Paper short abstract:

This study examines the power relations that shaped the design and implementation of a Community-Based Health Insurance (CBHI) programme in Nigeria. It showed how the design and implementation of the CBHI programme in rural Kwara was dominated by foreign actors. It serves a lesson for other nations.

Paper long abstract:

This study examines the power relations that shaped the design and implementation of a Community-Based Health Insurance (CBHI) programme in Nigeria. Healthcare reform is largely a political process which requires a careful analysis for better understanding. The process is often characterized by politics of domination and influence by various actors on the policy scene. Health policy triangle developed by Walt and Gilson serves as the analytical tool. Using a qualitative method of data collection, this study sheds light on the recent trends in health policy transfer to Africa from the global North. The study was conducted in selected archetypal rural settlements in Kwara State Nigeria. The study revealed that the design and implementation of the CBHI programme in rural Kwara had underlying politics. It also found that the foreign actors dominated the policy space and the local policy actors were given secondary roles. The study concludes that the inefficiency of the programme was due to the imposition of a policy that was not in tune with the realities of the people because they were not involved in the policy design. This raises the need to repurpose the role of the state towards achieving meaningful development, especially in the healthcare sector. In other words, the government should set out a comprehensive health policy plan that will be insulated against policy hijacking and directed towards the attainment of universal health coverage.