MEZIESBLOG

This study has examined some internal, national, and sector-based challenges that influence the conceptualization and operationalization of health innovation and healthcare management, with focus on how to improve PHC delivery in Nigeria. PHC as a concept is based on clearly defined principles that must be translated into action through the establishment of solid structures and efficient managerial processes. On this premise, the structure of PHC systems determine how roles, power and responsibilities are delegated, coordinated and controlled—including how information is shared across different channels and between management levels.

Figure 6.1: Quality and Care Framework

Source: Peabody et al (1996)

Research findings show that individuals and households need access to health care system in order to obtain the care necessary for maintaining and/or improving their health status. But simple access is not enough in developing countries. As shown in Figure 6.1, the capacity of health systems must be properly applied (i.e. optimizing material inputs and skill of practitioners) to provide quality health care.

Unfortunately, Nigeria has operated multiple administrative structures such as Federal Ministry of Health (FMoH), State Ministries of Health (SMoH), Ministry of Local Government, Local Government Service Commission (LGSG), and sometimes, Office of the Executive Governor at the state level that has concurrent and overlapping responsibility to manage PHC service. Lack of policy direction or strategic framework for transforming healthcare at the community level constitutes significant challenges. In response, NPHCDA relies on PHCUOR to strengthen governance mechanisms in the health sector and improve PHC delivery.

Based on findings from Anambra state, service utilization across primary and secondary health facilities is average. But health worker/population ratio falls below NPHCDA standard, and this highlights the need for an innovative, strategic framework that adds efficiency to health care delivery in Nigeria.

With respect to the availability of functional equipment, a large number of PHC facilities are not equipped with basic technologies for diagnosing, treating and controlling diseases in accordance with the NPHCDA minimum standard. In some cases, health workers rely on use unskilled hands to help them cope with increasing demands from care users and patients. Most of the healthcare workforce lack IT knowledge, too. This circumstance makes it difficult for them to install and use health management information systems (HMIS) software that enables collection, storage and dissemination of patient data across multiple platforms and between health organizations, ministries, states and LGAs. The NPHCDA minimum requirement – as a framework for innovative health management – states that every primary and secondary health facility must have at least one computer for both information storage and online communication.

The proposed innovative framework should therefore highlight collaboration at the local government, state, federal and international levels to integrate technologies that have a structured referral system. This action plan requires regular training of the healthcare workforce to improve overall effectiveness in the use of HMIS, thereby enhancing productivity levels and job satisfaction. Over 50 percent of PHC facilities under review do not have the capacity to treat and manage tuberculosis (TB) patients as well as other contagious disease. This is an avoidable security risk.

While taking cognizance of technology- and management-related challenges to an effective and equitable distribution of health resources, the proposed strategic health management framework should include sociocultural activities that harmonize relationships between health workers and communities. Organizing regular educative, sporting and entertainment events is key to realizing PHC objectives.

In the area of community development, most primary health facilities are dilapidated, dysfunctional and largely unproductive. Some facilities under review are disconnected from the health system. Nurses and midwifes attested to poor or non-availability of supportive supervision. Many of them also complained of working at the facilities for over ten years without assistants. Thus, the proposed framework should be structured to tackle staff shortages, integrate flexible hours of work, and provide industry-standard salaries and incentives as applicable in developed countries. Further, the government and its partners should increase development allocations to every state and establish effective mechanisms that ensure accountable, transparent and equitable use of health resources. Part of the state allocations should be channelled to building standard road networks that link health facilities located in hard-to-reach rural communities. In addition to providing drinkable water and regular electricity, health facilities should have secure staff accommodation equipped with modern toilets. Accommodation in line with the NPHCDA directives will enhance 24-hour service availability, increase staff motivation and boost the confidence and dignity of health workers, especially rural communities.

Health facilities should be equipped with health technologies (such as drones and e-Health apps) that enable contactless service delivery. The facilities should also have safe storage systems for keeping records and protecting patient data. Ease of access to health records is a function of technology diffusion and innovative management that should be integrated in the proposed framework.

Lastly, the proposed framework should include strategies to improve patient satisfaction. Only few of the care users interviewed during the case study analysis agreed that health workers in Anambra state friendly and approachable. Many respondents showed concern for the hostile and unprofessional attitude of the health workers. This has been identified as a major reason why individuals in rural communities have low uptake of services in the health facilities. The ideal framework for providing basic health services in PHCs across Nigeria is expected to tackle issues related to workers’ attitude, perception of health technologies, commitment to training and standard of remuneration. In addition to process improvement and localization of PHC implementation ideas in various catchment areas, the framework should enforce good corporate governance aligned with NPHCDA requirements.