Improving primary health care delivery in Nigeria: evidence from four states
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| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Washington, DC
World Bank
2010
|
| Edition: | 1. printing |
| Series: | World Bank working paper
187 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XXV, 90 S. graph. Darst. |
| ISBN: | 0821383116 9780821383117 |
Staff View
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Record in the Search Index
| _version_ | 1804148356354670592 |
|---|---|
| adam_text | Titel: Improving primary health care delivery in Nigeria
Autor:
Jahr: 2010
Contents
Foreword....................................................................................................................................ix
Acknowledgments....................................................................................................................x
Acronyms and Abbreviations................................................................................................xi
Executive Summary...............................................................................................................xiii
Primary Health Care Delivery in Four States..............................................................xiii
Understanding the Performance of Primary Health Care in the States...................xvii
Division of Responsibility among Government Levels.............................................xvii
Citizens/Clients-Policy Makers....................................................................................xviii
Policy Makers-Providers..................................................................................................xx
Clients-Providers.............................................................................................................xxi
Possible Ways Forward..................................................................................................xxii
1. Introduction............................................................................................................................1
Objectives.............................................................................................................................2
Conceptual Framework......................................................................................................3
Methodology.......................................................................................................................5
2. Context....................................................................................................................................7
Health Outcomes and Access to Health Services in Nigeria.........................................7
Context in States Included in the Study...........................................................................9
3. Status of Primary Health Care Services...........................................................................11
Organization of the Primary Health Care System........................................................11
Survey Results...................................................................................................................12
Infrastructure and Amenities.....................................................:....................................13
Services Available.............................................................................................................14
Equipment and Medical Supplies...................................................................................15
Pharmaceuticals................................................................................................................16
Health Personnel...............................................................................................................17
Exemption and Waiver Programs..................................................................................20
Education and Promotion Activities of PHC Services.................................................30
Service Charges..................................................................;..............................................31
4. Division of Responsibilities among Government Levels............................................33
Laws and Policies Informing the Division of Responsibilities for the Delivery of
Primary Health Care.................................................................................................33
Division of Responsibilities in Practice..........................................................................34
Policies and Guidelines....................................................................................................34
Personnel Training............................................................................................................36
Health Care Personnel Management.............................................................................36
Infrastructure: Construction and Maintenance.............................................................37
Procurement and Distribution of Pharmaceutical Products.......................................39
Supervision........................................................................................................................41
Possible Ways Forward....................................................................................................41
5. Clients-Policy Makers........................................................................................................43
Local Government Revenues and Responsibilities......................................................43
Public Financial Management.........................................................................................46
Local Government Civil Service.....................................................................................49
Local Government Health Expenditure.........................................................................50
Local Government Accountability for Service Delivery..............................................54
Possible Ways Forward....................................................................................................55
6. Policy Makers-Providers....................................................................................................61
