The key health management strategies involve a four-step process vis-a-vis: (a) data transformation (b) analytic transformation (c) payment transformation and (iv) care transformation. Data transformation focuses on establishing a baseline system management network for high-functioning analytic activities. Under analytic transformation, health leaders focus on building a data-based structure needed to easily identify and evaluate opportunities in a health management strategy. Payment transformation revolves around balancing financial risks with opportunities in a strategy whereas care transformation aims at modifying healthcare delivery models for efficiency and sustainable outcomes (Lilian., 2009; Glasgow et al., 2012).

1.0.2 RESEARCH AIM

The primary aim of this research is to explore the health management strategies currently being utilised in the Nigerian PHC system in order to recommend an innovative way of enhancing healthcare delivery to the Nigerian populace.

1.0.3 RATIONALE OF THE STUDY

Evidence-based studies from NDHS (2018) show that implementing robust national health policies, allocating resources to the health sector, and providing fully functional infrastructure to the PHC system are not enough to guarantee high performance from any Nigeria’s primary health care system. Nigerians deserve strategic health management ideas from stakeholders in the health sector whose priority is to continuously cater for people’s health needs. Thus, the rationale of this research stems from an urgent need to provide policymakers in Nigeria with the comprehensive blueprint they need to understand fundamental drivers of PHC performance—as well as best practices that are necessary to improve healthcare delivery in both rural and urban communities.

1.0.4 PROBLEM STATEMENT

According to Uzochukeu (2015), some of the major systemic factors affecting efficient delivery of healthcare in Nigeria are: (a) inadequate health facilities/structure (b) shortage of essential drugs and supplies (c) inadequate supervision of the healthcare system (d) poor management of human and material resources (e) application of outdated and/or unsuitable PHC management strategies (f) poor  remuneration and motivation (g) lack of fair and sustainable healthcare financing with very low per capita health spending etc. The 2018 NDHS study also highlighted the negative impact of neo-liberal economic policies and, of course, endemic corruption among public office holders. Other challenges include subjection of citizens to high out-of-pocket expenditure on healthcare services, and the absence of community-based integrated system for disease prevention, surveillance and treatment. These challenges are mostly managerial in nature and strongly linked to lack of innovation on the part of healthcare administrators in Nigeria.

A review of selected literatures on innovation, thus, shows that healthcare administrators in Nigeria have repeatedly used recommendations from innovative studies that lack a systematic design. For example, Adeyomo (2005), Agba et al (2010) and McSherry and Douglas (2011) conducted a determinant analysis before applying its results to the innovation strategy. Although more than one innovative strategy was applied in some of the reviewed literatures, none of them was based on a theory (i.e. theoretical methods for change). Therefore, the cited academic research journals added almost nothing to the body of knowledge because the use of theories is important, and besides saving time and money, it can help researchers avoid use of inappropriate and/or ineffective strategies (Day et al., 2013). Additionally, about two-thirds of the selected literatures failed to meet a second criterion linked determinants to the degree of implementation and response from both users and non-users. One major consequence of not using systematic designs while applying innovation strategies is failure to achieve the desired objective (Driscoll et al., 2013).

Further, there are well-designed literatures on innovation. But the problem is that implementation research in health care is still in its developing stage — in addition to the fact that there is dearth of innovation theories. For example, empirical studies mainly consist of case studies. Standardized methods for measuring determinants and the stages of change—dissemination, adoption, implementation and continuation—are also few. Therefore, it must be added, too, that the diffusion of good theories and studies is less common than expected. The availability of few well-designed literatures, thus, makes it difficult to compare determinants found in nan-systematically designed studies with those available in systematically designed studies (Obansa & Orimisan., 2013).

A third problem revolves around the fact that most innovation literatures showed methodological flaws (Scheck McAlearney., 2002; Calman et al., 2013; Alexnder et al., 2013). As already stated in the previous paragraph, determinants used in the reviewed literatures are unrelated to the degree of implementation, and the degree of implementation was analysed in dissimilar ways such as:

• Level of usage (i.e. full use, adapted use, non-use of innovations)
• Completeness of usage (i.e. applied proportion of recommended ‘innovative’ activities)
• Frequency of usage (i.e. number of times innovations were used)
• Intensity of usage (i.e. number of people who use innovation)
• Duration of usage.

This implies that the degree of implementing innovations and the linkage with selected determinants depend on the operationalization of implementation. In other words, if we are to define a ‘wife’ as someone who has at least one child (rather than, for example, as someone who is legally married), we would not only find a smaller number of ‘wives,’ but also different determinants of a married woman.

Despite these problems, the determinants of innovation identified by the literature review were consistent. Therefore, discrepancies in use and result of health management theories could be due to the non-systematic design of the applied studies. Another reason could be because professional recommendation was subjective and, in most cases, empirically invalid.

1.0.5 RESEARCH OBJECTIVES

This study will address the following objective areas in other to achieve the research aim:

1. To analyse different academic literatures on primary health care system and health innovations especially as it is being managed in Nigeria

2. To identify and evaluate the key health management strategies currently practiced in the Nigerian primary health care services

3. To investigate empirically the management challenges being faced by Anambra state PHC boards as it relates healthcare delivery to the various rural communities

4. To present an innovative strategic framework (ISF) that serves as a guide in enhancing the efficiency and management of Nigeria PHC services, evaluate and validate the framework as well as invent a guide for its implementation and future sustenance.

1.0.6 RESEARCH QUESTION

This research seeks to provide concrete answers to the following questions:

1. What are the key health management strategies employed by the stakeholders presently in trying to deliver primary health care services to the Nigerian people?
2. What are the constraints and challenges facing primary healthcare services?
3. What innovative solutions can be deployed to improve the delivery of PHC in Nigeria?
4. What are the experiences of PHC users and practitioners in Anambra?