1Nicholas Ukeyima Pever
2Felix Aondona Kor
Akperan Orshi College of Agriculture, Yandev
Gboko, Benue State
2Department of General Studies
Akperan Orshi College of Agriculture, Yandev
Rising health problems among the Nigerian populace are threatening the very foundation of Nigeria as a nation. Successive governments in Nigeria have adopted various policies to solve these health challenges. In spite of these efforts, several health problems have continued to rise unabated. This has informed the need to embark on this study with a view to determining the extent to which various health care programmes of the government have helped in achieving good health for all in Nigeria. The methodology adopted for the study is a descriptive analysis. Data were sourced from published material such as textbooks, journals, Internet sources and monographs. The study showed that health care policies of successive governments were not designed and implemented to achieve sustainable health in Nigeria. The article suggested proper formulation of policies that have direct bearing on the populace and proper monitoring of the various policies and programmes to achieve sustainable health for the Nigerian populace.
Globally, the place of health in the development of any nation is primodial. Undoubtedly, the significance of health to national life has made successive governments in many nations of the world, both developed and developing to design or formulate certain fundamental policies in order to regulate, control and guide the operations of health care services (Adeleke & Gafar, 2012). In Nigeria, over the years, various policies have been put in place in order to improve the health sector. Some of these policies include western and traditional health care integration, Basic Health Social Scheme (BHSS), Primary Health Care (PHC), the National Health Insurance Scheme (NHIS), National Action Committee on Aids (NACA) among others. These policies were put in place with certain objectives. Some of these are; to ensure that every Nigerian has access to good health care services; to ensure equitable distribution of health care facilities within the federation and at all levels of government; to maintain high standards of health care delivery; to limit the rise in the cost of health care services, to improve and harness private sector participation in the provision of health care services, and to ensure that all health care providers conform to laid down rules and regulations guiding health care operations (Adeleke & Gafar, 2012).
The implementation of these policies is often bedeviled with challenges. People’s attachment to customs, traditions, myths and legend, high level of corruption, ignorance, poverty and lack of needed commitment by the stakeholders constitute one form of problem or the other. This article examines health care as well as health related policies in the Nigerian social setting. The various problems that have hitherto constituted barriers to the effective health care services since the country attained independence in October 1960 are examined.
A critique of the past and present policies is provided in the study. The objectives of the study include among other issues; to determine the extent to which health care policies in Nigeria are subject to contingencies, to ascertain the extent to which policy attainment in good health care policies conforms to the major thrust of the World Health Organization’s policy and to determine the extent to which health care policies affect societal development. As regards review of literature, several theories by eminent scholars and researchers on health care policies are considered or reviewed to fill the existing gap in knowledge concerning the subject matter.
Statement of the Problem
The Nigerian state is hit by problems of poor health care delivery. This is often associated with poor policy formulation and implementation which are attributed to factors like mismanagement of human and material resources, indiscipline, lack of the political will by the government of the country beginning from the regime that took over from the British at independence (1960) up to the present-day Nigeria. Rather than tackle health problems in the society headlong, our policy makers or the political class has appeared to sacrifice good health care at the altar of self-acquisition of personal wealth.
Some scholars, like Adeleke and Gafar (2012) are of the opinion that the present health woes in the Nigerian society are associated with poor policy formulation while Tile (2000) argued that the health problems of Nigeria are as a result of wrong policy implementation.
Conceptual Issues: Health, Health Care and Health Care Policies
Health: Ordinarily, health could mean a state of the body where there is no sickness. But to World Health Organization (WHO) health is a state of complete physical, mental and social well being, and not merely the absence of diseases and infirmity. In a more exclusive use, health is having the ability to adapt continually to consistently changing demands, expectations and stimuli (Elwes & Ina, 1985).
Health Care: The concept of health care does not lend itself to a generally acceptable definition. The concept is viewed differently from person to person and from one discipline to the other. Heath care could therefore be defined in this article to mean the diagnosis, treatment and prevention of diseases, illnesses, injury and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery, medicine, nursing, pharmacy, psychology and other health care providers. It refers to the work done in providing primary, secondary and tertiary care, as well as public health.
