My Experience as a Global Health Policy Fellow
I have recently finished a two-month global health policy fellowship at the Center for Policy Impact in Global Health (CPIGH). This fellowship program is aimed at mid-career health professionals from CPIGH’s partner countries. As a researcher with the Health Policy Research Group, University of Nigeria, my main research interests are health services; health systems governance and accountability; analysis of health policies, plans and strategies; and getting research evidence into policy and practice. And so, when I discovered that my application for the fellowship at CPIGH was successful, I looked forward to opportunities to deepen my capacity in the field of global health policy and systems, which I hoped would help me to make a more impactful contribution to global heath.
Working as a public health physician in Nigeria exposes me to practical challenges and gaps in the health system and inspires me to find ways to address these obstacles. Therefore, the fact that CPIGH addresses critical challenges in financing and delivering global health was very interesting to me and caught my attention. The Center’s analytic work and policy engagement seeks to address the “middle income gap” that can arise when countries graduate from development assistance for health (DAH). The issue of transition of middle-income countries (MICs) from DAH is now high on the global agenda; transitioning MICs and donors are faced with the challenges and dilemmas of transition. Policy fellows at CPIGH have the opportunity to conduct a study relevant to CPIGH’s work—and so I chose a study that addressed the health system gaps in Nigeria when donors leave.
Transition from DAH has attracted global attention. Based on the eligibility criteria set by many multilateral donors, which is usually based on national income per capita, MICs are becoming ineligible to receive external funds, and are expected to transition out of DAH. However, just because a country’s national income per capita has risen above a particular threshold, it does not mean that the country’s disease burden has necessarily fallen. In addition, even when a low-income country becomes middle-income, there may still be very large variations across the country in income (there may be “pockets of poverty”). Nigeria and other lower middle-income countries are at risk of losing funds at a time when they should be making accelerated progress towards universal health coverage (UHC).
Gavi, the Vaccine Alliance, recognized the enormous health challenges facing Nigeria when it decided to extend its support to the country to 2028. Nigeria has one of the world’s lowest child vaccination rates, and so if Gavi exits too soon, this could threaten progress on vaccination.
Impending loss of external funds by MICs requires urgent attention as this loss could widen the existing financial gap between the rich and poor and shift the cost of services towards out-of-pocket payments, which are regressive. This shift could in turn push the vulnerable population further below the poverty line and make achievement of UHC more far-fetched.
Nigeria’s situation prompted me, as part of my fellowship at Duke, to conduct a qualitative case study of key stakeholders in Nigeria as well as bilateral and multilateral donor agencies to identify challenges, barriers, and key steps for making progress as Nigeria transitions out of health aid. Working with researchers at CIPGH, we conducted a study called “Transitioning responsibly toward UHC: best practices for sustainability and scaling up of gains achieved from external HIV and immunization funds in Nigeria.’ We explored the perspectives of stakeholders on donor funds and transition; the preparedness of the Nigerian health system for responsible transition (examining the policies and strategies in place and a roadmap for their implementation); and challenges facing Nigeria in its progress towards UHC and ways to overcome them. We aim to publish our study in 2020—so stay tuned for the results.
About the Author:
Dr. Uche Shalom Obi (tweets @Shalomobi700) is a Policy Fellow at the Center for Policy Impact in Global Health.