Characteristics of Health Personnel...............................................................................62
Education Level.................................................................................................................63
Incentives to Providers.....................................................................................................64
Mechanisms to Reward and Discipline PHC Personnel..............................................67
Other Negative Incentives Faced by PHC Personnel...................................................68
Health Personnel Coping Mechanisms..........................................................................70
Possible Ways Forward....................................................................................................71
7. Clients-Providers.................................................................................................................74
Increasing Clients Power................................................................................................74
Survey Results...................................................................................................................75
Possible Ways Forward....................................................................................................77
References.................................................................................................................................81
Appendixes...............................................................................................................................85
Appendix A: Sample Size................................................................................................85
Appendix B: Household Survey Sample Characteristics............................................88
Tables
Table 1. Primary Health Care Facilities Infrastructure across States and Facility
Ownership (in %)............................................................................................................xiii
Table 1.1. Analysis of Survey Questionnaires.......................................................................6
Table 2.1. Health Outcomes and Health Care Utilization across Geopolitical
Zones, Nigeria 2003...........................................................................................................8
Table 2.2. Population, Poverty, and Inequality Indicators, Nigeria 2004.........................10
Table 3.1. Health Facility Type by LGA Type.....................................................................12
Table 3.2. Basic Information from All States (in %)............................................................13
Table 3.3. Primary Health Care Facilities, Infrastructure, and Amenities across
States (in %)......................................................................................................................14
Table 3.4. Percentage of Facilities Offering Basic Services across States..........................15
Table 3.5. Percentage of Facilities with Equipment and Medical Supplies across
States..................................................................................................................................15
Table 3.6. Percentage of Facilities Having Basic Pharmaceuticals and Vaccines in
Stock across States............................................................................................................17
Table 3.7. Average Staffing of PHC Facilities across States and Across Type of
Ownership........................................................................................................................18
Table 3.8. Average Staffing of Public Health Facilities across Facility Type...................19
Table 3.9. Average Staffing of PHC Facilities across LGA Type.......................................19
Table 3.10 Average Staff in Basic Health Centers across Type of LGA............................20
Table 3.11. Percentage of Facilities Offering Exemption and Waivers across States.........21
Table 3.12. Opening Hours across Facility Type and LGA Type (in %)..........................21
Table 3.13. Percentage of Facilities Offering Basic Services across Type of Facility
and across Type of LGAs................................................................................................22
Table 3.14. Percentage of Facilities with Basic Equipment across Type of Facility
and Type of LGA.............................................................................................................23
Table 3.15. Percentage of Facilities with Basic Drugs and Vaccines in Stock across
Type of Facility and Type of LGA.................................................................................23
Table 3.16. Basic Information on PHC Facilities across Public and Private
Ownership (in %).............................................................................................................25
Table 3.17. Percentage of Facilities with Basic Equipment across Public and
Private Ownership...........................................................................................................26
Table 3.18. Availability of Basic Health Services in Nearest Facility across States
(in%)..................................................................................................................................28
Table 3.19. Household Satisfaction with Nearest PHC Facility across States (in %)......28
Table 3.20. Household Satisfaction with Nearest PHC Facility across Facility
Ownership and across Type of LGA (in %)..................................................................29
Table 3.21. Difference in Satisfaction with Nearest PHC Facility between Male and
Female Heads of Households (in %).............................................................................29
Table 3.22. Percentage of Households near a PHC Facility Visited by Facility
Health Personnel across States, Type of Ownership, and Type of LGA..................30
Table 3.23. Reason for Health Facility Worker Visit across States (in %).........................31
Table 3.24. Percentage of Services with a Charge across States........................................31
Table 3.25. Household Utilization of Nearest Health Facility across Type of LGA