Health Care Policy
According to the United States of America (USA) Department of Health and Human Services, Health Care Policy is an action taken by governments (National, State or Local) to advance the public health. It deals with organizations, financing and delivery of health care services. This includes training of health professionals, overseeing the safety of drugs and medical services, administering public programmes and regulating public and private health insurance. Generally, the goal of National Health Policy is to bring about comprehensive health care system based on primary health care that is protective, preventive and rehabilitative to every citizen of the country within the available resources. This is done so that individuals and communities are assured of productivity, social wellbeing and enjoyment of good living. Thus, health care policy refers to the various rules, regulations and guidelines made by the government to operate, finance and shape health care delivery. It covers a range of health-related issues including the financing of health care; public health, preventive health care, chronic illness and disability, and long-term care and mental health. Nigeria as a nation has a health care policy which seeks to provide health for all by the year 2020. In this regard, various programmes are designed to address the issue of health problems of the populace.
This study adopts “system theory” as a theoretical guide. System approach finds its brilliant manifestation in the work of Talcott Parson (1902-1979), Scott and Gordon (1994), Stressed Parson (1937) argument that the basic analytical component of the system theory is the unit act, which involves an actor, an end or goal, a situation composed of conditions, means, and collection of unit acts. Social system is a mode of organization of action elements relative to the persistence or ordered processes of change of the interactive patterns of a plurality of component actors.
This theory argues that a social system is faced by two major problems. One is the problem of production and allocation of scarce resources, the other is the problem of achieving social orders or integration. This notion gave rise to Parson’s famous development of four sub-systems, which responded to the external and internal “functional prerequisites of a system of action namely adaptation, goal attainment, integration and latency. He described this as AGIL model of social system (Ajala, 2003).
Health care policies in Nigeria are examined using the four typology enumerated above. These sub-systems are connected by flows of input and output, which Parson called “media of exchange”. These are money (representing adaptation), power (goal attainment), influence (integration) and commitment (Latency). The equilibrium of social system depends on these complex exchanges between the various sub-systems.
Nigeria’s Health Care Policies Since 1960
For several decades, the colonial government in Nigeria favoured the spread and expansion of western medicine in Nigeria. However, its services were only available to about 25-30 percent of Nigeria’s leaving about 70-75 percent of the population to the care of traditional medicine (Adeleke & Gafar, 2012:) However, many developing countries like Nigeria, which had similar problems, adopted the policy of western and traditional integration to combat their health problems (Hyma & Ramesh in Philip & Vergassett, 1994). The success in India, China, Indonesia and Singapore motivated several countries to seek for the integration of these medical systems. The impact and success in some of these countries led to the campaign for international recognition and general acceptability of the integration of the two systems of health care. The World Health Organization (WHO) in 1976 endorsed and approved the acceptability of the two (traditional and modern) as internationally reorganized health care services (WHO document 1984). For the purpose of global acceptability, traditional or indigenous health practice was repackaged and changed to “Alternative Medicine” (Tile, 2000). Upon the recognition of the infidelity of either western or traditional medicine to independently provide sustainable health care services in Nigeria, government then embarked on many experimental projects towards establishing linkages between traditional medicine and its western type (Ajala, 2003). The first attempt was made in 1966 at the University of Ibadan where a research programme inaugurated on local herbs: medicinal plants with reference to their medicinal properties, was sponsored by the Federal Government. Tella, (2000: p. 207) remarked that the attempt was the “first veneer” to integrate traditional medicine with western medicine.
