Malaria and Health Care System of Nigeria - Term Paper Example

Name: Course: Tutor: Date MALARIA AND HEALTH CARE SYSTEM OF NIGERIA Introduction Malaria is a common and fatal disease in tropical regions, a problem which the health care delivery systems should keenly focus on. The effectiveness of Nigeria’s health care delivery system is fundamental in meeting its health aspirations. Despite the fact that Malaria is a common health threatening disease, many Nigeria is failing to establish correct mechanisms to ensure that proper and reliable medical services are rendered to its citizens. The poor health care services result from inadequacy and inaccessibility of medical facilities, insufficient staff, lack of proper policies, and corruption. This report focuses on problems facing health care service delivery in Nigeria which have subjected its people into a medical nightmare. This report would evaluate the health care problems which have facilitated poor malaria treatment and prevention. These problems involve: the quality of health care; and accessibility to health care. Problems with quality of care include evaluation of the adequacy of health care facilities and systems, including health care policies at medical centers, adequacy of standard operating procedures at these centers, adequacy of level and scope of care provided by physicians in the light of present knowledge and acceptable standards of medical practice in the current world of medical literature. The problems associated with accessibility would include evaluation of adequacy of the number of health care facilities and proper distribution of these facilities to allow easy and immediate access to medical facilities to all people, affordability, thus, accessibility of quality health care to all patients. Finally, this report would look as the strategies The Nigerian government has laid down to combat malaria. Statistical information In 2008, the notified cases of malaria (malaria morbility) were 38259 per 100,000 populations. Malaria death rate, for age between 0 and 4, (malaria mortality) was 144 per 100,000, which increased to 151 per 100,000 in all ages. In addition to that, statistics shows that children under 5 years sleeping under insecticide-treated beds nets were 1.2 % in 2003 and 5.5 % in 2008. The number of children under five years with fever being treated with anti-malarial drugs was 33.9% in 2003 and 33.2 in 2008 (United Nations Statistics Division 2011; Nigerian Health System n.d). Performance of Health care system The Nigerian health care performance system has been highly stagnating for about 20 years under military rule. For instance, per capita investment in health had stagnated at $ 1.0 per son compared to $ 34 per person as it is internationally recommended. In addition to that, when compared with other less endowed African countries, Nigeria allocates less of its total budget to the health care facilities. For instance, in 2006, Nigeria allocated 5.6% of its total budget to its health care system, while Uganda did so with 11% of its total budget. The low level of expenditure of Nigeria on health care per capita appears not to meet requirements of effective treatment and prevention of Malaria amongst its citizens (Wadingu 2009; Moye 2006; Nigerian Health System n.d). Health Care System Organization and Management Nigeria’s national health system is decentralized into three-tier parts with responsibilities as federal, state, and local government levels. These tiers are concerned with roles like stewardship, financing, and service provision. The federal level is responsible for policy and technical support to the general health system, international relations to health issues, national health management information systems, and provision of health services. The state level is concerned with secondary hospitals and for regulation and provision of technical support for primary health care services. The local government level’s responsibility is to provide basic health care, where health services are organized through the ward. Despite that, there is regular duplication and confusion of roles and responsibilities amongst different governmental tiers, even if organizational health sector appears to be well coordinated. This implies that there are weaknesses in coordinating and trailing achievement and bench marking. The community level forms support structure for implementation basic health care services. The national policy involves the creation of primary health care (PHC) management, local government level, ward development committees, and community development committees at ward and community levels. Despite the formation of these committees, many of them are not working well. For example, in 2002, 89% of the local government had PHC management committees, and only 27% were functional. On top of that, 75% of the local government had created PHC technical committees, and only 44% were functional. This analysis shows that health care performance is not adequately executing its responsibilities to make sure that malaria is well handled in the country. Finally, proliferation of departments and agencies has regularly outdone the policies that created them, since as policies vary is usual to make new units without considering the departments/agencies that are already in existence. Therefore, there are disputes and disagreements in the inter-departmental/agency functioning relationship (Nigeria Federal Ministry of Health 2004; Idogho 2006; Nigerian Health System n.d). Payment for Health care Research reveals that the larger percentage of the health care funding is contributed by households. Also, the federal budgetary component of health expenditure is constantly decreasing. For instance, in 2006, even if the total budget had increased by 40% of 2002 budget, only 5.6% of the budget was proposed for the health expenditure, a figure which was less by 0.8% of the budget allocated in 2002. Health expenditure as a ratio of GDP was the lowest in 2000 at 4.39%, and highest in 1998 at 5.45% . These ratios cannot compare with 7.2% of Eastern and Southern Africa National Health Account Network. Therefore, Nigeria‘s health expenditure budgetary allocation is even less than resource-poor countries like Zambia, 6.2%; Malawi, 7.2%, south Africa, 7.5%, and others. As a result of this low health care fund allocation, poor people are meant to pay more than their capability. That makes health care in Nigeria highly inequitable to malaria patients (Nigeria Federal Ministry of Health 2004; Idogho 2006; Nigerian Health System n.d). Health Care budget Allocation The state and local governments of Nigeria, having received funds from the federal government, they decide how to spend them without providing budget and expenditure reports to the federal government. This implies that the federal government has no significant influence on the funds allocated to primary and secondary health services, except the funds from special programs and agencies. This lack of transparence has resulted in mismanagement of funds allocated for treatment and prevention of malaria (Nigeria Federal Ministry of Health 2004; Idogho 2006; Nigerian Health System n.d). National Health Insurance Scheme The National Health Insurance Scheme was solely focusing on public sector employees, whose health care cost may be free or subsidized, while majority of the poor must pay at the delivery point. The potentiality of this scheme to improve access for the poor and informal sector is determined by how fast in can establish the required number