Short-termism: The bane of health sector development in Nigeria

We all love quick wins. Quick wins represent our aspiration of implementing interventions that are relatively easy to achieve and hopefully impactful. Short-termism is a situation where the focus is on short-term results at the expense of long-term interests. Considering the modest progress made in strengthening Nigeria’s chronically weak health systems despite successive Government and donor efforts, we need some reflection on the impact of quick wins in our health sector.

Short-termism begins in the planning phase. A close look at strategies proposed within multi-year strategic plans such as the National Strategic Health Development Plan (2010-2015) or the Comprehensive Multi Year Plan reveals that  some long-term strategies are nested within multiple fire-fighting short-term strategies. Some of these rapid-impact interventions do little to address the core, deeply entrenched issues affecting healthcare in Nigeria. Strategic plans that the Government cannot implement without long-term commitment of donor funds is another example of how focus on rapid results can undermine sustainability. While donor funding is great for bridging short term gaps, it provides a perverse incentive to design grandiose plans with overpriced strategies. Sometimes these strategies could effectively be replaced with more modest, cost-effective, equally impactful strategies.

Some of Nigeria’s health sector problems are deeply entrenched and require non-superficial, more deliberate efforts to address them. For instance, there are institutional weaknesses in coordinating health care in Nigeria such as the “fragmented and cumbersome” health administration structure and the confusion over roles and responsibilities for Primary Health Care. Sometimes there is a massive breakdown of communication, collaboration and coordination among Government health agencies. Tackling these will require more than ‘program coordination’ efforts within vertical disease streams tracking meetings at technical working groups. While meetings within vertical programs have their place, fixing Nigeria’s healthcare coordination program requires multi-agency collaboration at national and sub-national levels and more concerted efforts at relevant health reforms to address the deeper issues.

Similarly, Nigeria faces a critical shortage of health care workers (HCWs) especially Primary Health Care (PHC) workers due to an inability to produce adequate HCWs. This is further complicated by a high turnover of PHC workers owing in part to HCWs preference for urban facilities regarded as better equipped.  One problem with short-termism is the inclination to address symptoms rather than the root cause. There have been concerted efforts to address Nigeria’s HCW shortage problem such as the Midwives Service Scheme. Still, many more interventions tend to focus on repetitive training of the available limited health care workers rather than a systematic approach for increasing quantity and quality of HCWs whilst promoting staff retention. There is also little consideration for evidence from learning science that people acquire 70% of their knowledge from job-related experiences, 20% from interactions with others, and 10% from formal educational events in the design of capacity building efforts. For some reason, it appears more appealing to conduct off-site training than to institute processes to improve the knowledge and skill of HCWs on site. So much so that the World Bank 2014 report on Service Delivery Indicators in Nigeria revealed that HCWs were absent from facilities and unable to provide services due to attending training 24% of the time.

Both the Government and development community have a role to play to achieve true development of the health sector. We need to take a longer-term view at Health Sector planning. This will not be merely with regard to longevity of timelines but will be in terms of quality strategies with high potential to address deeply entrenched problems and root causes rather than symptoms. We must take more deliberate, systematic approaches to implementation and monitoring ensuring consideration for the overall long- term value we create for the health system by our approaches.

More donors also need to consider longer-term grant cycles with required accountability built in to reduce the pressure on grantees to focus on demonstrating quick win results rather than incremental, long-term health sector development. More donors need to explore support contingent on the country fulfilling matching obligations.

It is my hope that this post will spur development practitioners and policymakers to maintain the right balance between a short- and long-term perspective on health development issues.

 About the Author:

Abiola Ojumu is a Health Systems Planning and Development Adviser based in Nigeria. She holds an MSC in Public Health (Health Services Management) from the London School of Hygiene and Tropical Medicine and an MSC in Development Management from the University of Birmingham. In her current role as the Director of Vaccines Program at the Clinton Health Access Initiative, Nigeria she works with the technical community and policymakers on strategies to improve Primary Health Care Services and increase immunization coverage rates in Nigeria.

Competing Interests:

I have read and understood the BMJ Group Conflicts of Interests Policy and affirm I do not have any conflicts of interests.

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