Similarly, in 1973 the Federal and Lagos State Governments co-sponsored a conference at the Department of Chemistry, University of Lagos. It was an international conference on traditional medical therapies. The conference was attended by both scholars on the subject and traditional healers. The government as part of its efforts towards a holistic health for its citizenry, noted as essential component of Basic Health Social Scheme (BHSS), the health policy and programme established in 1975 that community health should be promoted. This was basically hinged upon the recognition of the potency of traditional medicine in certain areas especially the use of herbs during child birth. Upon the establishment of the programme, a delegation was sent to India and China in 1977 by the Federal Ministry of Health to examine the system of traditional medicine in the two countries. The delegation produced its report and recommended that the integration of traditional medicine with western medicine was desirable (Tella & Lambo, 1977).
Follow up to the development was the establishment of National Committee on the Re-training of Traditional Birth Attendants (TBAs) by the Federal Ministry of Health. The committee established offices all over the country to upgrade the skills of traditional birth attendants in delivering babies. To facilitate its task and set national standards, the committee produced a national syllabus for the training of TBAs.
In addition, the declaration established Primary Health Centre (PHC), which were mandatory to all the states. The components of PHC included the community head who incorporated indigenous health knowledge into the scheme of PHC. Also in this declaration, WHO declared health for all by the year 2000 A.D. This implied that if states had to meet up with this target, health care system must not only be affordable, but largely accessible. A critical look at this target has proved that the year 2000 has come and gone without any achievement of the targets earlier set.
However, in 1984, the Federal Government embarked upon a readjustment of the existing health policy in Nigeria. It commissioned a committee to develop an official health policy for the whole nation (Tella, 1979). The committee was headed by a renowned international expert on public health, Professor A.O. Lucas. After a thorough consideration, the committee recommended the establishment of Primary Health Care as the key to Nigeria’s health services. The recommendation was based on the global interest in the Ama-ata declaration and on the vision of the Second National Development plan, (1970-1974).
National Health Policy and Primary Health Care (PHC)
The National Health policy declaration of the Federal Republic of Nigeria was for the country to attain a level of health for all citizens by the year 2000 through the implementation of Primary Health Care (PHC). The policy was based on the nation’s philosophy of social justice and equity for all communities, rural and urban. Some of the objectives of PHC implementation as outlined by Akeredolu-Ale (1995) included:
- To increase coverage of health services, extending such services to the grass-roots, especially to rural communities and the urban poor who were not well served.
- To change the orientation of health services, with more emphasis on preventive than curative components.
- To improve efficiency of services and coordination of health care delivery at different levels of government.
- To involve communities in the decision making process.
- To reduce to the barest minimum other broad range defects in our health system.
The components of primary health care include:
- Immunization against major infectious diseases
- Health education on prevalent health problems
- Maternal and child health including family planning
- Environmental sanitation
- Control of locally endemic diseases
- Promotion of food supply and proper nutrition
- Treatment of ailments
- Provision of essential drugs
It is important to note that the report of the committee did not receive any attention until 1987 when the Federal Executive Council was convinced by the Late Professor Olikoye Ransome Kuti, who was the then Minister of Health. This gave impetus to the establishment of National Primary Health Care Development Agency (NAPHCDA) as a vehicle for developing and supervising the Primary Health Care. Subsequently, the Federal Government established two hundred (200) model health care centres all over the country (World Health Organization, 1994).
Furthermore, the policy recognized a 3-tier system of health care namely; Primary Health Care, Secondary Health Care and Tertiary Health Care. The implication of the division was to ensure every category of people in Nigeria was cared for. The health needs of the people at the grassroots are to be addressed at the primary health care centre. The provision of health care at this level was largely the responsibility of local governments. At the secondary level, specialized services to patients referred from the primary health care level were to be provided at the district, division and zonal levels of the state. In addition, the state government was expected to provide adequate support services such as laboratory, diagnosis, blood banks, rehabilitation and physiotherapy services. At the Tertiary level, specialized and specific services such as orthopedic, eye, psychiatric, maternity and pediatric cases were to be addressed by the teaching hospitals (WHO, 1984).
