Legislators and Advocates at a health summit in Nigeria have adjudged the use of data-driven, evidence-informed advocacy models at a formal gathering as the most an effective way of influencing legislators to increase health sector funding in Nigeria.

In a post-survey conducted by the development Research and projects Center (dRPC), under the Partnership for Advocacy in child and family health at Scale project (PACFaH@Scale or PAS), during the 3rd summit by the Legislative Network for Universal Health Coverage (LNU), an initiative of Nigerian Lawmakers in the health committees at the National and States levels, held in Abuja from 13th-15th of November 2019, legislators believe that they are likely to increase health sector budgets if they are sensitized at formal gatherings to understand the impact of adequate health sector funding on their constituents and their prospective electoral values.

The 3rd LNU summit is an annual think tank gathering that brings about all lawmakers in the committees on health at the National Assembly, including Speakers at the national level and state levels, Clerks of the National and States Assemblies, as well as members of the health committees at the 36 state house of Assembly in Nigeria. Civil society organizations, donor agencies, heads of various health-related MDAs from across the 36 states and the FCT, and other government officials are members of the summit and they gather each year to deliberate and share experiences, synthesize lessons to guide the implementation of the BHCPF policy towards the achievement of UHC across Nigeria.

Overview

The summit started on the 13th day of November with a presentation on the status of health in Nigeria by the FMoH Departments and Agencies, followed by a plenary session. In day two, the morning session featured an address on finding solutions to healthcare financing for the achievement of UHC by the Senior Executive class 41 of NIPSS, the address was made possible by the efforts of dRPC-PAS. The evening session also powered by the dRPC-PAS was on ways of building and harnessing the human capital development necessary for the achievement of UHC. The 3rd day of the summit featured a technical session on health financing in Nigeria and the implementation status of the BHCPF policy by the FMoH representatives and development partners. The workshop was adjourned following the issuance of a communiqués and development of a 4-year National Legislative Health Agenda and Strategic Framework.

dRPC-PAS administered questionnaires to all the 200 participants to collect information that will form the basis for future engagement and advocacy to the legislators at the states and national level.

The Evaluation Findings

Evaluation Findings:

Analysis of responses generated through the questionnaires revealed the following:

Out of the 200 administered questionnaires, 117 were returned completed, making the response rate to be 59%.

Socio-demographic distribution of the respondents showed:

Sex: 86 Males (74%) and 31 females (26%)
Age: Respondents ≥ 60 years were 26 (22%), 59-40 years were 71 (61%) and 39-20 years were 20 (17%) and none of the respondents were ≤ 19 years.
Educational level: 66 (56%) respondents have master’s degree or its equivalent, 35 (30%) have a first degree, while 15 (13%) respondents possess Ph.D., 1 respondent with the technical level of education and none with secondary school certificate as their highest.
Profession: 52 (44%) of the respondents were Government officials, while 16 (14%) were politicians, 15 (13%) were legislators, 8 (7%) have media as a profession, 12 (10%) respondents identified as development workers (6 local and 6 international), 5 (4%) respondents identified as independents, 2 (2%) educators, 1 respondent equivalent to 1% identified as a diplomat , 2 (2%) academics, and 1 (1%) analyst.

