Effects Of Public Sector Reform On Health Service Delivery
This study is an investigation on Effect of Public Sector reform on health service delivery. The study was carried out in Ojo L.G.A, Lagos state. The main question was to what extent the public sector reforms has contributed or inhibited service delivery. The question was considered imperative to conduct a systematic inquiry in this area. The paper was guided by three objectives and instrumental questions towards the achievement of its findings. The questions were identification of reforms that have been effected, an assessment on its impact on service delivery and finally identification of challenges that affect implementation of reforms. Review of documentary information relevant to the subject matter was made. To compliment on secondary information the author administered questionnaires to sampled respondents. Observation method was also adopted. Data was qualitatively analyzed. Also descriptive approach was used for primary data. The paper concludes that, public sector reforms in local authorities for improved service delivery in Nigeria in general have had many positive results despite a few challenges. Findings justifies that, currently the contribution of public sector reforms in local authorities has significant impact. Findings were in agreement with the literature that reforms are necessary for improved service delivery. However, the implementation came with challenges that needed to be addressed for fruition, enjoyment and cerebration on results of reforms. The areas that need a special attention include the existing legal frame work aiming at addressing corruption and other unethical conducts and training are the issues this paper recommends.
1.1 Background to the Study
The importance of public sector reform to health and the grand economy cannot be overstressed. The current drive to improve management in governments through public service reform programs to increase efficiency, effectiveness, and the delivery of quality service to the public is common to many African countries, including Nigeria. The public sector has, for long, enjoyed a pride of place, particularly since the post-industrial revolution era. Public administration moved away from being mere watchmen, to being the engine of the society and become the major provider of various services, including health service delivery. Generally, all societies have some forms of public service provisions for reasons of economics, risk, and moral responsibility (Omoyefa, 2008).
Governments, in many parts of the world, are structurally and constitutionally tied to the civil service, irrespective of the system of government (Olagboye, 2005). This according to Agagu (2008) explains why the relationship between the government and the public service in Nigeria endured in spite of the various forms of governments the country has been experimenting with since independence.
Almost all African countries are caught in the web of public sector reform. Good governance and efficient public administration are regarded as a wishful thought without public sector reform. Also, accountability, transparency, and merit-driven public service are thought to be unachievable except programs of public sector reform are drawn up. Efficiency, effectiveness, and responsiveness of government to the yearning of its citizens could only be gauged through the lenses of the public sector reform (Omoyefa, 2008).
African governments are, therefore, churning out policies on a daily basis. Not minding their relevance and positive impact on their people provided, these policies are part of the new public sector management in the name of public sector reform, not minding the fact that the public sector reform was suggested and imposed on the African countries by external interests. Public service reforms, which have taken place in Africa during the last two decades, are part of a global phenomenon that has touched all parts of the world – developed, developing, and countries in transition (Mutahaba & Kiragu, 2002).
While the African leaders innocently and ignorantly accepted the externally induced programs of reforming their public sector institutions as a way of bettering health service delivery, the developed countries that are propellers of donor agencies are interested in re-colonizing African countries through the back donors. It is a subtle way of neo-colonialism and consequent perpetual slavery without realizing it.
In Nigeria, for instance, the Public Sector Reform (PSR) has been on the agenda for a number of years. As noted by Obasanjo (2005) the context of health is rapidly changing. In advanced economies, health care systems are deemed financially unstable, while in emerging economies, they are still being shaped. These systemic changes result from the government pressure to contain the cost of health care. These costs have increased due to the growing number of ageing population and sophisticated technological advancement in medicine (in developed countries) and high unemployment rate, population explosion and poor accountability in developing countries. Concerns for affordability of health care are rife and there is a need to operate the health system in a more efficient manner. However, Nigeria is faced with the challenge of non-implementation public policies to develop a vibrant and sustainable health care delivery; so the future of health care seems uncertain.
A great deal of attention in development research and policy circles has recently focused on the efficacy of public expenditures in providing basic services to poor people, and on how actually making services work for the poor is constrained by weak incentives of public agents (World Development Report 2004, Fosu and Ryan, 2004). In this context, decentralization to locally elected governments has been explored as a means of strengthening incentives of public providers for improved service delivery (Bardhan, 2002). How accountable are locally elected governments for the delivery of local public services? Hence, this research will investigate the Effects of Public Sector Reform on Health Service Delivery in Lagos State, with a special reference to the elderly in Ojo LGA.
1.2 Statement of Problem
It is important to note that, the health sector in any economy forms the backbone of its growth and development. Factors affecting the overall Nigerian health system performance include: inadequate health facilities and structures, poor management of human resources, poor motivation and remuneration, inequitable and unsustainable health care financing, skewed economic and political relations, corruption, illiteracy, decreased government spending on health, high user fees, absence of integrated system for disease prevention, surveillance and treatment, inadequate access to health care, shortage of essential drugs and supplies and inadequate health care providers.
Bilateral and multilateral assistance, and government spending on health (26.40 billion Naira or 26% of total annual budget for 2004) have not translated into enhanced health status of average Nigerians. Policy reversals and other inconsistencies over the years tend to undermine some health reforms of the past. Strategies developed for the effective implementation of national health programs in the three tiers of government (federal, state, and local government) are poorly implemented due to the politics of federalism (autonomy and resource control). High disease burden and population explosion have culminated in a vicious cycle of poverty, insecurity and uncertainty. While some contend that there are perverse incentives at the local level to misallocate public resources, others maintain that the problem is lack of adequate resource transfers to local governments to finance their expenditure responsibilities (Ekpo and Ndebbio, 1998; The World Bank, 2002).