Owing to the enormous financial problem confronting the health care sector in Nigeria, the government embarked on another health policy aimed at solving this financial burden on the governments through individual involvements. It was for this reason that the Federal Government established the National Health Insurance Scheme under Act 35 of the 1999 CFRN. The idea behind the establishment of the scheme was to find a lasting solution to the financial problems that had been the major obstacle to health in Nigeria. Indeed, the concept of social insurance was mooted in 1962 by the Halevi Committee, which passed the proposal through the Lagos Health Bill. Unfortunately, the idea was truncated. In 1984, forced by the desire to source more funds for health care services, the National Council on Health under Admiral Patrick Koshoni, the then Minister of Health, inaugurated a committee chaired by Prof. Diejomoah (Adeleke & Gafar, 2012). The committee, after a thorough study considered and advised the government on the desirability of Health Insurance in Nigeria and recommended its adoption (Ajala, 2003). Unfortunately, no meaningful action seemed to have followed the recommendation.
The scheme as part of the government’s efforts to reach every Nigerian operated through these design programmes in order to cover every segment of the country namely:
- Former sector health insurance (usually, the civil servants)
- Urban self-employed social health insurance programme
- Rural community social health insurance programme
- Children under-five social health insurance programme
- Permanently disabled persons social health insurance programme
- Tertiary institution and voluntary participation social health insurance programme
- Armed Forces, Police and Uniformed services.
The scheme was launched in 2005 with over four million identity cards issued to members (Adeleke & Gafar, ibid).
The Structural Integration of Health Care Professionals in the Development of Health Services in Nigeria
Considering the importance of traditional medicine to the health care delivery system, Tile (2000) suggested the integration of both systems of medical practices on these grounds:-
- The active pharmaceutical herbs of traditional healers have been found very useful and can be hygienically prepared, and appropriate dosages designed to complement the drugs of modern medicine.
- The expert knowledge of traditional healers and their healing practices can be utilized along side with services of modern physicians or health workers.
- Majority of people in the Third World make use of traditional healers, who are more accessible to them than modern physicians and other para-medical staff.
- Both the traditional and modern health care services or system have many things in common, and these could provide the basis for the integration of the two service systems.
- A substantial number of Africans continue to utilize both service systems, at times simultaneously, in their health seeking behaviour.
- When both systems are integrated, they will facilitate greater utilization by the people, most especially those inclined towards using both systems of health care (Tile, 2000, p. 84).
Oshuntokun (1979), Ademuwagun (1979) and Jazen (1987) have also argued in favour of the merger of modern health workers and their institutions of medications. Ityavyar (1984) used the role of traditional midwives in Sokoto state who sometimes assume the role of a surgeon by cutting patients to speed delivery as a good example of integration of traditional and modern medical practices.
For efficiency, Tile (1995) developed an integration formula for combination of traditional and modern medical professionals in the development of health services in Benue state which is typical of developing societies.
Comparative professional health matching between modern health works and traditional healers
|S/N||Modern health workers||Traditional healers|
|1||Physicians, Nurses etc||Berber surgeon, bone fracture healers etc|
|2||Pharmacists, chemists etc||Herbalist, medicine men etc|
|3||Modern Mid-wives etc||Traditional birth attendants etc|
|4||Lab technologists, radiographers etc||Diviners, soothsayers, sorcerers, oracle priests etc|
|5||Community health workers, dispensers, health assistants etc||Selected lineage, family heads, or elders in the family|
|6||Preventive care: vaccinations/immunizations, Health education, sanitation etc||Preventive care; taboos, waist bands, amulets, rituals etc.|
Source: Tile W.S (1995) Ph.D thesis University of Ibadan, Nigeria.
Challenges of Health Care and Health Care Policies in Nigeria
Health care and health care policies in Nigeria have encountered multi-dimensional obstacles. First and foremost, political crisis experienced thwarted the good health programmes and health policies in Nigeria.
Also, there is the problem of corruption. Corruption has become endemic in the socio-political structure of Nigeria. Money that is meant for the purchase of drugs in government hospitals is often diverted by some cliques who are out to enrich themselves through corrupt means. Even if these drugs are supplied at all, they are often sub-standard (Onuoha, 2000).