Findings

• 85% of the respondents agreed that advocacy is effective in influencing increased health financing. The above response also supports the following findings in this survey:
• 48% of the respondents adjudge the use of data-driven, evidence-informed advocacy models at formal gatherings like the recently held summit as the most effective way of influencing legislators to increase health sector funding. Also, 21%of the respondents believe legislators are likely to increase health sector budgets, if they are sensitized at formal gatherings to understand the impact of adequate health sector funding on their constituents and their prospective electoral values
• Similarly, 47% believe the executives could be influenced to increase the health sector budget through evidence-based advocacy engagements with sensitization on the burden of diseases and other health conditions in Nigeria.
• Both sexes agreed the use of evidence on diseases burden in Nigeria is the best advocacy tool for the executives. Also, a cross-analysis of the data showed more females (5%) believe the use of data on budget performance reviews and the analysis could is a better advocacy tool than the rest.
• Both sexes have a consensus on the use of data-driven, evidence-informed advocacy strategy as the most effective means of advocating the legislators to increase funding to the health sector
• 68% of the respondents believed that the most important health stakeholders with the capacity to influence Legislators’ view on healthcare financing was at the summit. The above findings underscore the number and magnitude of the health sector influencers in attendance at the summit to guide and support the participants on how best to cascade the lessons of the conference in their various states. More so, the response above supports the belief held by more than half (52% and 58%) of the respondents on the greater roles NGOs play in conducting budget performance review and to generate evidence for advocacy and attend budget public hearings to strengthen accountability and inclusive participation respectively.
• Approximately 2 out of three (74%) of the respondents believed the data presented at the the workshop will be an effective tool to influence legislators present at the workshop to increase the FG 2020 health budget
• More than 2/3rd of the respondents, 78%, of the respondents believed health budgets have a direct effect on the economy. The higher the health sector budgetary allocation, the higher the health status of the citizenry and in effect, the more productive the populations are bound to be. Also, on that note, 70% and 55% of the respondents believe NGOs have a greater role to play in mobilizing and educating the public on budgetary allocations, and tracking budgetary releases to MDAs respectively
• 81% of the respondents networked with others at the summit to foster peer-review learning on best practices and challenges
• Poor accountability and transparency coupled with the obligation of all MDAs to remit all unspent funds from the health sector back to the federation account at the end of the year despite passing the budget late, were adjudged (56% and 32% respectively) by the respondents as the leading reasons why the FG was unable to increase the % allocation to the health sector in the 2020 budget above the amount allocated in 2019
• 40% of the respondents believe untimely releases to the health sector are caused by Delays in the preparation, presentation, deliberation, and passage of budgets complicated by bureaucratic bottle necks affecting the budget calendar; 18% believe it is as a result of low Government revenues and unrealistic fiscal planning, 13% believe it is due to inadequate political will from the government, while 11% believe it is from competing government priorities and demands and 15% were not sure why. With the new efforts made by the executives and NASS to have the 2020 budget passed before December 2019, it could be the end of the short budget calendar drawback.
• 7% of the respondents encourage the use of data on budget performance reviews and analysis for advocacy to the executives and 5% suggested that FG should strengthen accountability and transparency mechanisms in the health sector to improve resources mobilization and utilization, while 4% believe the government should explore other innovative healthcare financing mechanism with more private sector involvement
• And, 9% of the respondents believe supporting and strengthening the oversight responsibility of the legislature could convince them to increase funding to the health-sector, while 6% of the respondents believe the legislators could be convinced to increase health sector funding through sustained public enlightenment and campaigns by CSO on health sector budget analysis and health indices

Outcome(s)

• Consensus built on Strategic Framework for the National Legislative Health Agenda focusing on efficiency and effectiveness
• Year 2020 activity work plan framework for NASS and state legislator
• Communiqué of action (link to communiqué)
• Increased knowledge and advocacy skills for PAS-CSOs in attendance
• Attainment of the strategic position of leverage by dRPC-PAS in building champions within the executives and the legislature

Conclusion

It is apparent from the workshop and survey that the use of evidence-informed, data-driven advocacy model at formal gatherings remain the most effective advocacy tool to engage and convince duty bearers at all levels to increase health sector budgetary allocation and releases. This further buttress why dRPC-PAS adopted the use of evidence gathered through research for advocacies to relevant government MDAs as the best advocacy model

Recommendations

The quality assurance tool needs to be updated and validated, so vital research information like the data from this the conference could be refined and published in journals
LISDEL to make more efforts in bringing federal executives on board as participants in subsequent workshops to foster synergistic actions
Use of evidence gathered from this survey to better inform subsequent engagement between dRPC-PAS and other legislative stakeholders

Next Steps:

• Attend post-workshop review meeting with LISDEL and other partners
• Synthesize lessons learned from the survey to improve the quality and outcomes of advocacy visits conducted by PAS-CSOs

For the full report, please click here

PHOTO GALLERY OF 3RD ANNUAL SUMMIT OF LEGISLATIVE NETWORK FOR UHC AT TRANSCORP HILTION, FCT ABUJA