Politics, the new National Health Act and Local Government Areas


The next few months will be filled with politics in Nigeria. At Nigeria Health Watch, we will focus on keeping health on the political agenda, enabling you, the voter, to ask the right questions on the issues that matter to you. Health and healthcare matters to all of us, and together we must ask our politicians what their plans are for this important sector.


Although the current government appears not to want to make any political capital out of it, the new National Health Act, after ten years in gestation, is one of its key achievements. A major aspect of the act is the clarity it provides on where the responsibility for providing primary healthcare services in Nigeria lies: at the Local Government Area tier of government. If you have read the new National Health Act, you may have noticed that one of the most important contents of the new act is the creation of a new “Basic Health Care Provision Fund”, which will be financed by law through a Federal Government Annual Grant of not less than one per cent of its Consolidated Revenue Fund, plus any other third party funding sources available. The National Primary Health Care Development Agency (NPHCDA) will be responsible for disbursing these funds through State and Primary Health Care Boards to Local Government and Area Council Health Authorities. The new act is also very specific on how the funds will be used, stating as follows:

(a) 50% shall be used for the provision of basic minimum package of health services to citizens, through the National Health Insurance Scheme (NHIS);

(b) 20% shall be used to provide essential drugs, vaccines and consumables;

(c) 15% shall be used for the provision and maintenance of facilities, laboratory, equipment and transport;

(d) 10% shall be used for the development of Human Resources for Primary Health Care; and

(e) 5% shall be used for Emergency Medical Treatment.

These funds will be disbursed directly to LGAs unless a specific state government chooses to take over at least 25% of the total cost of delivering the services listed above. And, by law, the National Primary Health Care Development Agency shall not give out money to any LGA if it is not satisfied that the money earlier disbursed was applied in accordance with the provisions of the act.


This has many implications. An obvious one is that the National Primary Health Care Development Agency has, through the new act, become exponentially more powerful in its ability to act as driver for change in primary health care in Nigeria. To do this effectively, it will need to rapidly scale up its “stewardship” capacity especially around technical supervision, financial management, governance, management and leadership. We will focus on NPHCDA in more depth in a subsequent post.

The most critical institutions to the delivery of primary healthcare as provisioned in the new National Health Act are the LGAs. The 774 LGAs in Nigeria will now have not only the responsibility but also the funding needed to deliver primary healthcare to their people. But as we have learnt in Nigeria, assigning the responsibility and the funding does not necessarily mean that the job will start in the near future.

Local Government is currently perceived as the weakest tier of government in Nigeria. One the reasons for this is the undermining of the role of LGAs by State Governments either not conducting local government elections or manipulating the elections to install stooges of the state governors. Another reason is the excessive influence the states have over the disbursement of funds, from the joint accounts maintained between States and Local Governments, often based on patronage rather than results. In consequence, there is a great deal of variation across states in their capacity for governance at the local government level. With the new act, there is a critical need for resources and expertise to improve the capacity of the Local Government tier to deliver on their new responsibilities in primary healthcare.

You may be wondering why local governments are important in national elections, since local government elections are organised separately. The reason is simple – to hold the LGAs accountable, their State Governments must be accountable. In the coming elections, we must ask the gubernatorial candidates what they plan to do about local government. Just as an example, for all the good work Mr Peter Obi did in Anambra State, the sore point of his era will remain his reluctance to carry out local government elections in his state. We cannot claim to hold democratic ideals when we choose when and where these are practiced.

Finally and most importantly, for the impact of the new National Health Act to be felt, the biggest challenge will not be funding – as there will be guaranteed levels of funding which will increase as the economy grows. It will also not be capacity. While capacity to manage the funds will definitely be a challenge, capacity can be built through deliberate interventions at the state and primary care levels as the PATHS2 programme and many others have worked towards that goal in the past. The most difficult challenge will be whether Nigerians will be able to hold their local and state governments accountable on their responsibilities outlined in the Act, in the presence of so many other existential challenges. The Act makes provision for increased representation and participation of communities in the decision-making processes relating to primary healthcare in-order for them to hold their local and state governments to and make them more responsive to their needs. Primary health care is one problem that money will not solve. Neither will great plans and strategies be the solution, although both of them are needed. The success of primary health care requires the active engagement of the communities for whom healthcare is being provided. It is only by including health in our list of demands and advocacy at the local level that our politicians will find political capital to include health on their political agenda.



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