This problem necessitated the establishment of the National Agency for Food and Drugs Administration and Control (NAFDAC). The agency was established in 1993 to check the activities of the nefarious individuals who engaged in these acts of wickedness. Indeed, the high level of illiteracy, especially among the rural people of Nigeria, constitutes a serious problem to health care services. Many people in Nigeria still prefer traditional methods of treatment to the modern health care services. Moreover, poverty and Nigeria’s bad economy have negative impacts on the health status of Nigerians. Many people have died of trivial and treatable illnesses, because of their level of poverty. Drugs are not available in the hospitals. And even if they are, they are not affordable by the common man estimated to be between 70-75 percent of the total population (Paul, 2002). In Nigeria, to sum it up, there are good policies that have been clogged up by problem of implementation.
Despite the challenges enumerated above which continue to affect the success of health care pragrammes in Nigeria, the programmes have achieved much in the area of health promotion and sustenance. The requirement is that for every medical bill charged, the individual is required to pay only 10 percent of the amount. This in a way has reduced the financial burden on the affected citizens.
National Health Management System has also aided the provision of basic information needed concerning the health status of Nigerians. The prospects of this programme are not high due to the problems of data and record keeping in the country.
Also, the National Agency for the Control of AIDS (NACA) has done very well in the area of awareness on HIV/AIDS epidemic. The programme has done and is still doing very well both in the cure and prevention of the dreaded disease by provision of anti-retroviral drugs to HIV/AIDs victims to increase their immunity level and enable them live longer. In this direction, the agency has achieved reasonably well in terms of prevention and control of HIV/AIDs.
In the area of research, the National Health and Research Centre has been working round the clock to discover new methods of controlling and prevention of disease and infection in the society. Emergent diseases like sleeping sickness, cholera outbreak, measles, tuberculosis, Ebola and others are controlled through innovation/invention by experts and researchers in the institute. This has helped in coping with the health challenges facing the Nigerian state.
On the whole, the policies/programmes have contributed in one way or the other to reduce the suffering of average Nigerians who were hitherto trapped by social, political and economic constraints in their quest for access to good health services.
This article shows that health care services have gone a long way in Nigeria. Initially, the traditional health practitioners dominated the health care scene. However, the coming of the missionaries and colonial administration led to the commencement of western medicine. The colonial government favoured western health care above the traditional methods. However, after independence, the Federal Government introduced different measures to improve on the existing methods. With the approval of the World Health Organizations (WHO), there was a general clamor for integration of western and traditional medicine. This was followed by the introduction of Basic Health Social Scheme (BHSS), Primary Health Care (PHC) and National Health Insurance Scheme (NHIS). In spite of these lucid government policies, the health care services in Nigeria are still faced with different problems.
The work has shown that in spite of the challenges faced by health policies in Nigeria, achievements have been recorded by some of these policies. This is to Adeleke and Gafar’s (2012) claim that the policies have failed to address the health challenges of the Nigerian populace. To them this explains why there is high prevalence of communicable and non-communicable diseases.
Considering the importance of health to the wellbeing of the human society, policies concerning health should be properly formulated and implemented. This can be achieved through these ways:
- The Government of Nigeria should set up machinery in motion with the responsibility of ensuring full implementation of government health policies.
- Knowledge of experts such as medical doctors, pharmacists, radiographers and so on should be utilized effectively by stakeholders in the sector. This will achieve efficiency in terms of formulation and implementation of health care policies in Nigeria.
- Government and non-governmental organisatons
should organize workshops and conferences on the best methods of integration of traditional and modern medicines as well as the efficiency of the two systems.
- The National Health Insurance Scheme (NHIS) which is only formulated to cover all sectors of the society but is implemented for Federal Civil and Public Servants in Nigeria should cover the rural dwellers and the unemployed in the society. This will help in solving the health challenges of the Nigerian masses.
- Other health policies and programmes should be properly monitored by government officials for effective implementation. This is because the success of health care policies and programmes depend greatly on monitoring and evaluation.
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