title: Bridging the Policy-Implementation Gap in Federal Health Systems: Lessons from the Nigerian Experience.
abstract: The Partnership for Reviving Routine Immunization in Northern Nigeria - Maternal, Newborn and Child Health initiative supports efforts by the government of Nigeria to bridge primary health care (PHC) policies and services at three levels of government: federal, state and local. The paper suggests that understandings informed by complexity theory and complex adaptive systems have been helpful in shaping policy and programme design across these levels. To illustrate this, three initiatives are explored:Bringing PHC under one roof, enhancing access to funding provided by the Global Alliance for Vaccines and Immunization, and strengthening the midwives service scheme. These initiatives have demonstrated how concepts and experience developed at subnational level can influence national policy and practice, and how work at subnational levels can add value to nationally conceived and nationally driven plans for PHC.
authors.affiliation: Health Partners International , Cape Town, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: McKenzie
authors.affiliation: Health Partners International , Abuja, Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sokpo
authors.affiliation: Mailman School of Public Health, Columbia University , New York, NY, USA.
authors.forename: Alastair
authors.initials: A
authors.lastname: Ager
keywords: complexity theory; drivers of change; health policy; health system; maternal health; primary health care