Health System Management in Nigeria

Introduction

• The presentation is a lecture note on health system management.
• The presenter is Dr. M.J. Saka, a professor of public health.
• Dr. Saka has numerous roles in various Nigerian universities.
• Contact information is provided for the presenter.

Outline

• The presentation includes background information.
• It details the statement of problems.
• It includes the components of the health system.
• It discusses challenges for each system.
• It details the conclusion and recommendations.

Background Information

• FRN is located in West Africa.
• It has a land area of 923,768 km2.
• The projected population in 2010 was 160,821,353 million.
• The annual population growth rate is 3.2%.
• The population demographics show 51% male and 49% female.
• National development initiatives highlight human capital development, with health a key factor in Nigeria's poverty reduction strategies.
• The health sector aims to strengthen the National Health System.

Map of FRN

• A map of FRN is displayed, showing the various states, capital cities, and national borders.

Background Cont'd

• National development initiatives stress human capital development, with health being crucial.
• The health sector has translated national development initiatives to strengthen the National Health System.

Statement of Problems

• In 2000, the NHS performance was ranked 187th among 191 WHO member states.
• Health trends and indicators are poor.
• There is a lack of capacity in policy formulation, implementation, and monitoring.
• Coordination and harmony are poor.
• Epidemiological transition leads to a "double disease burden."

Definition of Health Systems and the Conceptual Framework

• Health systems are organizations, institutions, and resources devoted to producing health actions (WHO).
• A health system strengthening (HSS) initiative is an array of strategies that improves HS functions, leading to better health through improvements in access, coverage, quality, or efficiency.
• Definition includes various players, like NGOs (local and international).
• Encompasses all levels involved in funding or implementing health activities.

Management is Getting Things Done

• Management focuses on getting things done through people, who are the most crucial resource.
• Management involves efficient use of resources like human, material, financial, time and information resources.
• Management is about harmonizing efforts to achieve objectives.

Health Systems and the conceptual framework

• The WHO 2000 report identifies the four key functions of the health system: Stewardship, Financing, Human and Physical resources, and Organization and management of service delivery.

Historic Development of NHS (Pre-Colonial Era)

• The NHS is pluralistic, including allopathic and traditional care systems.
• Traditional medicine existed before allopathic medicine, which was introduced by missionaries in the late 19th century.
• Public health services originated from British Army Medical Services.
• Religious organizations and private bodies have played a role.

Historical Dev. HSS Post Colonial

• National Development Plans (NDP) and government decisions have shaped health systems since 1960.
• Three- and four-year development plans have been implemented.
• Departments of Health existed before 1960 under the British government.

KEY COMPONENTS OF HEALTH SYSTEMS AND THE ACHIEVEMENTS

• The government's role is policy and advocacy, developing policies, regulations, and guidelines affecting the system.
• Revised NHP (1988), updated in 2004, and the National Health Bill are significant achievements.

Stewardship Achievements

• Several significant achievements in health system stewardship have been made, including the establishment of National Hospital Services Commission, framework for health-related MDGs, the revitalization of the National Council on Health and State Council for Health, and the formal launch of the NHIS & CBHIS.

4-step approach to PHC strengthening

• A four-step approach for strengthening PHC involves diagnosis, intervention, verification, and adjustment.
• Key aspects of this approach include micro-planning, management support, and partnerships.

Human Resource For Health

• Human resource actions, workforce objectives, health system performance, and health outcomes are key factors for a functioning health system.

Achievements

• HRH profile for the country
• HRH policy and Strategic plan
• State Specific HRH SIP
• HRH HIS
• HRH crisis, shortage, migration and Attrition

Health Care Financing

• Health care financing involves resource mobilization from donors, firms, and households, with risk pooling and purchasing decisions.
• Various forms of health insurance and financial mechanisms are employed.

Achievements

• Expenditure patterns in Nigeria show progress in federal budgetary allocation for health.
• Tertiary health care institutions receive a large portion of the budget.
• The MTEF, NHA document, expenditure tracing systems, and accountability tracking systems are crucial achievements.

Health Management Information Systems

• The NHMIS provides the needed infrastructure and mechanisms for collecting and analyzing health data.
• The data management cycle involves collection, reporting, validation, transmission, analysis.

NHMIS Achievements

• Increased attention to the NHMIS through the NSHDP25.
• National level reporting from states has increased.
• The use of the NHMIS Software (DHIS 2.0) is adapted.

Health Systems Performance

• The national health system performance reflects clarity concerning roles and responsibilities.
• A strong structure for harmonizing federal and state financing is lacking.
• The NCH has limited capacity.
• Nigeria has limited progress in delivering critical health services.
• Income inequality is present in health outcomes.
• Facilities are not adequately stocked.
• Tertiary institutions are now enjoying financial discretion from internally generated revenue.

Issues and challenges

• Nigeria's healthcare system faces significant challenges.
• Attaining MDGs by 2015, tackling epidemics, the country's size and diversity, stewardship/coordination issues, funding, and human resources for health.

Impact of Health Systems Function and Performance

• The overall health status of populations in Nigeria is presented using nine indicators in the NSHDP 2010-2015.
• Statistical indicators, like maternal mortality rate, under-5 mortality rate, infant mortality rate, life expectancy, prevalence of measles, among others are presented.

Summary

• HSS is defined with a conceptual framework.
• Historical development of HSS in Nigeria is detailed.
• HSS is making progress.
• Many challenges exist.
• Performance has not met MDG goals.
• Recommendations are presented.

Conclusion

• HSS Management makes considerable progress towards national health outcomes.
• Sustainability remains a challenge.
• The prevailing economic, security, and political climate affects sustainability. Discontinuity can lead to reversing progress.

Conclusion

• HSS Priorities need to be agreed upon.
• Community resources should be harnessed for vulnerable populations.
• Equity in health services distribution and utilization is critical.
• Effective management of fiscal resources is needed for the health sector.

Recommendations

• Transparency and ethical stewardship are needed across all spheres of national life.
• Continued political commitment is necessary for HRH.
• Funding needs are substantial and require inter-sectoral collaboration.
• Strong public-private partnerships should be pursued.

Health Systems Issues and Challenges

• Health systems issues and challenges are becoming more apparent. Discussions about the issues must become ongoing.

Concept of PHC

• Essential health care relies on practical, scientifically sound, and socially acceptable methods. This approach should make these methods accessible to all communities while remaining affordable and maintaining self-reliance and self-determination.

PHC Organogram

• The structure of the PHC system in Nigeria is presented in an organogram form. Levels of responsibility within the structure are laid out.

Summary

• HSS is defined with a conceptual framework.
• Historical development of HSS in Nigeria is presented
• Progress in HSS has improved in accessibility, affordability areas. Sustainability is an open issue.
• Many challenges are addressed in the HSS Block.
• Despite the issues, performance is evaluated against MDG goals.
• Recommendations regarding solutions are included.

Thank You

• Presentation concludes with a thank you.