GIVE AN ACCOUNT OF QUALITY HEALTH CARE IMPROVEMENT IN NIGERIA
There is no gainsaying the fact that the quality of healthcare in Nigeria is far from standardization and there is hardly any effective quality assurance system in the country’s health system. The Nigerian health care has suffered several down-falls. Despite Nigerian’s strategic position in Africa, the country is greatly underserved in the health care sphere. Health facilities (health centers, personnel, and medical equipments) are inadequate in this country, especially in rural areas. While various reforms have been put forward by the Nigerian government to address the wide ranging issues in the health care system, they are yet to be implemented at the state and local government area levels. According to the 2009 communiqué of the Nigerian national health conference, health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care. The communiqué further outlined the lack of clarity of roles and responsibilities among the different levels of government to have compounded the situation.
Unarguably, problems in the health care improvement of any country abound to a certain extent. Although health has the potential to attract considerable political attention, the amount of attention it actually receives varies from place to place. In their commentary of the 3T’s road map to transform US health care, Denise Dougherty and Patrick H. Conway rightly stated a step by step transformation of the US health care system from 1T →2T →3T which is required to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality care. Provision of timely information aimed at combating possible health menace among many other things is an important function of public health. Hence, inadequate tracking techniques in the public health sector can lead to huge health insecurity, and hence endanger national security, etc.
For decades ago, communicable diseases outbreak was a threat not only to lives of individuals but also national security. Today it is possible to track outbreaks of diseases and step up medical treatment and preventive measures even before it spreads over a large populace. Medical and epidemiological surveillance, besides adequate health care delivery, are essential functions of public health agencies whose mandate is to protect the public from major health threats, including communicable diseases outbreak, disaster outbreak, and bioterrorism. To avoid the various threats and communication lapses to strengthen the health work force planning, management, and training which can have a positive effect on the health sector performance, one requires timely and accurate medical information from a wide range of sources. The Nigerian health care had suffered several infectious disease outbreaks and mass chemical poisoning for several years. Hence, there is immense need to tackle the problem
HEALTH CARE REFORMS LAUNCHED IN NIGERIA
Ten-year developmental plan
Before independence in 1960, a 10-year developmental plan (1946–1956) was introduced to enhance health care delivery. Several health schools and institutions (Ministry of Health, several clinics and health centers) were developed according to this plan. By the 1980s, there had been great development in health care—general hospitals and several other health centers (over 10,000) had been introduced.
The primary health care plan
August 1987, the federal government launched its primary health care plan with the following major objectives:
1. Improve collection and monitoring of health data
2. Improve personnel development in the health care
3. Ensure the provision essential drug availability
4. Improve on immunization programs
5. Promote treatment of epidemic diseases
6. Improve food supply and nutrition
7. Improve material and child care, and family planning
8. Educate people on prevailing health problems and the methods of preventing and controlling them.
This health care plan made little impact on the health sector, as it continued to suffer major infrastructural, and personnel deficit, in addition to poor public health management.
Nigerian health insurance scheme
As an effort by the federal government to revitalize the worsening state of health, the Nigerian health insurance scheme (NHIS) that was established in 2005 by Decree 35 of 1999 provided for the establishment of a governing council with the responsibility of managing the scheme. However, Ladi Awosika noted that the scheme was first proposed in 1962 under a bill to parliament by the then Minister for Health.
The objectives of the scheme were to
1. Ensure that every Nigerian has access to good health care services
2. Protect Nigerians from the financial burden of medical bills
3. Limit the rise in the cost of health care services
4. Ensure efficiency in health care services
5. Ensure equitable distribution of health care costs among different income groups; equitable patronage of all levels of health care
6. Maintain high standard of health care delivery services within the scheme
7. Improve and harness private sector participation in the provision of health care services
8. Ensure adequate distribution of health facilities within the Federation
9. Ensure the availability of funds to the health sector for improved services.
The objectives and functions of the NHIS according to this present review have hardly attained any height as health care delivery continues to be limited; not equitable and does not meet the needs of the majority of the Nigerian people. This is indicative of the high infant mortality rate/poor maternal care, very low life expectancy as at 2010, and periodical outbreak of the same disease, as well as the long period of time spent for control of the various outbreaks
The appendage program of the NHIS launched in October 2008—Millennium Development Goals—also reported little positive effect a year later. The Nigerian National Health Conference in 2006 which was attended by more than 400 participants, including high cadre dignitaries ranging from the presidency to local governments and their agencies were aimed at ensuring effective, qualitative, affordable, and accessible health care for all Nigerians beyond 2007. According to the 2005 January issue of CARE-NET limited health insurance report concerning the NHIS, the Nigerian national health policy objective was the attainment of a level of health that will enable all Nigerians to achieve socially and economically productive lives. Since its lunching primary health care has not gained its right place in the priority of things. As part of the struggle to advance health care, the Nigerian senate in 2008 launched a bill for an act to provide a framework for the regulation, development, and management of a national health system and set standards for rendering health services in the federation and other matters connected with it.
In spite of the several failures of the Nigerian health care system, recent study had suggested that if managed well, the NHIS could be a useful ground for good health care delivery. At its present state, it is true that the scheme does not adequately account for the needs of the Nigerian people.
INDICATORS OF HEALTH CARE IN NIGERIA
In spite of the huge development in the health care in relation to the last decades, much is still needed to be done in the health care system. Although the total expenditure in health amounts to 4.6% GDP, financial managerial competency, besides inadequate funding, remains a major problem. Current statistics show that health institutions rendering health care in Nigeria are 33,303 general hospitals, 20,278 primary health centers and posts, and 59 teaching hospital and federal medical centers. This represents a huge improvement in regards to the last decades; nonetheless, health care institution continues to suffer shortage.
The backward and forward reference searches on second phase keywords search revealed increasing role of health information, communication as integral to leadership, as well as increasing role of medical intelligence/surveillance in the health care system in the United States and Europe.
THE WAY FORWARD FOR THE NIGERIAN HEALTH CARE SYSTEM-IMPROVEMENT AND RECOMMENDATIONS
Several flaws in the health care system could have been averted through adequate MIS, which is supposed to be the first line of approach to developing the Nigerian health care system. Of course, there is a long list of barriers which lie on the pattern of leadership, infrastructures, man power challenges, clinical training, standardized diagnostic instruments, etc. The reforms and changes made to retain health security seem not to have made positive effect on the health care system. Considering the threats of health insecurity, there is therefore immense need to revitalize the Nigerian health care system and provide specific project design to enhance cooperation and efficiency. To account for the modern day needs of Nigerians, the health care delivery system must adequately meet the following functions:
1. Effectively assess patients’ dilapidating state of health
2. Refer patients to specialists for appropriate treatments and supportive services
3. Recognize, treat, or refer comorbid medical and psychiatric conditions for specialists’ treatment
4. Perform age, gender, and culturally appropriate disease screening
5. Provide brief interventions to patients with dilapidating state of health
6. Chronic diseases management and prevention
7. Family planning to be cooperated effectively into the health care delivery system
8. Systematically and routinely measure the quality of services provided by the health system
9. Mortality data of specific project enrollees to measure the effectiveness of health care provided
10. Carry out health campaigns and awareness
11. Develop effective counseling methods
The huge problems encountered by the Nigerian health care system could partly be due to the absence of MIS system which holds the key to successful medical leadership, as well as health care delivery. Hence, there is necessity to setup a model of MIS systems for action to suit the interest of the Nigerian people. It is supposed that if adequately managed, MIS system model for the Nigerian health care will turn out to be the Cinderella of Nigerian health care system.
As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles.
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