Aspirations and realities of intergovernmental collaboration in national- level interventions

Insights from maternal, neonatal and child health policy processes in Nigeria, 2009–2019

Datos Bibliográficos

ID21880660
AutoresEnyi Etiaba (0000-0003-0238-950X, University of Nigeria, autor de correspondencia), Ejemai Amaize Eboreime (0000-0001-8277-2570, University of Alberta), Sarah L Dalglish (0000-0002-7218-5193, Johns Hopkins University), Uta Lehmann (0000-0002-2627-8954, South African Medical Research Council)
Año2023
Volumen8
Número2
Páginase010186
Fecha de publicación2023-02-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-010186
PMID36810159
OpenAlexW4321452075
IdiomaEN
Citas recibidas5
Referencias citadas53

In Nigeria’s federal government system, national policies assign concurrent healthcare responsibilities across constitutionally arranged government levels. Hence, national policies, formulated for adoption by states for implementation, require collaboration. This study examines collaboration across government levels, tracing implementation of three maternal, neonatal and child health (MNCH) programmes, developed from a parent integrated MNCH strategy, with intergovernmental collaborative designs, to identify transferable principles to other multilevel governance contexts, especially low-income countries. National-level setting was Abuja, where policymaking is domiciled, while two subnational implementation settings (Anambra and Ebonyi states) were selected based on their MNCH contexts. A qualitative case study triangulated information from 69 documents and 44 in-depth interviews with national and subnational policymakers, technocrats, academics and implementers. Emerson’s integrated collaborative governance framework was applied thematically to examine how governance arrangements across the national and subnational levels impacted policy processes. The results showed that misaligned governance structures constrained implementation. Specific governance characteristics (subnational executive powers, fiscal centralisation, nationally designed policies, among others) did not adequately generate collaboration dynamics for collaborative actions. Collaborative signing of memoranda of understanding happened passively, but the contents were not implemented. Neither state adhered to programme goals, despite contextual variations, because of an underlying disconnect in the national governance structure. Collaboration across government levels could be better facilitated via full devolution of responsibilities by national authorities to subnational governments, with the national level providing independent evaluation and guidance only. Given the existing fiscal structure, innovative reforms which hold government levels accountable should be linked to fiscal transfers. Sustained advocacy and context-specific models of achieving distributed leadership across government levels are required across similar resource-limited countries. Stakeholders should be aware of what drivers are available to them for collaboration and what needs to be built within the system context

Accountability · Business · Centralisation · Collaborative governance · Corporate governance · Economic growth · Economics · Political science · Politics · Public relations · Sociology · Technocracy · Global Health Care Issues · Global Maternal and Child Health · Local Government Finance and Decentralization · Public Administration