(in%)..................................................................................................................................32
Table 4.1. Level of Government or Agency that Provided the Health Facility
Building (in %)...........................,.....................................................................................37
Table 4.2. Main Agency Responsibility for the Maintenance of Equipment and
Buildings across States....................................................................................................38
Table 4.3. Main Supplier of Medical Consumables, Drugs, and Equipment to PHC
Facilities across States......................................................................................................40
Table 5.1. Changes in the Actual Distribution of Federation Account Revenues
across Three Government Levels (in %).......................................................................44
Table 5.2. Main Fiscal Trends for the Consolidated Government, 1999-2005,
(billions of naira)..............................................................................................................45
Table 5.3. Budget Execution Rate across LG in Kaduna and Cross River (in %)............46
Table 5.4. Capital Budget Execution Rate across LG in Kaduna and Cross River
(in%)..................................................................................................................................48
Table 5.5. Wage Bill in Different Sub-Saharan Africa Countries, 2005.............................49
Table 5.6. Percentage of Civil Servants out of Total Population in Sub-Saharan
African Countries.............................................................................................................50
Table 5.7. Real Growth Rate of Kaduna LG Expenditures in 2003-04 and 2004-05
(in%)..................................................................................................................................53
Table 5.8. Real Growth Rate of Cross River s LG Expenditures in 2005-06 (in %).........54
Table 5.9. Cross River Local Governments Expenditure 2005...........................................59
Table 5.10. Kaduna Local Government Expenditure 2005.................................................60
Table 6.1. Health Care Personnel Sampled across States...................................................61
Table 6.2. Health Care Personnel Sampled by Gender across States................................62
Table 6.3. Characteristics of PHC Personnel across States and across Type of
Facility Ownership..........................................................................................................63
Table 6.4. Characteristics of PHC Personnel across Type of Personnel...........................63
Table 6.5. Highest Level of Education Completed by PHC Staff Interviewed (State
Comparison).....................................................................................................................64
Table 6.6. Average Salary of PHC Personnel across Type of Facility Ownership..........65
Table 6.7. Salary of Doctors and Nurses in Relation to GDP per Capita in Different
Sub-Saharan African Countries (in %)..........................................................................65
Table 6.8. Salaries and Fringe Benefits (State Comparison) (in %)...................................66
Table 6.9. Average Salary of Public PHC Personnel across Type of LGA.......................67
Table 6.10. Criteria for Promotion of Staff (in %)................................................................68
Table 6.11. Negative incentives Faced by PHC Personnel across States (in %)...............68
Table 6.12. Obstacles in Doing Job across Rural and Urban Areas (in %).......................69
Table 6.13. Obstacles in Doing Job across Type of Facility Ownership (in %)................69
Table 6.14. Percentage of Personnel Who Are Fulltime Employees and
Supplement Their Salary................................................................................................70
Table 6.15. Activities to Supplement Salaries of Health Staff across States (in %).........71
Table 7.1. Percentage of Health Facilities with a Functioning Health
Management/Development Committee and Gender of Committee Members
across States, and across Facility Ownership...............................................................75
Table 7.2. Frequency of Meetings of Health Committees across States...........................76
Table 7.3. Actions of Community Health Management/Development Committees
across States and Facility Ownership (in %)................................................................76
Table 7.4. Final Decision on Health Facility Managerial Issues (in %).............................77
Table B.l. Employment and Occupation of Household Survey Respondents................88
Table B.2. Housing Characteristics of Household Survey Respondents..........................89
Table B.3. Household Survey Respondents Proximity to Nearest Health Facility........90
Figures
Figure 1. Percentage of Facilities Having Equipment and Consumables across
States.................................................................................................................................xiv
Figure 2. Percentage of Facilities Having Basic Pharmaceuticals and Vaccines on
Stock across States............................................................................................................xv
Figure 3. Household Satisfaction with Nearest Primary Health Care Facility...............xvi
Figure 4. Accountability Relationships between Politicians/Policy Makers,
Providers, and Citizens/Clients...................................................................................xvii
Figure 5. Clients/Citizen-Policy Makers Relationship.....................................................xviii
Figure 6. Relationship between Local Governments and Providers................................xx
Figure 7. Accountability Relationship between Clients and Providers..........................xxi
Figure 1.1. Accountability Relationships between Politicians/Policy Makers,
Providers, and Citizens/Clients.......................................................................................4
Figure 2.1. Socioeconomic Disparities in Health Outcomes and Basic Service
Utilization, Nigeria, 2003..................................................................................................8
