National and subnational governance and decision-making processes during the COVID-19 pandemic in Nigeria: an empirical analysis

Abstract

Governance of the COVID-19 pandemic required decision-makers to make and implement decisions amidst uncertainty, public pressure and time constraints. However, few studies have attempted to assess these decision-making processes empirically during health emergencies. Thus, we aimed to understand governance, defined as the process of decision-making and implementation of decisions, during the COVID-19 pandemic in Nigeria. We conducted key informant interviews and focus group discussions with national and subnational government officials, civil society organisation (CSO) members, development partners and academic experts. Our study identified several themes on governance and decision-making processes. First, Nigeria established high-level decision-making structures at the federal and state levels, providing clear and integrated multisectoral decision-making mechanism. However, due to the emergence of conflicts between government levels, there is a need to strengthen intergovernmental arrangements. Second, while decision-makers relied on input from academic experts and CSOs, additional efforts are required to engage such stakeholders in decision-making processes, especially during the early stages of health emergencies. Third, Nigeria's previous experiences responding to disease outbreaks aided the overall response, as many capacities and coordination mechanisms for cohesive action were present. Fourth, while decision-makers took a holistic view of scientific, social and economic factors for decision-making, this process was also adaptive to account for rapidly evolving information. Lastly, more efforts are needed to ensure decisions are inclusive, equitable and transparent, and improve overall public trust in governance processes. This study provides insights and identifies opportunities to enhance governance and decision-making processes in health emergency responses, aiding future pandemic preparedness efforts.

Keywords: COVID-19; Health policy; Public Health.

Figure 1

List of primary data collection methods, types of participants and geographic distribution of participants included for key informant interviews and focus group discussions. (A) Types of participants and data collection methods used in the study. (B) Data collection at the state level from four states in Nigeria (Kano State, Gombe State, Ekiti State and Bayelsa State). Mapchart was used to depict states in Nigeria (https://www.mapchart.net/).

Figure 2

Decision-making and operational organisation structures for COVID-19 pandemic preparedness and response at the federal and state level in Nigeria.

Figure 3

Summary of factors which influenced decision-making of Nigeria’s COVID-19 pandemic measures. PPE, personal protective equipment; SOP, standard operating procedure; SORMAS, Surveillance Outbreak Response Management and Analysis System.

Figure 4

Overview of the process of decision-making established during the COVID-19 pandemic in Nigeria and incorporation of elements of governance in decision-making. The general process of decision-making employed by decision-makers that included identifying decisions to be made related to prevention, detection and treatment of the virus, gathering relevant information for making decisions and assessing decision options. This process was dynamic as decision-makers were constantly assessing the state of the pandemic and adapting decisions based on emerging and evolving information. Numerous factors such as scientific data, funding availability and economic factors were considered while making decisions on measures to implement to respond to the pandemic. PFT, Presidential Task Force.

Figure 5

Opportunities for improving governance arrangements during health emergency crises. PTF, Presidential Task Force.