Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 The Adequacy and Perceived Impact of Nigeria's Health Policy Kennedy Magoma Ongwae Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of thePublic Health Education and Promotion Commons, and thePublic Policy Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Kennedy Ongwae has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Bethe Hagens, Committee Chairperson, Public Policy and Administration Faculty Dr. C.J. Schumaker, Committee Member, Public Policy and Administration Faculty Dr. Melanie Smith, University Reviewer, Public Policy and Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract The Adequacy and Perceived Impact of Nigeria's Health Policy by Kennedy Ongwae MBChB, University of Nairobi, 1994 MPH, University of Dar es Salaam, 2000 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy Administration Walden University May 2017 Abstract From 2004 to 2015, the health sector in Nigeria was substantially underfunded despite the existence of a federal health policy committing 15% of the national budget to health care financing. The purpose of this narrative and phenomenological study was to explore the nature and significance of economic claims made in this policy. The central research question examined the extent to which these economic claims were perceived to be realistic, attainable, and successful in meeting their intended policy objectives and impact. The study’s conceptual framework combined Kingdon’s ambiguity and multiple streams theory, Roe’s narrative policy analysis, and Skocpol’s policy feedback theory. Seventeen major health policy documents and transcripts from key informant interviews with a convenience sample of 15 representative health policy experts, were imported into a data software. Twenty-six nodes were identified and then manually organized into 3 themes to generate the findings. Policy experts perceived the 147 economic claims in the policy documents as marginally realistic, and a majority of these experts assessed the claims as unattainable and with limited chance of succeeding in addressing the underfunding of Nigeria’s health sector. The study opened a new area of research inquiry in health policy and health care financing by linking the veracity of economic claims made in the national health policy with the actual financing of health care. Health policy experts can use study results to promote the formulation and use of evidence-based economic claims in future health policies. Increased use of specific, measurable, attainable, realistic, and time-bound economic claims will enhance future health policy contributions to human wellbeing and positive social change. The Adequacy and Perceived Impact of Nigeria's Health Policy by Kennedy Ongwae MBChB, University of Nairobi, 1994 MPH, University of Dar es Salaam, 2000 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University May 2017 Dedication Dedicated to my dear wife Beatrice Monyenche Motari for encouraging me to register for the PhD; lovely children Moraa Nyatichi Ongwae, Nyamoita Kwamboka Ongwae, Okindo Aondo Ongwae; and caring mother Mary Gesare Ongwae. In memory of my father, the late Nelson Ongwae. Acknowledgments This journey will never have been without the unfailing protection from the Almighty God, who kept me in good health, and protected my family as I pursued the doctoral studies. I wish to sincerely express my gratitude to Dr. Elizabeth Hagans, for agreeing to be my chair when we met during my first residency, for keeping the faith in me, and for technically and professionally holding my hand all through the dissertation process. Similarly, I would like to extend my appreciations to Dr. C.J. Schumaker Jr., my committee member for the unfailing and prompt feedback that enabled me to move my dissertation to the next level every time I received the inputs. To Dr. Melanie Smith, University Research Reviewer, thank you. You all made my dissertation process smooth and more than worth the time and resources put into it. I would like to thank my colleagues Dr. Boniface Kalanda, Charles Nzuki, and Sam Too for the encouragement to pursue and get done with the studies. I would like to thank Dr. John Onyeokoro for helping me access many of the policy and strategy documents from the Federal Ministry of Health in Nigeria, Dr. Garba Safiyanu, Dr. Fatima Cheshi, and Ms. Josephine Okide for following up on my study’s ethical clearance in Abuja, Nigeria. The study would never have taken shape without the cooperation, time, and information obtained from the 15 health policy experts in Nigeria who served as my study key informants. Last but not least, I would like to thank the management of UNICEF for granting me study days every time I traveled to the U.S for the residency program. Table of Contents List of Tables .......................................................................................................................v List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background ....................................................................................................................2 Problem Statement .........................................................................................................4 Purpose of the Study ......................................................................................................5 Research Questions ........................................................................................................5 Conceptual Framework ..................................................................................................6 Nature of the Study ........................................................................................................7 Definitions......................................................................................................................8 Assumptions ...................................................................................................................9 Scope and Delimitations ..............................................................................................11 Limitations ...................................................................................................................13 Significance..................................................................................................................15 Summary ......................................................................................................................16 Chapter 2: Literature Review .............................................................................................18 Introduction ..................................................................................................................18 Literature Search Strategy............................................................................................19 Conceptual Framework ................................................................................................21 Organizational Theory .......................................................................................... 22 i Kingdon’s Ambiguity and Multiple Streams Theory ........................................... 23 Policy Feedback Theory ....................................................................................... 24 Narrative Policy Framework ................................................................................. 26 Departments and Programs of the Federal Ministry of Health Nigeria .......................29 Health Policy Actors ....................................................................................................34 Awareness on the Health Policy ..................................................................................34 Health Care Financing in Nigeria ................................................................................35 Claims Made in Health Policies ...................................................................................37 Summary and Conclusions ..........................................................................................39 Chapter 3: Research Methods ............................................................................................40 Introduction ..................................................................................................................40 Research Design and Rationale ...................................................................................41 Role of Researcher .......................................................................................................43 Methodology ................................................................................................................44 Participant Selection Logic ................................................................................... 44 Instrumentation ..................................................................................................... 46 Data Analysis Plan ................................................................................................ 47 Issues of Trustworthiness .............................................................................................49 Ethical Procedures ................................................................................................ 51 Summary ......................................................................................................................52 Chapter 4: Results ..............................................................................................................53 Introduction ..................................................................................................................53 ii The Setting ...................................................................................................................54 Demographics ..............................................................................................................55 Data Collection ............................................................................................................55 Data Analysis ...............................................................................................................57 Evidence of Trustworthiness........................................................................................58 Coding of the Key Informants .....................................................................................60 The Health Policy Documents .....................................................................................61 Economic Claims on Increasing the Financing of Health Care in Nigeria ..................62 Content Analysis of the Health Policy Documents............................................... 62 Perceptions of the Key Informants on the Economic Claims ............................... 65 Economic Claims on Prudent Use of Resources for Health Care ................................74 Content Analysis of the Health Policy Documents............................................... 74 Perceptions of Key Informants on the Economic Claims ..................................... 76 Economic Claims on Protecting Beneficiaries against Financial Costs ......................83 Content Analysis of the Health Policy Documents............................................... 83 Perceptions of Key Informants on the Economic Claims ..................................... 84 Summary ......................................................................................................................92 Chapter 5: Discussion and Recommendations ...................................................................95 Introduction ..................................................................................................................95 Interpretation of the Findings.......................................................................................96 Formulation and Implementation of Health Policy .............................................. 96 Perceptions on Increasing Health Care Financing ................................................ 98 iii