPSR priorities, with active engagement of HPSR researchers from conceptualization.” He also said it was important for “… researchers to align with these research priorities such that, policymakers will be begging for the results. With this demand in place, there will be willingness to fund HPSR.”
A strong case was made for the role of capacity building by Dr David Ogbuabor, a former parliamentarian in Enugu State who is actively involved in HPSR. He stated that “Capacity building in HPSR for policymakers and citizens is an advocacy strategy, as this will improve the understanding and importance placed on HPSR funding and inclusion in the budget.”
Capacity building in HPSR should target government stakeholders and Departments of Planning Research and Statistics (DPRS) in both health and non-health Ministries/agencies, as the R (for research) has been missing in these departments. Dr David Ogbuabor also made a call for building the capacity of citizens to empower them to demand action and accountability on HPSR funding.
Dr Tina Nweze, a member of the Fiscal Responsibility Commission, stressed the need to build the capacity of those who prepare budgets, as the usual practice is to copy and paste the old budget even if the old budget does not include HPSR.
On advocacy groups and platforms, Dr Sunday Nwangele, advocated for inter-professional and intersectoral advocacy groups. He said “Professional bodies of health providers with other sectors should overlook differences and coalesce to form advocacy groups for key platforms, such as the Nigeria Governors’ Forum, to insist on the importance of funding HPSR and the use of evidence in policymaking.”
Another area discussed in the conference was directing advocacy towards making HPSR a higher priority among stakeholders in the health sector. Dr Christian Achi, the Permanent Secretary of the Ebonyi State Ministry of Health (MOH), spoke during the panel discussions on ‘what worked, didn’t work and can work in the HPSR funding space’ and stated that “Nobody takes HPSR funding as a priority. It is not usually represented in the budget and it is difficult to make progress without it. We should target advocacy at getting policymakers to prioritize HPSR in order for them to fund it.”
As the lead facilitator for the capacity building sessions, Prof Jesse Uneke, who serves as the Founder/Director of the AIHPS and the Deputy Vice-Chancellor (academics), Ebonyi State University, Abakaliki, Nigeria, stated “We should quit emphasizing that funding is not enough because this is a universal problem. Rather, we should focus on how to prioritize and maximize the existing funds to finance HPSR in Nigeria and this is where targeted advocacy comes in.”
With more calls for HPSR funding to be taken more seriously, participants resolved to target advocacy for HPSR inclusion into the subnational and national budgets at different phases. These phases include: planning (budget capturing); public hearings by the legislature; and appointing a desk officer for HPSR at the MOH who would ensure HPSR is captured in annual budget estimates. Participants reiterated the importance of continuous advocacy to ensure that budgeting transits to funding release, implementation, and partnership with private sector for funding of HPSR.
Overall, the convening was successful in meeting the convening team’s expectations. The identified advocacy strategies will be deployed in influencing stakeholders at the national and sub-national levels towards providing adequate funding for HPSR in Nigeria. In addition, the AIHPS mentorship program will provide mentorship and technical support for advocacy groups to achieve these strategies.
The conveners, in close partnership with AIHPS, will also contribute to addressing the identified gaps that influence HPSR funding, such as poor demand, absence of HPSR priority setting, low capacity for evidence generation and use, and bridging the researcher-policymaker gap.
It is hoped that all of these actions will improve domestic HPSR funding, demand, ownership and use of evidence in policymaking in Nigeria, as well as nip the overdependence on donor funding for HPSR in the bud.