USAID governance initiative in Nigeria : a strategic assessment of primary health care and local government

Following an introduction, Chapter 2 examines government initiatives in decentralization to local government and in the health sector. It also identifies USAID health initiatives and explores how governance issues can be applied to strengthen decentralization and health care delivery in Nigeria. Chapter 3 reviews current health conditions and the implementation of PHC policy. Chapters 4-6 examine management and organizational issues related to PHC planning and programming; budgeting and financial sustainability; and monitoring, evaluation, and supervision. Chapters 7 and 8 treat grassroots participation and intergovernmental relations issues as they affect PHC delivery. Chapter 9 identifies the systemic problems facing local governance of PHC, while Chapter 10 presents detailed discussion of the study"s main recommendation: that USAID establish, over 3 years, centers at four regionally diverse Nigerian universities with the goal of training PHC, LGA, and community leaders in PHC policy, planning management, applied problemsolving, financing, and community mobilization. It is noted that the change of the government back to the military on November 18, 1993, while affecting this strategy, does not fundamentally alter it.