Problems And Prospects Of Health Service Delivery At Grass Root Level
This study seeks to highlight the recent activities of local government in health care delivery. Health care in Nigeria is prone to so many problems which are attributed to the fact that health services are in great demand but accessibility to health services is very low. Result shows that factors such as socio-economic, cultural, political as well as poor planning and/or poor implementation of health policies and programmes by the government are some of contributing factors. The literature review reveals the interconnectedness between local government and the sustenance of primary health care in Nigeria. The study traced the historical antecedent of health service delivery from the colonial era to the present day. It identifies the major contradictions in the management of primary health care implementation, using a local government as case study. In this study, Ife-East L.G.A was used as case study in this research. They include shortage of qualified personnel and finance, inadequate transportation, inaccessibility to communities, lack of maintenance culture, political instability, high degree of leadership turn-over. For the sustainability of health care service delivery at the grassroots, the study recommends increase financial allocation, community mobilization, improved health education, policy consistency and provision of qualified health workers.
1.1 Background of Study
Health services delivery in Nigeria had its historical antecedents. It had evolved through a series of developments including a succession of policies and plan, which had been introduced by previous administrations. Previous administration here refers to the unorganized administration of the colonial and post-colonial administration in Nigeria.
Oyewo (1991) traced the historical epoch of Nigerian health sector beyond the organized colonial period and asserted that maternal and child care of pre-colonial period through primitive, compared to the orthodox medical care, served the people with precise efficiency which was proportional to their level of development. He further identified the beginning of a meaningful health service policy with the first Ten year National plan (1946 – 1956) wherein health was put on the concurrent legislative list with both Federal and Regional government exercising defined powers within their areas of direct administrative control.
Similarly, many published and unpublished works remarked that Public Health Services in Nigerian and other West African Protectorates originated from the British Army Medical Services. When the army became integrated with the colonial government, medical care was extended to the local civil servants and their relatives and eventually to the local population, especially those living close to government station. At the same time various religious bodies especially Christian Missionaries and private agencies made spirited efforts to established hospitals, dispensaries and maternity centres in different parts of the country, particularly in the South and the Middle Belt.
The first Ten-year National plan (1946 – 1956) whose proponents were mainly expatriate officials had a number of deficiencies, especially in the health services. The health policy at the Second National Development Plan (1970–1974) focused in part at correcting some of the deficiencies in the health delivery services. There was a deliberate attempt to draw up a comprehensive national health policy dealing with such issues as health man-power development, provision of comprehensive health care based on basic health care service scheme, disease control, efficient utilization of health resources, medical research and health planning.
The local government is essentially created as a viable political and administrative organ for the transformation of all communities and for delivery of essential services to the citizens. Local government plays a central role in enabling the achievement of development at the grassroots level. Governments should therefore continuously seek new and better ways to build service institutions that have the capacity to champion and advance the course of development. Local government must create an appropriate and conducive environment for the people at the local level through efficient and effective service delivery.
1.2 Statement of the Problem
The study on problems and prospects of health service delivery at grass root level came about as a result of lack of infrastructure, lack of conducive environment in terms of war breakout, illiteracy of the local government citizens and lack of awareness, due to the fact that the people have not been given an awareness as to what health service delivery is all about, they might cause riot thereby leading to destruction of any infrastructure and equipments provided as well as lives. Finally, most of the research has been carried out health service delivery but not even a single research has been carried out on problems and prospects of health service delivery at grass root level.
1.3 Aims and Objectives of Study
The main aim of this study is to determine the problems and prospects of health service delivery at grass root level. Other specific objectives of the study include:
- To determine the effect of lack of infrastructure on health service delivery.
- To determine the effect of the unskilled in health service delivery.
- To determine the extent to which local government authorities affect health service delivery.
- To determine the impact of health service delivery on the grass root citizens.
- To determine the effect of provision of adequate and effective health facilities and care on the entire population.
- To determine the factors affecting health care service delivery at grass root level.
- To determine the relationship between health service delivery and the grass root citizens.
- To proffer possible solution to the stated problems.
1.4 Research Questions
- What is the effect of lack of infrastructure on health service delivery?
- What is the effect of the unskilled in health service delivery?
- What is the extent to which local government authorities affect health service delivery?
- What is the impact of health service delivery on the grass root citizens?
- What is the effect of provision of adequate and effective health facilities and care on the entire population?
- What are the factors affecting health care service delivery at grass root level?
- What is the relationship between health service delivery and the grass root citizens?
- What are the possible solutions to the stated problems?
1.5 Statement of Research Hypothesis
H0; Health care service delivery has no significant effect on the grass root citizens.
H1; Health care service delivery has a significant effect on the grass root citizens.
1.6 Significance of Study
The study on the problems and prospects of health service delivery at grass root level will be of immense benefit to the entire local government citizens and as well as the local government authorities in the sense that it will enable them to utilize the solution that is stated in this study effectively which include; the local government authorities to employ an agency which will watch over the facilities of the health care centres to avoid theft, warn the youth, men and women of the communities not to cause riot as the implementation of health care service delivery is for their good. Finally the study will contribute to the body of existing literature and knowledge in this field of study and provide a basis for further research.
