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Status of Health Sector Regulation in a Nigerian State

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Status of Health Sector Regulation in a Nigerian State

Obi I. E.1, Nwobodo E.2, Arinze–Onyia S.3, Ugbene E.4, Idoko A. C.1, Egboh M,5 Yisa I.5

1Department of Community Medicine, University of Nigeria, Nsukka.

2Department of Physiology, Nnamdi Azikiwe University, Awka.

3Department of Community Medicine, Enugu State University of Science and Technology.

4Health Reform Foundation of Nigeria, Enugu.

5Partnership for Transforming Health Systems Phase II F.C.T, Abuja



  • Effective regulation, ensures quality improvement in health service delivery.
  • Health regulation is the array of factors peripheral to the practice or administration of medical care that sways behavior in the provision of health care.
  • Effective regulation is known to enforce compliance with quality standards by service providers.
  • Health sector regulation has recently been identified as a corruptible health system area, but necessary for universal health coverage.
  • This study represents a situation assessment of health sector regulation in the study state prior to an intervention.


  • A cross sectional survey in Enugu State, South East Nigeria, a LMIC.
  • Approach was document review and key informant interviews to determine status of factors relevant to health sector regulation.
  • Content analysis and application of an adapted matrix determined existence, functionality, strengths and weaknesses of the factors -

-          Legal instruments  - Policy and Law

-          Structures –

  • Existence of certification/licensing body or bodies
  • An institutional home
  • A desk officer
  • Constituted standards committee
  • Funding mechanism, scope and if regulatory services are voluntary

-          Operational guidelines –

  • Framework document
  • Existence and format of standards manual (departmental or functional),
  • Focus of existing standards (structure, process or outcomes),
  • Regulatory methodology and tools
    • Presence of statement of intent
    • Accreditation processes
    • Presence of indicators
    • Existing scoring scale
    • Certificates of standards
  • Comprehensive list of registered facilities,
  • Public health information medium,
  • Complaints investigation mechanisms and sanctions,
  • M&E plan
  • An indigenous scale ranging from (0 – non-existence, 1 – existence with weaknesses and 2 – existence with no identifiable weakness) was used to score factors, with summation of scores to ascertain the proportion against a maximum possible score expressed as a percentage.


  • Status on factors in place for integrated health sector regulation was at an average of 45%.
  • National and state health policies in support of regulation were in place, backed by an extant state health law and a brand new national health act, medical and other health professional regulatory laws were in place.
  • An allusion in the extant state health law existed, of a body called a ‘joint inspectorate’ for coordination/integration. This body however did not exist and information sharing among the directorates, was lacking.
  • No framework for implementation, monitoring and evaluation of integrated regulation was in place.
  • ‘Standards’ for facility and personnel inspection across board, consisted of checklists and focused on structures and equipment and not processes nor function.
  • Facility certification was of initial registration and yearly renewals, inspection and accreditation visits to monitor standards were inconsistent at best and plagued by bureaucratic hassle.
  • Some of the health professional bodies regulated personnel by re-certification based on continuing education.
  • The state ministry of health regulates different types of private health sector facilities driven by the directorates of Medical Services, Nursing, Pharmaceutical Services and Laboratory Services.
  • Public health establishments in the state were supervised by the State Health Management Board.
  • Complementary and alternative medicine practitioners and their establishments were regulated by the medical services directorate.
  • Traditional/herbal medicines practitioners were not regulated, despite an extant traditional medicines board law.
  • Public complaints yielding action were few and far between and usually became media events.
  • Rare sanctions included withdrawal of facility or professional certification.


Health sector regulation in the study state was hitherto uncoordinated. National and State laws, provided legal backing for status reversal in the state in favor of integrated regulation of health care service delivery. There was thus evidence in support of the need to develop a framework for integrated health sector regulation in the state.  

Funded by UKaid from the DFID, PATHS2 programme.

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