Organization and Financing of Primary Health Care in Nigeria: Problems, Issues and Alternative Approaches
CHAPTER ONE
OBJECTIVE OF THE STUDY
The broad objective of the study is to assess the problems, issues and alternative approaches of organization and financing of primary health care in Nigeria as it is expected to provide an important role in national economic development strategy. Specifically, the study will address the following major issues:
(i) The problems confronting the Primary Health Care sector in Nigeria
(ii) The measures to reverse the trend through reforms
(iii) The impact of reform on the health sector and the challenges
(iv) Health care financing and organization for economic development
(v) Make recommendation on the way forward
CHAPTER TWO
LITERATURE REVIEW
PRIMARY HEALTHCARE SYSTEM IN NIGERIA
Nigeria is situated in Sub Saharan Africa. It is Africa’s most populous nation with about 200 million citizens. Its population is expected to reach 214,028,302 by the beginning of the third quarter of the year 2020. By 2050, Nigeria’s population is projected to have risen to about 390 million, making it the fourth largest population in the world (CIA, 2020). Majority of its population are between 0-14 years (NBS, 2018). National adult literacy rate in any language is 71.6%, 79.3% among males and 63.7% among females. 65.1% of the male gender and 50.6% of the female gender representing 57.9% of the Adult population are literate in the English Language (NBS, 2018).
Nigeria operates a federal system of government with a national government and sub-national state and local governments. Congruously, Nigeria operates a three-tier system of health care delivery in which the federal government is responsible for the provision of health services through the tertiary and teaching hospitals, the state governments provide same through secondary hospitals, while the local governments deliver health services through the primary health care centers (PHCs).
CHAPTER THREE
RESEARCH METHODOLOGY
RESEARCH DESIGN
The study employed a comprehensive review of literature from a wide range of resources including official reports, academic journals, statistical bulletins, and online resources. In addition, qualitative methodology was applied.
TARGET POPULATION
Two Local Government Areas were randomly selected in Ibadan to elicit information from primary healthcare policy makers and policy implementers. The two LGAs are Akinyele (Rural/Semi Urban) and Ibadan North (Urban). The study was limited to these locations due to cost and time.
CHAPTER FOUR
RESULTS AND DISCUSSION
COUNTRY HEALTH PROFILE AND PUBLIC SPENDING ON HEALTH-RELATED SECTORS
Nigeria is ranked as a low middle-income economy and its spending on the health sector has not met the 15% stated in the Abuja Declaration by the African Union in 2001 (Downie, 2017). In 2016, Nigeria’s annual budget stood at 6.06 trillion naira, with N257 Billion or about 4.13% of the overall budget going to the Health sector (Downie, 2017). In 2018, Nigeria budgeted N340.46bn for health, which was 3.96 per cent of the total estimates for the year (BudgIT, 2019). In the current year, 2020, the budget for health stood at N427.3bn or about 4.5 per cent the total yearly estimate (BudgIT, 2020). Out of pocket expenditures accounts for 75.2 percent of total health expenditure and 25 percent of households spend more than 10 percent of their household consumption on health (Hafez, 2018). Table 1 below presents budgetary allocations to health relevant sectors as a share of total budget.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
CONCLUSION
The paper investigated the problems, issues and alternative approaches of organization and financing of primary health care in Nigeria. Primary health care in Nigeria is currently inefficient and is incapable of achieving health related sustainable development goals. Given the low level of government funding of health sector, particularly the PHC system over the years, foreign donations have been increasing and have become essential for the development of a functional and sustainable primary health care in Nigeria. This challenge becomes more urgent against the background of projected declines in foreign donations towards improving healthcare because of a number of socioeconomic factors. Foreign donations have created two major spillover issues: weakening of commitment to domestic funding and neglect of health system strengthening. Foreign donations cannot be a replacement for increased domestic spending on public health. Increased domestic funding must be made a prerequisite for foreign funds. Increase in domestic funding for health along with the strengthening of the health system in Nigeria will ensure that when donor funds are no longer available, Nigeria’s primary health care system would be ready, and able to deliver quality health care to Nigerians.
