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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]