The federal budget in recent years has included programs of facility construction in local governments. However, there are no established rules or policies for the provision of financial assistance from the higher tiers of government, and it is not clear how well any assistance that is forthcoming is coordinated with LGA budgets and plans for primary health services. Therefore, this study will intensively consider the Effects of Public Sector Reform on Health Service Delivery in Lagos State, with reference to the elderly in Ojo LGA.
1.3 Objectives of the Study
The major objective of this study is to examine the Effects of Public Sector Reform on Health Service Delivery in Lagos State.
While other specific objectives are:
- To investigate the effects of public sector reform on health service delivery in Lagos State.
- To determine the impact of public expenditure on primary health care service for the elderly in Ojo LGA.
- To determine the impact of government policy on poverty reduction in Nigeria.
1.4 Research Questions
This research work shall be guided by the following research questions:
- Is there any significant relationship between public sector reform and health service delivery in Lagos State?
- What is the effect of public expenditure on primary health care service for the elderly in Ojo LGA?
- Is there any significant relationship between government policy and poverty reduction in Nigeria?
1.5 Research Hypotheses
The following under mentioned hypotheses will be tested in the course of the research study;
- Ho: There is no significant relationship between public sector reform and health service delivery in Lagos State.
- Hi: There is a significant relationship between public sector reform and health service delivery in Lagos State.
- Ho: There is no significant relationship between public expenditure and primary health care service for the elderly in Ojo LGA.
- Hi: There is a significant relationship between public expenditure and primary health care service for the elderly in Ojo LGA.
- Ho: There is no significant relationship between government policy and poverty reduction in Nigeria.
- Hi: There is no significant relationship between government policy and poverty reduction in Nigeria.
1.6 Scope of the study
The study was carried out on the effect of Public Sector reform on health service delivery. The study was limited to Ojo L.G.A, Lagos state, Nigeria.
1.7 Organization of Study
The study is divided into five chapters. Chapter one deals with the study’s introduction and gives a background to the study. Chapter two reviews related and relevant literature. The chapter three gives the research methodology while the chapter four gives the study’s analysis and interpretation of data. The study concludes with chapter five which deals on the summary, conclusion and recommendation.
Conclusion and Recommendation
From the findings of the research derived from the data presented and analyzed, it may be concluded that the adoption and implementation of public sector reforms in Local Authorities for improved service delivery in Ojo L.G.A, Lagos state has had many positive results despite a few challenges. These results have therefore achieved to a great extent the research objectives number two and three which aimed at finding out the impact of reforms on service delivery as well as the challenges related to the implementation of the reforms in Ojo L.G.A in Nigeria as discussed earlier.
The findings of this study justifies that, currently the contribution of public sector reforms in Local Authorities has had significant positive impact in service delivery. The findings of the study were in agreement with the literature that reforms are relevant and necessary for improved service delivery..However; the implementation came with challenges that needed to be addressed if the fruition and benefits of the reforms are to be enjoyed and cerebrated by the public. .
Respondents argued that instituting community involvement in planning process would lead to an increased ownership of projects, accountability, sustainability, effectiveness and efficiency of the process.
It is the researcher’s opinion that, the outcome of the analysis reached by this study may have been influenced by the choice of the sample that was used for conducting the research. The Dares Salaam city Council is just one among the over one hundred councils in the country, and is advantaged by being the capital city hence most of the reforms have immediate effect and impact to it based on its comparative advantage endowed. The choice of this study area may not have therefore clearly indicated the ‘real’ picture of the status of public institutions in Nigeria compared to other areas as far as implementation of public sector reform programme is concerned.
Based on the findings of this study and overview of the implementation process of the reforms and its impact on service delivery, the researcher makes the following recommendations:
- There is a need to enhance training to both councilors and local authority employees on reforms so as to improve the impact of the reforms on service delivery. Further, there is need for the policy on local government to state clearly on the importance of under- going training to the newly elected leaders of the Councils. Since, when they are declared winners of elections of local government, no training is conducted to equip the elect on their responsibilities including the don’ts and does of their careers. The gape suggests that the effectiveness and efficiency of the elect leaders at local government level is by chancing. In the same vein willingness to disengagement and/or engagement becomes obvious options for elect leaders.
- There is a need for improved public awareness as key stake holders in the reforms.
- There is a need to improve timely allocation of resources to facilitate reforms. and hence bear fruition on service delivery.
- There is a need for more commitment and political will from both bureaucratic and political leadership for successful reforms.
- There is a need for a clear separation between the government and the ruling party to avoid political linkage and administrative overlaps between political leaders and government officials.
- There is a need for a reviewed legal frame work and institutional frame work to address the problem of corruption in the country.
- There is a need to have integrated reforms which cut across all sectors due to interdependence nature of public institutions in their operations. The reforms should target political and administrative, economic as well as social cultural arena.
- For that matter, councils should ensure that they effectively involve the community in setting their priorities and develop their own plans involve them in the planning process; the available human resources at the level should also be well and effectively utilized for fruitful implementation of the plans and projects identified, this will at the end facilitate solving of their socio-economic services and enhance the availability, accessibility and quality of services.
- The reforms agenda also should be home grown to ensure relevance on the model and environment under which such reforms are implemented. The ownership of reform agenda is very critical for any reforms to bear fruition.
- Reforms should be comprehensive to cover both systems, structures, processes and the people that are involved in the adoption and implementation.
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