Identifying advocacy strategies, challenges and opportunities for increasing domestic health policy and health systems research funding in Nigeria: Perspectives of researchers and policymakers

Abstract

Introduction Poor funding for Health Policy and Systems Research (HPSR) is a major constraint to the development, generation and uptake of HPSR evidence in Low and Middle-Income countries. The study assessed the status of HPSR domestic funding and advocacy strategies for improving HPSR funding in Nigeria. It equally explored the knowledge and perception of the domestic funding status of HPSR and the effect of capacity building on the knowledge of domestic funding for HPSR in Nigeria. Methods This was a sub-national study involving policymakers and researchers from Enugu and Ebonyi States in Southeast Nigeria who participated in the sub-national Health Systems Global convening for the African region. A before-after study design (workshop) was utilized. Data collection employed semi-structured questionnaires, group and panel discussions. The workshop facilitated knowledge of HPSR, funding processes, and advocacy strategies for increased domestic funding for HPSR. Pre and immediate post-workshop knowledge assessments were done. Data were analyzed using SPSS version 25 and thematic analysis. Results Twenty-six participants were involved in the study. Half were females (50.0%) and 46.2% were aged 35–44 years. Policymakers constituted 23.1% of the participants. Domestic funding for HPSR in Nigeria was adjudged to be grossly inadequate. Identified barriers to domestic funding of HPSR included bureaucratic bottlenecks, political and policy transitions, and corruption. Potential opportunities centered on existing policy documents and emerging private sector willingness to fund health research. Multi-stakeholder advocacy coalitions, continuous advocacy and researcher skill-building on advocacy with active private sector involvement were the strategies proffered by the participants. Pre-workshop, understanding of the meaning of HPSR had the highest mean ratings while knowledge of budgeting processes and use of legal action to enable opportunities for budget advocacy for HPSR funding had the lowest mean ratings. Following the capacity-building workshop, all knowledge and understanding parameters markedly improved (percentage increase of 12.5%–71.0%). Conclusion This study found that there was paucity of domestic funding for HPSR in Nigeria alongside poor knowledge of budgeting and advocacy strategies among both policymakers and researchers. We recommend the deployment of these identified strategies and wider national and regional stakeholder engagement towards prioritizing and improving domestic funding for HPSR.

Engaging stakeholders to identify gaps and develop strategies to inform evidence use for health policymaking in Nigeria.

“…Signi cant work has been done over the years to bridge the gap between research and policymaking in Nigeria. These efforts have resulted in considerable improvement [2,19,20,[25][26][27][28]. However, our study (as many other studies) shows that more work needs to be done to improve the use of evidence in health policymaking.…”

“…Whereas donor funding has re ected in bene cial outcomes of many interventions, such can also have a deleterious effect on the health system, as noted by stakeholders at the convening. Donors have been known to skew local research and policy agenda in favour of foreign interests [19,40] Research Council of Nigeria) [41]. Many other policy-backed avenues toward increased government and industry investment for research have since followed but nancial, governance and resource complexities have proven to be stumbling blocks.…”

“…Many other policy-backed avenues toward increased government and industry investment for research have since followed but nancial, governance and resource complexities have proven to be stumbling blocks. For example, a national health research agenda currently exists in Nigeria, but only 0.08% of the national health expenditure is allocated to research [19]. This is despite the country's commitment to a 20% increase in budgetary support to health research institutions for research by 2022 [42].…”

“…Recent efforts to promote HPSR as a means to bridge the evidence-policy gap in low-and middle-income countries has seen growing interest from key audiences such as government, civil society, international organizations, private sector players, academia and media [1,[19][20][21][22][23]. Nigeria is not an exception, and this development signi es that a broader range of policymakers in the country are becoming potential evidence-users' than ever.…”

Halting COVID-19 Requires Collective, Decentralized, and Community-Led Responses

“…With an overarching goal of changing pertinent upstream factors like regulations, laws, and institutional practices, public health advocacy has historically contributed significantly to public health promotion, including successful HIV/AIDS control and injury prevention campaigns (Chapman, 2001 ; Hubinette et al, 2017 ). However, existing evidence shows that, in LMICs such as Nigeria and South Africa, governments have historically underfunded public health priorities such as Health Policy and Systems Research (HPSR) and mental health care during the COVID-19 pandemic (Okedo-Alex et al, 2021 ; Davies et al, 2022 ). Advocacy mechanisms such as the print and electronic media and community coalitions could be engaged to rally governments and their private-sector allies to prioritize and amplify their investments in public health infrastructure and research.…”