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Health Systems Administration in Nigeria
- 1. HEALTH SYSTEMS ADMINISTRATION IN NIGERIA Chimankpam Williams Uzoma Centre for Public Policy Alternatives
- 2. Outline • Introduction • Evolution of health systems – Pre-colonial – Colonial – Post-colonial • Health reforms • Health systems • National Health system composition • Health system administration – Federal government – State government – Local government • Challenges
- 3. "For the most part, when there's smoke, there's fire." Mark Wagar
- 4. • Life expectancy at birth is 53/55 years (male/female) • 4% coverage of NHIS • 60% pay out of pocket for health coverage • 3.1% HIV/AIDS prevalence rate Introduction
- 5. Evolution of health systems • Pre-colonial • Colonial • Post-colonial
- 6. Pre-colonial • Traditional medicine – herbalists, divine healers, soothsayers, midwives, spiritualists, bone- setters, mental health therapists and surgeons • Western explorers – The first record of modern medical services in Nigeria was during the various European expeditions in the early-to mid-nineteenth century • Missionary Churches – Roman Catholic Church, Church Missionary Society, American Baptist Mission
- 7. Colonial • Under the Governor, Lord Lugard – St. Margaret's Hospital, was built in Calabar in 1889 • War world – lead to the establishment of several military health care facilities – several government-owned health care facilities were established, ranging from rural health centers to general hospitals • Centralized Control of Health Care Services – Gambia, Sierra Leone, Ghana (then Gold Coast) and Nigeria were merged and controlled by the Colonial Office in London • Regional administration – Chief Medical Officer – 1952 and 1954, the control of medical services was transferred to the Regional governments
- 8. Health Reforms • The First Colonial Development plan from 1945- 1955 (Decade of Development) • The Second Colonial Development plan from 1956- 1962 • The First National Development Plan from 1962- 1968 • The Second National Development Plan from 1970- 1975 • The Third National Development Plan from 1975- 1980 • The Fourth National Development Plan from 1981- 1985 Nigeria's • Five year Strategic Plan from 2004 - 2008
- 9. Health Systems • The Nigerian healthcare administration is organized into three (3) tiers of Government namely Federal, State and Local. • Health care in Nigeria is categorized into three tiers: primary, secondary and tertiary levels • Administration of this levels of healthcare may overlap in some states.
- 10. National Health System Composition • The Federal Ministry of Health • The Ministry of Health in every State and the Federal Capital Territory Department responsible for Health • Parastatals under the federal and state ministries of health • All local government health authorities • The ward health committees • The village health committees • The private health care providers • Traditional health care providers • Alternative healthcare providers
- 11. Health System Administration ADMINISTRATIVE LEVELS SERVICE STRUCTURE PERSON IN CHARGE Federal Government Tertiary Health Services Federal Ministry of Health Secondary Health Services State Ministry of Health State Government Local Government Areas Primary Health Services Local Government Areas Private Sector Private Services Private Providers
- 12. CABINET National Advisory Council on Health Inter Sectoral Collaboration Federal Ministry of Health Private sector, NGOs, Traditional/Faith healers Teaching Hospitals, Federal Medical Centres State Ministry of Health General Hospitals Local Government Department for Health Primary Health Clinics and Health Posts Technical committee
- 13. State Level Administration State Ministry of Health Health Management Board Hospital Management Board Primary Healthcare Board Traditional Medicine board Health Service Commission Medical Services Pharmaceutical Services Nursing Services Finance and Administration Accounts legal services Pensions and Establishment Matters Engineering Services
- 14. Local Government Level Administration CHOs VHWs TBAS Secondary (Referrals & Technical) Tertiary (Referrals & Technical) Village Health Service MOH Supervisory Councillor LG Chairman & Council LG PHC Mgt Committee PHC Technical Committee Ward Health Committee
- 15. Challenges of Health Administration • Multiple lines of reporting • Mismanagement of funds • Red-tapism • Inter- cadre conflicts
- 16. Way out • Integration of all information into the Health Management Information System (HMIS) • Corruption control • Funding • Clear division between administrative/management role and specialist role • Restructuring of the bureaucratic system
Notas do Editor
- The origin of diseases in Africa was simplistic. It is either an enemy had cast a spell on you or you are being punished by divine powers for your sins Although the Arabs have had the distinction of early-organized medical services, there is no recorded evidence of the introduction of such services to Sub-Saharan Nigeria during trade interactions of the fifteenth century In the expedition of 1854, Dr. Baikie introduced the use of quinine, which greatly decreased mortality and morbidity among the expeditioners It would seem from available accounts that the earliest form of Western-style health care in Nigeria was provided by doctors brought by explorers and traders to cater for their own well being. The services were not available to the indigenes. It is stated that the first health care facility in the county was a dispensary opened in 1880 by the Church Missionary Society in Obosi, followed by others in Onitsha and Ibadan in 1886. However, the first hospital in Nigeria was the Sacred Heart Hospital in Abeokuta, built by the Roman Catholic Mission in 1885
- Under the Governor, Lord Lugard, Lokoja was the military headquarters in 1900. Aside from military health services, civilian services were also established and it is known that the first government hospital for civilians, the St. Margaret's Hospital, was built in Calabar in 1889 central administration of health care services became regionalized, while maintaining some common West African facilities such as the West African Council for Medical Research
- National Council on Health coomposition-The Minister, the Minister of State for Health, the Commissioners responsible for matters relating to Health in the States of the Federation; and the Secretary responsible for Health in the Federal Capital Territory, Abuja.
- Functions of the SMH Formulation, monitoring, evaluation of policies, strategies, plans of action and supervision of health services Supervision and control of all health facilities in the State in order to ensure a minimum standard in all public and private health facilities Supervision and control of all Hospital Boards and Government Health, bodies and Agencies including Traditional Medicine Board Formulation of regulations and subsidiary legislations for the approval of the Lagos State House of Assembly Approval of long-term plans and variations of such plans Development of management, financial guidelines and performance standards for internal control of public hospitals Policy approval of rate and scale of charges for services rendered to the public by the Hospital Boards Recommendation for capital and operating budgets for Hospital Boards (which includes recommendation for major adjustments, increase in salaries, allowances and fringe benefits for hospital employees) Elevating the quality of health practice in the professional disciplines through the advancement of appropriate standards and research priorities Collation and analysis of monthly medical statistical data (attendance, morbidity, mortality and utilization of services) from Hospital Boards Obtaining annual audited accounts of hospitals and Hospital Boards within three months after the end of the preceding financial year which must be submitted to the State Auditor-General’s Office for verification (applicable only to public Hospitals) Co-ordination and integration of the various hospital services at all levels in the State to ensure that they conform with the State health policies and programmes Maximizing the effective use of resources within the health sector in the State.