RECOMMENDATION
The Federal Government should explore ways towards improving access to primary health care: Extending the reach of primary health care and improving its performance requires action on several fronts’ simultaneously-including new delivery models to increase access, a greater role for nonprofit and private organizations in service delivery, and the introduction of performance incentives to improve it.
Better mind-sets and behavior: Pay-for- performance bonuses and other incentive programs would motivate health workers to provide high-quality care efficiently. Improved delivery of supplies would reduce frustration. Better management capabilities would help ensure that workers were paid on time. To further improve the attitudes of health workers, the system should give them management training and other skill-development opportunities and a more supportive working environment. A mind-set shift among patients is needed as well so that they seek needed treatments more promptly. The presence of community health workers in each village may help change the mind-sets by making patients see that the health system is addressing their immediate needs. Experience in other sub-Saharan countries suggest that many of them face similar problems.
Strategic and progressive leadership in health delivery service: At a time when much is being made of foreign reserves that are being built up and the general improvement in Nigerian economic indices, it is perhaps time to re- examine the systems that will be needed to deliver results to the Nigerian people from the funds that have been stock piled through prudent economic management. We owe a duty to the people of Nigeria to utilize the windfalls from the increases in oil prices to effect changes in their lives. One way we can do this is through ensuring that these funds are used to eradicate preventable diseases and despair.To achieve this, the Federal Ministry of Health will need to provide strategic, progressive leadership.
Effective monitoring and evaluation (M&E) of performance and tracking the use of resources, health policies and reforms: The Government should appoint a committee or set up an agency in the monitoring and evaluation (M&E) of performance and tracking the use of resources, health policies and reforms continuously to enable technical efficiency in the delivery of their services. Implementation of health financing policies and actions need to be monitored and evaluated at regular intervals. Monitoring and evaluation exercise are needed for building evidence for future policies and for the assessment of whether the policy objectives have achieved the expected results. Monitoring and evaluation strategies contribute to the assessment of MDG, child and maternal health and other national and international development goals. The evidence will be useful for better targeting of donor action on MDG. The amount of investments in health is expected to increase with the provision of evidence to justify the magnitude of investment. It is also necessary to ensure the effectiveness of public health expenditure through the institutionalization of performance-based budgeting and other mechanisms for preventing fraud.
Building a fairer economic relation with the world: There should be concerted effort to “build a fairer world” that limits the health damaging consequences of the unjust economic and political relation between the developed and the developing countries, to which Nigeria belong. In this regard, the power of the World Bank, the IMF and WTO in forcing programmes on the poor countries that exacerbate poverty and endanger the health of the population must be addressed. The current WTO agreements on intellectual property rights, which effectively limit the access of the poor countries to essential medicines and cheap drugs, must also be opposed by the governments and peoples of the poor countries. The framework of unequal economic and political relations between Nigeria and the advanced capitalist countries -unequal trade, the ecological debt, the external debt, has to be addressed.
Increased funding to the health sector: Government should massively increase investment and public spending on health. The health system currently relies on mixture of government budget, health insurance, external funding and private sources including non-governmental arrangements and out of pocket payments. Despite the variety of financing sources, the level of health spending is relatively low.
Implementation of integrated model for community-based chronic and communicable disease control in health services delivery: The FMoH should promote the implementation of integrated model for community-based chronic and communicable disease control in health services delivery. Government should develop guidelines for the practice of traditional medicine and facilitate the retraining and registration of traditional medical practitioners to improve their skills and effectiveness and thus, help promote their integration with the primary health care system. Also, government should strive to promote the development of industries and relevant manpower to enhance local capabilities in the production of drugs, including ARV and laboratory reagents, medical equipment and spare parts to improve supplies and maintenance capabilities so as to reduce cost and improve efficiency.
REFERENCES
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