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

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

Responsibility		Tier of Government			Comment
Responsibility		FG	SG	LG	Comment
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

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
Source: Okpani AI; Abimbola S. 2015 [44]

ISSN: 2397-0642