The Contextual Setting of Health Care Prioritization in Nigeria

Although several different approaches to priority setting in health care, have been used throughout the world little is known about the process of prioritization in Low and Middle-Income Countries (LMICs).This study assesses the process of health prioritization in a LMIC, using Nigeria as a case study.It specifically looks at the context in which Nigerian's health policies are implemented and resources distributed.Semi-structure interviews were used to elicit responses from policy-makers on the process of health care prioritization.These responses were then analysed thematically in an iterative process.Participants (n=22) were interviewed from the three tiers of the health system as well as from the private sector.The findings are grouped under three main themes: the organizational context; the financial context; and the political context.It was suggested from the findings, that though organizational frameworks and structures for prioritization existed, the political context exerted a much higher influence in determining the outcome of the process.Another key issue was the limited operationalization of roles and responsibilities as defined by law in the organization and structure of the health system.To achieve an efficient and equitable health systems, health care policymakers should be prepared to actively engage with all stakeholders, particularly the political stakeholders, to understand the underlying influences leading to the set political agenda for health.