title: The impact of political institution and structure on health policy making and implementation: Nigeria as a case study.
abstract: BACKGROUND
  Typical of the political structure of the United States of America, Nigeria operates a federal presidential system of government. Political power is shared between the three levels of Federal, State and the Local Governments. The political affairs of the country at these levels are determined by elected politicians from different political parties, with different political and developmental ideologies. This scenario has implications on policy making and implementation especially in the health sector. This paper sought to discuss the type of political structures and institutions and, the effect of these on health policy implementation in selected countries, with emphasis on Nigeria. CURRENT STATUS OF FINANCING HEALTH CARE: The National Health Insurance Scheme (NHIS) was launched almost a decade ago but currently covers an estimated four percent of the population, majority of which are in the formal sector. The poor coverage of the scheme in Nigeria has been attributed to the type of political institution and structure it operates. This is evident with examples of some countries in the world; whereas, the scheme in Nigeria was implemented almost at the same time like in neighbouring Ghana, the scheme in Ghana has made a considerable progress. Likewise, prepayment scheme for health in Britain has been in practice for decades, the U.S.A. is just currently making progress in the implementation of a nationwide prepayment scheme despite several years of efforts. It is important to note that Nigeria and the U.S.A. has similar political institution and structure different from what Ghana and Britain have in common.
  
  
  CONCLUSIONS
  The current low level of coverage of the NHIS in Nigeria is largely due to the type of adopted political institution and structure. The implications of this on the health status of the people and national development cannot be overemphasized.
authors.forename: D A
authors.initials: DA
authors.lastname: Adewole
mesh_terms: D005869:Ghana; D006291:Health Policy; D006801:Humans; D037141:Mandatory Programs; D009549:Nigeria; D011057:Politics; D016730:Program Development; D006113:United Kingdom; D014481:United States; D019472:Universal Health Insurance / Q000458:organization & administration* / Q000706:statistics & numerical data