INTRODUCTION
The National Health Policy represents the collective will of the governments and people of this country to provide a comprehensive health care system that is based on primary health care. It describes the goals, structure and strategy and policy direction of the health care delivery system in Nigeria.
ABSTRACT:
The abysmal failure of
public health care system in Nigeria has attracted comments and criticisms from
local and national levfils. The provision of adequate health care services to
the citizens. particularly those residing at the rural areas has left much to
be desired. In spite of media propaganda and the current health sector reforms
by the government, the public health care system in Nigeria is still
inefficient in all ramifications. It is therefore argued that the problems
facing the public health care system in Nigeria could be traced to poor
implementation of National Health Policy as well as other health-related
policies and programmes. Also, the implementation of National Health Policy and
the current reforms fn the health sector are therefore expected to address the
perennial problems inflicting public health care development in Nigeria. The
paper further argues that it is only when the government ensures that health is
regarded as the right of all citizens of the country, irrespective of status
that the public health care system 1s said to be developed in Nigeria The paper
adopts descriptive method and content analysis to arrive at the conclusion that
poor implementation of health care policies and programmes is the major
constraint to the achievement of desired goals in public health care provision
in Nigeria, particularly at the local government level. For better improvement.
the paper suggests the need for pol1t1cal commitment as well as elimination of
bureaucratic bottlenecks in public health care provision in Nigeria
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In
August 1987, the federal government launched its Primary Health Care plan
(PHC), which President Ibrahim Babangida announced as the cornerstone of health
policy. Intended to affect the entire national population, its main stated
objectives included accelerated health care personnel development; improved
collection and monitoring of health data; ensured availability of essential
drugs in all areas of the country; implementation of an Expanded Programme on
Immunization (EPI); improved nutrition throughout the country; promotion of
health awareness; development of a national family health program; and
widespread promotion of oral rehydration therapy for treatment of diarrheal
disease in infants and children. Implementation of these programs was intended
to take place mainly through collaboration between the Ministry of Health and
participating local government councils, which received direct grants from the
federal government.
Of
these objectives, the EPI was the most concrete and probably made the greatest
progress initially. The immunization program focused on four major childhood
diseases: pertussis, diphtheria, measles, and polio, and tetanus and
tuberculosis. Its aim was to increase dramatically the proportion of immunized
children younger than two from about 20 percent to 50 percent initially, and to
90 percent by the end of 1990. Launched in March 1988, the program by August
1989 was said to have been established in more than 300 of 449 LGAs. Although
the program was said to have made much progress, its goal of 90 percent
coverage was probably excessively ambitious, especially in view of the economic
strains of structural adjustment that permeated the Nigerian economy throughout
the late 1980s.
The
government's population control program also came partially under the PHC. By
the late 1980s, the official policy was strongly to encourage women to have no
more than four children, which would represent a substantial reduction from the
estimated fertility rate of almost seven children per woman in 1987. No
official sanctions were attached to the government's population policy, but
birth control information and contraceptive supplies were available in many
health facilities.
The
federal government also sought to improve the availability of pharmaceutical
drugs. Foreign exchange had to be released for essential drug imports, so the
government attempted to encourage local drug manufacture; because raw materials
for local drug manufacture had to be imported, however, costs were reduced only
partially. For Nigeria both to limit its foreign exchange expenditures and
simultaneously to implement massive expansion in primary health care, foreign
assistance would probably be needed. Despite advances against many infectious
diseases, Nigeria's population continued through the 1980s to be subject to
several major diseases, some of which occurred in acute outbreaks causing
hundreds or thousands of deaths, while others recurred chronically, causing
large-scale infection and debilitation. Among the former were cerebrospinal
meningitis, yellow fever, Lassa fever and, most recently, AIDS; the latter
included malaria, guinea worm, schistosomiasis (bilharzia), and onchocerciasis
(river blindness). Malnutrition and its attendant diseases also continued to be
a refractory problem among infants and children in many areas, despite the
nation's economic and agricultural advances.
