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Table 1 A simplified illustration of the sharing of health sector responsibilities by the tiers of government in Nigeria

From: The midwives service scheme: a qualitative comparison of contextual determinants of the performance of two states in central Nigeria

Responsibility

Tier of Government

Comment

FG

SG

LG

Health policy making

***

**

—

Whilst the FG leads, SG participate through the National Council on Health

Regulation

Price

***

**

—

FG determines salary scales. SG can decide to adopt it or not. User fees are determined separately by FG and SG

Quality

***

*

—

FG sets health workers training curricula, licenses practitioners, facilities and commodities. SG participates in enforcement

Quantity

**

*

—

FG and SG control location of public sector facilities. There is generally very little control over number of practitioners trained

Resource generation

***

**

*

LG lacks capacity to invest substantially in human capital development and health infrastructure

Planning, budgeting and resource allocation

***

**

*

A substantial share of the FG health budget is spent in providing support to SG and LG

Service provision

Primary Care

*

**

***

Primary care is provided at all levels but most of the primary health care responsibilities lie with the LG

Secondary Care

**

***

—

Secondary care provision also happens at tertiary level health facilities

Tertiary Care

***

**

—

Many SG own tertiary level facilities, typically affiliated to universities as teaching hospitals

Monitoring and evaluation

***

**

**

All tiers have established M&E mechanisms

  1. FG federal government, SG state government, LG local government, *** mostly responsible, ** partly responsible, * minimally responsible, − not responsible. For the purpose of simplicity, the roles played by private sector and donor organisations are excluded from the table
  2. Source: Okpani AI; Abimbola S. 2015 [44]