1.7 Scope of Study
The study on the problems and prospect of health service delivery is limited to the grass root level.
1.8 Limitation of Study
Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
1.9 Definition of Terms
It is a situation that is unsatisfactory and causes difficulties for people.
The possibility or likelihood of some future event occurring.
Is the ability of a biological system to acquire, convert, allocate, distribute, and utilize energy with maximum efficiency.
The action of helping or doing work for someone.
Grass root Level
The ordinary people as distinct from the active leadership of a party or organization:
Conclusion and Recommendation
In conclusion, the healthcare problems in Nigeria result from a combination of factors. There is therefore an urgent need for a concerted effort on the part of individuals, communities, governments and partners interested in the provision of qualitative healthcare in Nigeria, towards putting in place workable structures at the healthcare facilities to alleviate these problems. In the short term, provision of health services that are adequate, accessible, available, and affordable and user friendly, and development of transportation, and availability of adequate healthcare infrastructural facilities such as good roads, water and providers as well as equipment/structures to take care of emergency obstetrics, are areas that need emphasis and urgent attention. In the long term, it is the combination of education, improved socioeconomic standard of the people, women empowerment and education of women, career opportunities and full access to reproductive health information and services that will have the target impact on health.
The essence of transferring Primary Health Care to the Local Government are to make the management of PHC services more effective and closer to the grassroots. However, in view of the level of health awareness, one begin to question the extent to which health care has been taken to the doorstep of the rural / urban dwellers.
One of the hindrances to the development of health especially in Nigeria and our case study in particular has to do with insufficient number of medical personnel as well as their uneven distribution. There has been too much concentration of medical personnel at the urban to the neglect of the rural areas.
Another significant problem in the management of PHC is transportation. It was observed during this study that there are no enough vehicles for workers to perform their task especially to the rural areas. The maintenance culture of the existing vehicles was poor while PHC vehicles were used for other purposes other than health related activities.
The irregular accessibility to many parts of the communities owing to natural topographical condition such as excessive flooding during rainy season, hilly and mountainous terrain of the landscape. One other problem has to do with inadequate finance. This manifest itself in increase in wage bills, over dependence of the LGA on Federal, State and International Agencies. The internally – generated revenue of the LGA is merger and not anything one can to write home about.
The level of community involvement in PHC management is another matter of concern. There are evidences of low community participation. It is a truism that the cornerstone of PHC is community involvement but to a large extent this has becoming crisis ridden problem throughout Nigerian Local Government.
Another problem is the general misuse and abuse of the scarce resources, human, material and financial by some political and administrative leadership.
Similarly, lack of continuity of LGA leadership posses another problem. There are high degree of leadership turn-over as well lack of continuity in Local Government leadership in between 1996 – 2001, there are five
Administrators either appointed or elected in the LGA. This accounted for inconsistencies in health policy decisions. Undoubtedly, the problems facing LGA – PHC are legion and in exhaustive.
Having identified the litany of problems against effective and efficient implementation and achievement of the goals and objectives of Primary Health Care Services Delivery at the Local Government, the following recommendations are suggested as a way forward.
There is the dearth need for the Local Government as well as all the other tiers of government to increase their allocation to the health sector. Local Governments on the other hand should be more inward-looking and aggressive in the area of internally-generated revenue. This is to reduce the dependence on the federation account in financing health programmes.
Priority should be given to improved living condition of the people beyond the present poverty level, so as to enhance better healthy living. To this end, intensive and effective health education of the public must of necessity be reinforced, in other to eliminate such diseases as malaria, typhoid and other infectious diseases. There is the need for maintenance of minimum health standard, improved housing condition, water, environment, sanitation and food supply for the sustenance of good health condition.
Poor leadership and political instability have been the basis for unsuccessful implementation of most government policies and programmes on health care delivery. Therefore good leadership and political stability is desirable to provide enabling environment for the implementation of the PHC programmes. This will invariably reduce the problem of abandoned projects in the health sector.
There is the need to put a stop to unnecessary responsibilities being given to LGA’s by the state governments. It is a common occurrence for federal and state governments to shift part of their responsibilities to LGA, such as purchase of useless books, Calendars/Almanac and imposition of sponsored programmes. All these are drains on the lean purse of the Local Governments with its attendant effects on health services delivery.
Adequate supervision, monitoring and evaluation of programmes should be pursued with vigor and required manpower provided.
The Nigerian health policy makers should give priority to the training of more rural health workers. This is to prevent the drift of rural health workers from the rural communities to the urban centres. More financial and other incentives should be provided to prevent the high staff turn-over of health workers.
In conclusion, Primary Health Care in Nigeria and especially Ife-East Local Government have come a long way and certainly still require more effort so as to achieve the goal of health for all now and beyond.
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