The Nigeria healthcare system serves to provide efficient, timely and adequate healthcare services to Nigerians, as well as to monitor and control outbreak of infectious diseases. As enshrined in the Constitution of the Federal Republic of Nigeria, provision of healthcare in the country is a sole responsibility of the three-tiered government. While the local governments exclusively provide primary healthcare—with human and material inputs from the higher cadres in PHC structure, it is pertinent to note that the federal and state governments have the prerogative of providing tertiary and secondary healthcare respectively. Regulated by the Nigeria primary healthcare development agency (NPHCDA), the federal government coordinates the work and activities of federal medical centres and university teaching hospitals whereas the state government coordinates and manages various state-owned general hospitals throughout the country (Oyibocha et al., 2014; Nwankwo., 2019).
Figure 4: Structure of the Nigerian health care system
Adopted from TWG, 2009
As explained in Figure 2, local governments in Nigeria have the role of coordinating activities of various health centres located in the nooks and crannies of the 774 local government areas (LGAs) nationwide. It is, however, arguable that the local governments are figuratively “pipelines” used by corrupt federal and state health administrators to misuse funds earmarked for developmental projects. It is therefore more agreeable that corruption—not only poor funding and ineffective or outdated health management strategies—is the bane of quality health care delivery in Nigeria as compared to other countries in Sub-Saharan Africa. Studies also show that Nigeria has, in recent years, struggled among the least performers in public health indicators.
Maternal and child mortality remains on the increase in Nigeria, and this trend underscores gross incompetence among health care administrators in all three tiers of government. Local government administrators, nonetheless, should take responsibility for the inefficient implementation of healthcare policies in the country—particularly because they’re closest to health care users and have first-hand information on factors hindering health service delivery in rural communities. Over the years, however, there have been various intervention programmes initiated by the governments to ensure efficient and timely access to healthcare facilities. Health initiatives (such as the National Malaria Elimination Programme) were carefully designed to achieve dramatic and visible impact on the health of Nigerians, especially the poorest and most vulnerable members of the society (Owolabi & Olusegun, 2020).
In May 1999, the government established the National Health Insurance policy, a scheme which was intended to serve government employees, the informal sector, as well as the organised private sector — including children aged below 5 years old, disabled persons and prison inmates. One of the many objectives of this health programme is to insure people against the cost of seeking healthcare services. But until 2017, only 1.5% of the Nigeria population has been successfully registered under the scheme. This ugly trend highlights the negative perspective and poor attitude of Nigerians towards the functions and usefulness of the PHC system. Other interventions by the government to address improved healthcare delivery include National Immunization Coverage Scheme (NICS), Midwives Service Scheme (MSS) and Nigerian Pay for Performance Scheme. (NPPS). This research will investigate some healthcare management theories to recommend innovative and workable strategies that can enable health service administrators revamp the PHC system in Nigeria.
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