Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria
Cross-programmatic inefficiencies are duplications or misalignments that arise from undue fragmentation of health systems by vertical health programs. Identifying and addressing the root causes of cross-programmatic inefficiencies in a health system can ensure more efficient use of resources to make...
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Taylor & Francis Group
2024-12-01
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| Series: | Health Systems & Reform |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/23288604.2024.2441533 |
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| author | Obinna Onwujekwe Uchenna Ezenwaka Prince Agwu Chukwudi Nwokolo Francis Ukwuije Alexandra J. Earle Agnes Gatome-Munyua Susan Sparkes |
| author_facet | Obinna Onwujekwe Uchenna Ezenwaka Prince Agwu Chukwudi Nwokolo Francis Ukwuije Alexandra J. Earle Agnes Gatome-Munyua Susan Sparkes |
| author_sort | Obinna Onwujekwe |
| collection | DOAJ |
| description | Cross-programmatic inefficiencies are duplications or misalignments that arise from undue fragmentation of health systems by vertical health programs. Identifying and addressing the root causes of cross-programmatic inefficiencies in a health system can ensure more efficient use of resources to make progress toward Universal Health Coverage. This paper examines the root causes of cross-programmatic inefficiencies related to governance and financing in the state health system of Anambra in southeast Nigeria. Data were collected from 38 in-depth interviews and four focus group discussions and analyzed thematically. The governance- and finance-related cross-programmatic inefficiencies identified were duplicative and misaligned roles within and between state and federal agencies, functions, and activities within and across health programs; misaligned donor priorities with that of the state; and poor formulation and implementation of the approved annual state health budget. The root causes of governance and financing cross-programmatic inefficiencies included weak policy development, communication, and enforcement; excessive influence of external donors and the federal government; weak accountability mechanisms affecting program coordination and service delivery; and a disharmony between state priorities and objectives with planning, budgeting, and execution of the budget. Addressing the root causes of cross-programmatic inefficiencies has the potential to significantly improve the overall efficiency and performance of the health system to contribute to improved health outcomes in Anambra state. This approach can serve as a model for other states and regions facing similar challenges. |
| format | Article |
| id | doaj-art-bd4d232be47e419dba47ba3dde892dea |
| institution | DOAJ |
| issn | 2328-8604 2328-8620 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Health Systems & Reform |
| spelling | doaj-art-bd4d232be47e419dba47ba3dde892dea2025-08-20T03:12:50ZengTaylor & Francis GroupHealth Systems & Reform2328-86042328-86202024-12-0110310.1080/23288604.2024.2441533Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, NigeriaObinna Onwujekwe0Uchenna Ezenwaka1Prince Agwu2Chukwudi Nwokolo3Francis Ukwuije4Alexandra J. Earle5Agnes Gatome-Munyua6Susan Sparkes7Health Policy Research Group and Department of Health Administration and Management, University of Nigeria, Enugu, NigeriaDepartment of Health Administration and Management, University of Nigeria, Enugu, NigeriaSchool of Humanities, Social Sciences, and Law, University of Dundee, Dundee, UKDepartment of Economics/Centre for Entrepreneurship and Development Research, University of Nigeria, Enugu, NigeriaWorld Health Organization (WHO), Abuja, NigeriaWorld Health Organization (WHO), HQ, Geneva, SwitzerlandResults for Development, Nairobi, KenyaWorld Health Organization (WHO), HQ, Geneva, SwitzerlandCross-programmatic inefficiencies are duplications or misalignments that arise from undue fragmentation of health systems by vertical health programs. Identifying and addressing the root causes of cross-programmatic inefficiencies in a health system can ensure more efficient use of resources to make progress toward Universal Health Coverage. This paper examines the root causes of cross-programmatic inefficiencies related to governance and financing in the state health system of Anambra in southeast Nigeria. Data were collected from 38 in-depth interviews and four focus group discussions and analyzed thematically. The governance- and finance-related cross-programmatic inefficiencies identified were duplicative and misaligned roles within and between state and federal agencies, functions, and activities within and across health programs; misaligned donor priorities with that of the state; and poor formulation and implementation of the approved annual state health budget. The root causes of governance and financing cross-programmatic inefficiencies included weak policy development, communication, and enforcement; excessive influence of external donors and the federal government; weak accountability mechanisms affecting program coordination and service delivery; and a disharmony between state priorities and objectives with planning, budgeting, and execution of the budget. Addressing the root causes of cross-programmatic inefficiencies has the potential to significantly improve the overall efficiency and performance of the health system to contribute to improved health outcomes in Anambra state. This approach can serve as a model for other states and regions facing similar challenges.https://www.tandfonline.com/doi/10.1080/23288604.2024.2441533Anambra stategovernancehealth financinghealth system reforminefficiencyNigeria |
| spellingShingle | Obinna Onwujekwe Uchenna Ezenwaka Prince Agwu Chukwudi Nwokolo Francis Ukwuije Alexandra J. Earle Agnes Gatome-Munyua Susan Sparkes Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria Health Systems & Reform Anambra state governance health financing health system reform inefficiency Nigeria |
| title | Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria |
| title_full | Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria |
| title_fullStr | Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria |
| title_full_unstemmed | Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria |
| title_short | Assessing Root Causes and Solutions to Address Cross-Programmatic Inefficiencies in a Subnational Health System: A Case Study of Anambra State, Nigeria |
| title_sort | assessing root causes and solutions to address cross programmatic inefficiencies in a subnational health system a case study of anambra state nigeria |
| topic | Anambra state governance health financing health system reform inefficiency Nigeria |
| url | https://www.tandfonline.com/doi/10.1080/23288604.2024.2441533 |
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