Figure 2.2. Utilization of Outpatient Care across Population Consumption
Quintiles and Type of Provider or Type of Provider Ownership...............................9
Figure 3.1. Percentage of PHC Facilities Offering Basic Services across Public and
Private Ownership...........................................................................................................25
Figure 3.2. Percentage of Facilities Having Basic Pharmaceuticals and Vaccines on
Stock across Public and Private Ownership.................................................................27
Figure 4.1. Government Agencies with Responsibilities in PHC in Cross River............35
Figure 4.2. Government Agencies with PHC Delivery Responsibilities in Kaduna.......35
Figure 5.1. Average Ratio between Actual and Projected Internally Generated
Revenues in Bauchi s Local Governments....................................................................47
Figure 5.2. Share of Total LG Expenditure Allocated to Health in Kaduna LG, 2005.... 52
Figure 5.3. Total per Capita Public Expenditure across Local Governments in
Kaduna and Cross River, 2005.......................................................................................52
Figure 6.1. Process to Discipline PHC Personnel................................................................67
Figure B.l. Household Survey Respondents Literacy Level............................................88
Figure B.2. Household Survey Respondents Education Status........................................88
Boxes
Box 1.1. Declaration of Alma-Ata: International Conference on Primary Health
Care, Alma-Ata, (presently Almaty, Kazakhstan) 1978................................................3
Box 3.1. Proposed Health Manpower for a PHC Center to Provide the Minimum
Health Care Package.......................................................................................................18
Box 5.1. Extract from Report of the Auditor-General for Local Governments on the
Accounts of the 23 Local Government Councils of Kaduna State. For the Year
Ended 31st December, 2004.............................................................................................49
Box 5.2. Citizen Report Cards: The Bangalore Experience................................................57
Box 5.3. Participative Approaches in the Management of Education: Literacy
Enhancement Assistance Project (LEAP)......................................................................57
Box 7.1. Kaduna: Example of Facility Health Committee Role in Improving the
Condition of PHC Facilities............................................................................................78
Box 7.2. Experience with Vouchers for Health Services.....................................................79
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| geographic | Nigeria (DE-588)4042300-1 gnd |
| geographic_facet | Nigeria |
| id | DE-604.BV039540402 |
| illustrated | Illustrated |
| indexdate | 2024-07-10T00:05:50Z |
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| physical | XXV, 90 S. graph. Darst. |
| publishDate | 2010 |
| publishDateSearch | 2010 |
| publishDateSort | 2010 |
| publisher | World Bank |
| record_format | marc |
| series | World Bank working paper |
| series2 | World Bank working paper Africa human development series |
| spelling | Improving primary health care delivery in Nigeria evidence from four states World Bank, Africa Region Human Development Department 1. printing Washington, DC World Bank 2010 XXV, 90 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier World Bank working paper 187 Africa human development series Statistik Primary health care Nigeria Primary Health Care statistics & numerical data Nigeria Health Care Surveys Nigeria Statistics Quality of Health Care Nigeria Statistics Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Nigeria (DE-588)4042300-1 gnd rswk-swf Nigeria (DE-588)4042300-1 g Gesundheitswesen (DE-588)4020775-4 s DE-604 Weltbankgruppe Sonstige (DE-588)5340594-8 oth Erscheint auch als Online-Ausgabe 0-8213-8313-2 Erscheint auch als Online-Ausgabe 978-0-8213-8313-1 World Bank working paper 187 (DE-604)BV018160274 187 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024392497&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Improving primary health care delivery in Nigeria evidence from four states World Bank working paper Statistik Primary health care Nigeria Primary Health Care statistics & numerical data Nigeria Health Care Surveys Nigeria Statistics Quality of Health Care Nigeria Statistics Gesundheitswesen (DE-588)4020775-4 gnd |
| subject_GND | (DE-588)4020775-4 (DE-588)4042300-1 |
| title | Improving primary health care delivery in Nigeria evidence from four states |
| title_auth | Improving primary health care delivery in Nigeria evidence from four states |
| title_exact_search | Improving primary health care delivery in Nigeria evidence from four states |
| title_full | Improving primary health care delivery in Nigeria evidence from four states World Bank, Africa Region Human Development Department |
| title_fullStr | Improving primary health care delivery in Nigeria evidence from four states World Bank, Africa Region Human Development Department |
| title_full_unstemmed | Improving primary health care delivery in Nigeria evidence from four states World Bank, Africa Region Human Development Department |
| title_short | Improving primary health care delivery in Nigeria |
| title_sort | improving primary health care delivery in nigeria evidence from four states |
| title_sub | evidence from four states |
| topic | Statistik Primary health care Nigeria Primary Health Care statistics & numerical data Nigeria Health Care Surveys Nigeria Statistics Quality of Health Care Nigeria Statistics Gesundheitswesen (DE-588)4020775-4 gnd |
| topic_facet | Statistik Primary health care Nigeria Primary Health Care statistics & numerical data Nigeria Health Care Surveys Nigeria Statistics Quality of Health Care Nigeria Statistics Gesundheitswesen Nigeria |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=024392497&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV018160274 |
| work_keys_str_mv | AT weltbankgruppe improvingprimaryhealthcaredeliveryinnigeriaevidencefromfourstates |