The development of a procurement strategy for primary health care facilities in Nigeria

The Federal Government of Nigeria (FGN) introduced the Ward Health System (WHS) in 200 I to facilitate the provision of sustainable and integrated Primary Health Care (PHC) services by revitalising the principle of community co-ownership and co-management of PHC facilities. To date, the extent to which the WHS scheme has achieved its objectives remains questionable and a strong case for further re-examination of its structure, process and function, including its overall place in the PHC subsystem has been made. The FGN has also shown considerable interest in attracting the private sector to boost investment and efficiency in the healthcare sector, although it is yet to formulate any strategies towards actualising that desire. Accordingly, this research aimed at developing a sustainable procurement strategy that will facilitate the achievement of community co-ownership or co-management of PHC facilities in Nigeria, was launched. The research utilised the best practices within the UK Local Improvement Finance Trust (LIFT) procurement strategy for integrated primary and social care facilities to recommend practices that can facilitate the achievement of sustained improvement in the Nigerian context. A variety of qualitative and quantitative research methods were employed including interviews, questionnaire survey and focus groups. Strategic evaluation of the WHS model was conducted in Nigeria through exploratory interviews. The investigations indicated that the planning and implementation of on-going strategies lack focus, impact and sustainability. Consequently, further exploratory interviews were undertaken in the UK to investigate some key implementation issues on the LIFT schemes that can be used to promote sustained improvements in the Nigerian context. The best practices identified relate to stakeholder identification, analysis, engagement and aligrunent; defmition of processes, roles, responsibilities and accountabilities; periodic reviews throughout the whole-life cycle of each project; and some new project roles and tasks. Accordingly, a procurement strategy based on the Public-Private Partnership (PPP) principle that will be responsive to the peculiar needs of the host community and have adequate accountability structure for sustaining PHC facilities in Nigeria was proposed. This proposal falls in line with the new macroeconomic strategy adopted for growth and the health reform agenda of the present government, which have variously emphasised the expansion of the approach to improving healthcare delivery through increased private sector participation, whenever feasible. It is expected that the active participation of various components of the communities will offer considerable social and economic benefits such as social inclusion, employment and training opportunities for the members of the host communities in addition to the attainment of other fundamental philosophies of PHC provisioning. In addition, a supplementary questionnaire survey was carried out in Nigeria to investigate the perceptions of Nigerian professionals on the success and risk factors associated with the use of PPPs for infrastructural developments in Nigeria. The results show that seven out of the top ten most important PPP risk factors in Nigeria are endogenous (risk events and consequences of which occur within the system boundaries of the project being considered). The results also show that while the majority of the endogenous risk factors could be assigned to the private sector partner, the public sector should retain political and site acquisition risks, while relationship-based risks should be shared between the private and public sector partners. The three most important PPP success factors in Nigeria were found to be favourable legal framework, well-organised public agency to negotiate on behalf of government and strong private consortium: The comparison of the fmdings of this study with similar previous study in the UK suggests commonalities in the success factors of PPP projects. On the basis of the results of the exploratory interviews and questionnaire survey, focus groups were held to assess the appropriateness of the proposed procurement strategy in the light of on-going procurement and healthcare reforms and recent legislative developments. On the basis of the positive feedback obtained from the validation, a modified procurement strategy was put forward. However, the. need for developing a comprehensive framework for achieving continuous improvement that will make learning followed-through from plarming, design and construction into occupancy, and post occupancy to become a natural part of the process of procuring PHC facilities was highlighted.