RAISING ACCOUNTABILITY BAR FOR HEALTH SECURITY FINANCING IN NIGERIA

Introduction
The health security landscape in Nigeria has witnessed considerable transformations in the last couple of years with significant investment in epidemic prevention, detection and treatment by the National Centre for Disease Control (NCDC). However, the public health infrastructure is still fraught with identifiable gaps, one of which is poor funding of health systems for epidemic response; which is worsened by the on-going COVID-19 pandemic that has stretched the country's health security infrastructure and exposed its suboptimal capacity to cope in the face of epidemics.
In order to improve the sustainability of health security investments in Nigeria and remove policy bottlenecks that have stifled progress in epidemic preparedness and response, the Global Health Advocacy Incubator (GHAI) is partnering with the Legislative Advocacy Initiative for Sustainable Development Goals (LISDEL) to provide requisite assistance to the Government of Nigeria through the Preventing Epidemics (PE) Project; with the goal of achieving improved and sustained domestic financing for epidemic preparedness and response in Nigeria.
A workshop aimed at raising the accountability bar for health security financing through the development of a health security financing accountability framework and scorecard was held on 13^th August 2020. The LISDEL team and representatives of Civil Society Organizations (CSOs), Budget Office of the Federation and development partners participated at the workshop to develop the health security

financing accountability framework and discuss the modalities for implementing it. This brief outlines the key points that emanated from the workshop.
Description of the health security financing accountability framework
The proposed health security financing accountability framework is built on the health financing accountability framework that was developed by the Health Sector Reform Coalition (HSRC). The framework includes selected health security financing indicators (both target and actual) and the data source. The second part of the framework deals with accountability action which identifies the roles and expected responses of different stakeholders to the trend of the health security financing indicators. The stakeholder category includes the legislature, the executive arm of government, the media and CSOs. The accountability framework is expected to bring the aforementioned stakeholders together to raise the accountability bar for health security at both national and sub-national levels through improved transparency, answerability and evidence-based decision making on health security financing.
Alignment of the accountability framework to the overall health system
The upcoming joint review of the National Health Strategic Development Plan presents a unique opportunity for advocacy to the Federal Ministry of Health (FMoH) to incorporate the health security financing accountability framework in

the Strategic Plan. The framework also needs to be integrated to the FMoH dashboard.
Broadening the depth of the framework
In as much as it is important to track the overall budget allocations and releases to health security, it is also important that the framework shows specific items that the funds are allocated to. This will reveal budget items that are prioritized and amounts allocated to critical line items; which will help in checking efficiency of spending.
Domiciliation of Intervention Funds with Implementing Agencies
Intervention funds are usually domiciled with FMoH, which causes delay in implementation because of the procedures involved in accessing the funds. A case should be made for domiciling intervention funds in the implementing agencies and allowing them to be responsible for their expenditures, for easy implementation and accountability.
Alignment of the framework with the economic plan for the country
In response to the effects of the COVID-19 pandemic, the Federal Government developed the National Economic Sustainability Plan to which all MDAs’ plans should align. The Government plans prioritize funding items that will help achieve the objectives of the plan; thus, MDAs should be encouraged to include items that are prioritised by the plan in their budget. These items should also be included in the accountability framework.
Roles of the legislature
Using the existing Legislative Health Agenda, the roles of the legislature in epidemic preparedness and response should be incorporated into the framework. This can subsequently form part of

the Legislators’ reports to their constituencies, which would then help mobilize citizens’ action.
Sources of data for the framework
A potential challenge anticipated is the quality and level of disaggregation of available data. To have access to data on line items of interest at the national level, the team in charge of Open Treasury Platform should be engaged to prioritize making such data available on the platform. At the state level, continuous dialogue with the agencies in charge of the data of interest will be necessary. However, access to data on donor, private and other third party financing is still a challenge as they are not included on the open treasury platform.
Actions expected from the CSOs and Media
The CSOs should use the data provided on the accountability framework as evidence for targeted advocacy at the Legislative and Executive levels. Also, the media needs to be involved in the advocacy from the onset for greater representation, to enable them report progress of epidemic preparedness and response using information from the framework.
Conclusion
Improving the sustainability of health security investments in Nigeria and removing policy bottlenecks that have hitherto stifled progress in epidemic preparedness will require a multi-stakeholder and multi-sectoral approach towards engaging the executive and legislative arms of the government. This framework will be a useful tool for tracking performance and providing evidence to engage the government.

Based on the comments and inputs from the workshop, the framework will be reviewed and a user’s guide will be developed.