In 2022, I became a Millennium Fellow. This was shortly after I became a UPG champion. The Millennium Fellowship is awarded to young changemakers in the university who have demonstrated interest in executing change-making projects in their society. After being accepted into the program, fellows must carry out an SDG-related project to be awarded a certificate.
My team’s project involved raising awareness about Nigeria’s National Health Insurance Scheme. Our target audience was men and women who traded in a popular market located in the city’s centre. Armed with the knowledge gained from being a UPG Champion and eager to drive change in my society, I set out for the outreach. As I left the hostel that Saturday morning with my teammates, my plan was simple: carry out the awareness outreach and return to the library to continue poring over my books. Little did I know that this Saturday would lead me into direct contact with the imperfections of policy implementation.
As I conversed with the market men and women, I quickly realised that there was a limited need for awareness. They knew about the scheme. About 75% or more of these traders were aware of the Insurance Scheme, yet enrollment was low. A June 2024 article published in the Journal of Global Health and Economics, revealed that less than 5% of Nigerians have been enrolled in the scheme. So what were the hindrances?
Our target audience was pregnant with answers. The scheme did not take into consideration their socio-economic status i.e. since they could barely afford two square meals a day, how could they save up money for a health emergency that may never happen? The healthcare system inefficiencies and the subpar services it offered, religious beliefs banning trust in any non-spiritual healthcare scheme, and a general fear of government initiatives were other prominent factors listed.
I left the outreach with the hindsight that the National Health Insurance Scheme was perfect on paper but impractical in its transition into practice. Sadly, it isn’t only the NHIS facing the policy implementation gap problem. According to the World Health Organization, most health policies are not carried out effectively, with implementation gaps ranging from 30% to 50%, particularly in low- and middle-income nations.
What I got to experience that day was the impaired implementation of policies and their effect on accessibility.
WHY ARE POLICIES NOT FULLY IMPLEMENTED?
Guided by a concept and frequently carried out through programs, public policy is an institutionalised plan or a decided set of features such as laws, rules, guidelines, and activities to solve or address pertinent and troublesome societal issues. These policies govern many facets of life, including education, healthcare, work, finance, economics, transportation, and other societal components.
Policies are seen as the vehicle by which a large group of citizens, common individuals, can implement change in society and #maketheworldabetterplace. While public policies enacted for the benefit of the public are mainly created by the government, well-meaning citizens and civil communities can contribute to their formulation. ‘Tiny changes but large impact is what it’s all about.
There are various reasons why public policies fail to be implemented. These reasons include but are not limited to poor policy design, lack of stakeholder involvement, inadequate funding and resources, weak institutional capacity, political interference, instability, corruption and mismanagement, and poor monitoring and evaluation.
Using the aforementioned NHIS as an example. About 75% of Nigerians would inevitably pay out of pocket for healthcare access when direct funding for simple primary healthcare is abysmal and below the standards set as far back as 2001’s Abuja declaration (which stated that a minimum of 15% of African countries’ budgets should be allocated to healthcare). Stakeholder involvement, particularly for awareness, has been delegated to non-governmental organisations, for the most part. And the level of corruption makes it such that increased funding might not even translate to increased quality of implementation. Couple these with the influence of culture, religion, and family on citizens’ health, and the state of policy adherence and implementation becomes more concerning.
ADDRESSING FACTORS AFFECTING POLICY IMPLEMENTATION
As I reflect on my conversation with the traders, I’m forced to think deeper about the various reasons the scheme has failed to achieve full enrollment. Could it be that the intended scheme failed to incorporate the main stakeholders, the citizens, in the formulation of these policies? Or have institutions tasked with implementing weakened capacity?
Interaction with these citizens revealed that their economic status had not been incorporated into the policy design, making the insurance contributions more of a financial burden than a relief.
Addressing these factors would involve conversations between policymakers, the government, and citizens to come to common ground, which would lead to a successful implementation.
It’s cheers to making our communities a better place via effective policy implementation.