of donors, who have yet adequately responded. Variations in public funding, poor management, political interferences, and poor harmonization between state and local governments restrict the efficiency of federal programs of anti-malaria campaigns. Even if the programs are well organized, they regularly supply to fragmentation and duplication, with various programs operating under dissimilar administrative and reporting arrangement-each making diverse demands on the same health staff (Idogho 2006; Nigerian Health System n.d). Human Resources The core classes of human resources in health care system are nurses, doctors, public health nurses and community health workers. Even if there are no large regional discrepancies in the number of nurses, there are more doctors per capita in the South than in the North. Most nurses and doctors work in secondary and tertiary level hospitals or in private practices. In addition to that, 88% of 26361 doctors practicing in the country work in hospitals, and 74% of these work in private hospitals. Only 12 % of practicing doctors work at the PHC level in private or public facilities. This is an exclusive aspect of health care system of Nigeria which is not common in other countries, and it is one cause of malaria mortality rate in rural areas. Additionally, high remuneration packages and better working and living conditions, have attracted skilled health personnel to urban areas and private sector. Many health workers have second sources of income in rural areas due to irregular payment of staff salaries. More so, inadequate supplies of equipment and poor provision of training and advancement opportunities are causes of medical care underperformance ( Idogho 2006; Nigerian Health System n.d). Management of Drug Supply Procurement of drugs in the public sector is decentralized and fragmented. Despite the that fact that most of the drug stores are well managed, they do not fulfill any central procurement functions because that is done directly by local government authorities and individual hospitals. The supply of drugs is insufficient at the PHC level, and one of the reasons is that the local government gives salaries a priority, and then distributes leftovers to recurrent expenditures including anti-malaria drugs, bed nets and other requirements. On top of that, there is delay and insufficient supply of drugs, which makes the staff to purchase and sell drugs privately. Therefore, medical facilities constantly experience drug shortages in some length of time. Generally, tertiary and secondary hospitals have more reliable drug supplies because of better funding and management, but the supply is inadequate to meet the needs of the population. A revolving drug fund that was established and supported by donors to ensure constant essential drug supply, poor management and political interference led to discontinuation of the fund. The failure of the project was contributed by state and local governments’ desire to have the its funds centrally controlled, which weakened transparency and control, and gave way for the funds to be used in other areas other than replenishing drug supply. Besides that, the funds were often used to meet other needs such as salary remuneration, even when the facility retained the funds (Nigeria Federal Ministry of Health 2004; Idogho 2006; Nigerian Health System n.d). Health Care Service Delivery System There are over 13000 public sector PHC facilities and about 700 private PHC facilities. Even if the population per PHC facility proportion is higher in the northern, northwest and south-south (as secondary facilities), the inequality is not marked. PHC facilities are more in the North than in the South. 71% of households in Nigeria are within 5km of PHC facility, and distribution of PHC is higher in urban areas as represented by 80%, compared to rural ’s 65%. The general population to facility ratio is about 5500; however, most of them are not working because they are poorly equipped with important supplies and qualified staff. There are about 54 tertiary and specialist hospitals in Nigeria. In addition to that, there are about 885 public sector secondary facilities with improved population to facility ratio of 13000.The number of private hospitals bring the total number of secondary operated facilities to 3002. Despite that, there is unequal distribution of the private facilities, with North having fewer than South. Generally, private hospitals represent 72% of secondary health care facilities with only 5% in the North-East and 24% in the North-West regions, compared with90% in the South- East and above 80% in the South-West regions. This indicates than northern region has less public secondary facilities than the southern region (Nigeria Federal Ministry of Health, 2004; Idogho, 2006) Health Care Reform Program Due to increasing malaria incidences and poor health care service delivery in Nigeria, the government has established a program to counter that this disease. Among the strategies highlighted include: strengthening national health care system and its management; promoting partnership, collaboration and coordination; improving public awareness and community involvement; improving access to quality health service; and improving the stewardship role of the government (Ayonrinde, Gureje &Lawal, 2004; Nigeria Federal Ministry of Health, 2004 ). Organizational and coordination health system improvement The government has drafted a National Health Bill, whose goal is the provision of a frame work for development and management of Nigeria health care system. The Bill will provide minimum health service delivery standards across the country; define clear roles and responsibilities for the three tiers of the government; and provide for creation of primary health care development fund. In addition to that, the Bill clearly elaborates on how funds are to be utilized and managed to ensure smooth running of the health care service delivery (Nigeria Federal Ministry of Health 2004; Idogho 2006). Financing National Health Care Development Fund The local and state governments have a defined statutory contribution, which is deducted at the source and paid into the account. These funds would be used to provide basic minimum packages in primary health care facilities, which involve: buying of important drugs; provision of maintenance facilities, equipments, and transport; and payment for salaries (Nigeria Federal Ministry of Health, 2004; Idogho, 2006). Reduction of Distance to Health Care facility The National Primary Health Care development Agency is constructing and equipping additional 200 PHC centers throughout the country to promote consumer access and provide high quality health care (Nigeria Federal Ministry of Health, 2004; Idogho, 2006). Conclusion Malaria is dominating disease in Nigeria, and it is a problem contributed by poor health care service delivery system. This problem is connected to: unequal distribution of health facilities in the country; insufficient allocation and mismanagement of health care funds; and poor organization and coordination within the health care management system. If all these problems are solved, Nigeria’s health care system will be at apposition of combating malaria in its population. Works Cited Ayonrinde, O., Gureje, O & Lawal, L. Psychiatric Research in Nigeria: Bridging Tradition and Modernization. British Journal of Psychiatry, 184(2004):536-538. Print. Baba, M. & Omotara, B. Nigeria's Public Health: Gains and Challenges, (2012). Web. Accessed 17 April 2014 from Read More