Among
the worst of the acute diseases was cerebrospinal meningitis, a potentially
fatal inflammation of the membranes of the brain and spinal cord, which can
recur in periodic epidemic outbreaks. Northern Nigeria is one of the most
heavily populated regions in what is considered the meningitis belt of Africa,
stretching from Senegal to Sudan and all areas having a long dry season and low
humidity between December and April. The disease plagued the northern and
middle belt areas in 1986 and 1989, generally appearing during the cool, dry
harmattan season when people spend more time indoors, promoting contagious
spread. Paralysis, and often death, can occur within forty-eight hours of the
first symptoms.
In
response to the outbreaks, the federal and state governments in 1989 attempted
mass immunization in the affected regions. Authorities pointed, however, to the
difficulty of storing vaccines in the harsh conditions of northern areas, many
of which also had poor roads and inadequate medical facilities.
Beginning
in November 1986 and for several months thereafter, a large outbreak of yellow
fever occurred in scattered areas. The most heavily affected were the states of
Oyo, Imo, Anambra, and Cross River in the south, Benue and Niger in the middle
belt, and Kaduna and Sokoto in the north. There were at least several hundred
deaths. Fourteen million doses of vaccine were distributed with international
assistance, and the outbreak was brought under control.
Lassa
fever, a highly contagious and virulent viral disease, appeared periodically in
the 1980s in various areas. The disease was first identified in 1969 in the
northeast Nigerian town of Lassa. It is believed that rats and other rodents
are reservoirs of the virus, and that transmission to humans can occur through
droppings or food contamination in and around homes. Mortality rates can be
high, and there is no known treatment.
The
presence of AIDS in Nigeria was officially confirmed in 1987, considerably
later than its appearance and wide dispersion in much of East and Central
Africa. In March 1987, the minister of health announced that tests of a pool of
blood samples collected from high risk groups had turned up two confirmed cases
of AIDS, both HIV Type-1 strains. Subsequently, HIV-2, a somewhat less virulent
strain found mainly in West Africa, was also confirmed. In 1990 the infection
rate for either virus in Nigeria was thought to be below 1 percent of the
population.
Less
dramatic than the acute infectious diseases but often equally destructive were
a host of chronic diseases that were serious and widespread but only
occasionally resulted in death. Of these the most common was malaria, including
cerebral malaria, which can be fatal. The guinea worm parasite, which is spread
through ingestion of contaminated water, is endemic in many rural areas,
causing recurring illness and occasionally permanently crippling its victims.
The World Health Organization (WHO) in 1987 estimated that there were 3 million
cases of guinea worm in Nigeria--about 2 percent of the world total of 140
million cases- -making Nigeria the nation with the highest number of guinea
worm cases. In affected areas, guinea worm and related complications were
estimated to be the major cause of work and school absenteeism.
Virtually
all affected states had campaigns under way to eradicate the disease through
education and provision of pure drinking water supplies to rural villages. The
government has set an ambitious target of full eradication by 1995, with
extensive assistance from the Japanese government, Global 2000, and numerous
other international donors.
The
parasitic diseases onchocerciasis and schistosomiasis, both associated with
bodies of water, were found in parts of Nigeria. Onchocerciasis is caused by
filarial worms transmitted by small black flies that typically live and breed
near rapidly flowing water. The worms can damage the eyes and optic nerve and
can cause blindness by young adulthood or later. In some villages near the
Volta River tributaries where the disease is endemic, up to 20 percent of
adults older than thirty are blind because of the disease. Most control efforts
have focused on a dual strategy of treating the sufferers and trying to
eliminate the flies, usually with insecticide sprays. The flies and the disease
are most common in the lowland savanna areas of the middle belt.
Schistosomiasis
is caused by blood flukes, which use freshwater snails as an intermediate host
and invade humans when the larvae penetrate the skin of people entering a pond,
lake, or stream in which the snails live. Most often, schistosomiasis results
in chronic debilitation rather than acute illness.
Data
as of June 1991
References
https://photius.com/countries/nigeria/society/nigeria_society_primary_health_care_~10006.html
E. J. C. Duru, C. I. Nwagbos, Bachudo Science, (1999) THE PROBLEMS AND
PROSPECTS OF PUBLIC HEAL TH CARE DEVELOPMENT IN NIGERIA'S LOCAL GOVERNMENT
SYSTEM
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