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CHAPTER ONE

INTRODUCTION

1.1   BACKGROUND TO THE STUDY

Many countries today have committed themselves to achieving equity in healthcare coverage by including healthcare goals in human rights declarations, constitutions, and health policy documents (Adeyemo, 2005). Expanding health insurance is a strategy that countries use to alleviate the adverse health outcomes of all citizens, especially the poorest. It is one of the methods that low-income countries may consider to achieve universal health coverage (UHC). Universal Health Coverage implies that there is access to and use of high-quality healthcare services by all citizens, especially the poor, and protection for all individuals from the catastrophic financial effects of ill health (Dutta and Hongoro, 2013).

In the Nigerian constitution, health is a concomitant responsibility of the three tiers of government (the Federal level, 36 states including the Federal Capital Territory and 774 Local Government Authorities [LGAs]). As outlined in the national health policy and in the understanding of all the stakeholders in Nigeria, the Federal level is responsible for tertiary health care, the State level for secondary care and the LGA level for primary health care. However the reality on the ground is different, especially as the policy is not backed up with adequate legislation (McKenzie,   2012). ‘Health is Wealth’ goes the popular saying and therefore in every country, the health sector is critical to social and economic development with ample evidence linking productivity to quality of health care. In Nigeria, the vision of becoming one of the leading 20 economies of the world by the year 2020 is closely tied to the development of its human capital through the health sector (National Strategic Health Development Plan, 2009).

Now, to bring about national transformation in Nigeria the federal government implemented the Health Sector Reform Program (HSRP) from 2004-2007, which addressed seven strategic thrusts revolving around government’s stewardship role, management of the national health system, the burden of disease, mobilization and utilization of health resources, health service delivery, consumer awareness and community involvement, partnership, collaboration and coordination. The Health Sector Reform Program (HSRP) recorded a number of policy and legislative initiatives, notable among which are the National Health Policy review, the National Health Bill and strengthening the National Health Insurance Scheme (NSHDP, 2009). In addition, the NSHDP further puts that efforts were directed at strengthening disease programmes and improving the quality of care in tertiary health facilities. Despite these initiatives, much of the underlying weaknesses and constraints of the health sector persist.

Consequently, the Federal Ministry of Health has articulated this framework, as an overarching guide for the development of the National Strategic Health Development Plan (NSHDP) with its appropriate costing. The NSHDP would result from the harmonization of Federal, States’ and local governments’ health plans, thereafter serving as the basis for national ownership, resource allocation and mutual accountability by all stakeholders – government, development partners, civil society, private sector, communities, among others. The framework is based on the principles of the Four Ones: one health policy, one national plan, one budget, and one monitoring and evaluation framework for all levels of government. It also provides the template to concretize the health sector development component of the 7-point Agenda, Vision 2020 and a platform for achieving the MDGs. Hence the need to investigate the impact of health policy on national transformation is sacrosanct at the time being.

1.2   STATEMENT OF RESEARCH PROBLEM:

The centrality of health to national development and poverty reduction is self-evident, as improving health status and increasing life expectancy contribute to long term economic development. The legitimacy of any national health system depends on how best it serves the interest of the poorest and most vulnerable people, for which improvements in their health status gear towards the realization of poverty reduction goals (Omoleke, 2005). In the Nigerian context, current reviews show that the country is presently not on course to achieving the health Millennium Development Goals (MDGs) by 2015. This poses a major developmental challenge, which will impede and undermine development and economic growth. Health indicators in Nigeria have remained below country targets and internationally-set benchmarks including the MDGs. Currently, the health sector is characterized by lack of effective stewardship role of government, fragmented health service delivery, poor financing, weak health infrastructure, insufficient number of medical personnel as well as their uneven distribution.

The Nigeria government has often enacted policies and also carried out health reforms but to no avail the problems of the health sector linger on, as Nigerians who can afford the bills travel to overseas for mere body checkups while the poor citizens who are battling with major health concerns are left unattended to. The Nigeria health sector has become a nightmare to many.  The weak health sector in Nigeria is to be blamed as the country loss billions of Dollars annually. Many are calling on the government and the relevant ministries of health across the country to cross-examine and carry out necessary reforms that would bring about a grand national transformation in Nigeria. It is on this backdrop that this research seeks to examine the impact of Health Policy on National Transformation in Nigeria with a special reference to the Lagos State Ministry of Health.

1.3   OBJECTIVES OF THE STUDY:

The major objective of this study is to examine the impact of health policy on national transformation in Nigeria. While other specific aims are:

i.  to investigate the impact of health policy on national transformation in Nigeria.

ii. to investigate the impact of government financing on health service delivery.

iii. to investigate the impact of primary health care service on poverty alleviation in Lagos.

iv. to provide plausible recommendation and way forward on the impediments of public health policy.

1.4   RESEARCH QUESTIONS:

This research work shall be guided by the following research questions:

1. Is there any significant relationship between health policy and national transformation in Nigeria?

2. Is there any significant relationship between government financing and        health service delivery?

3. Is there any significant effect of primary health care service    on poverty     alleviation in Lagos?

1.5   RESEARCH HYPOTHESES:

The following under mentioned hypotheses will be tested in the course of the research study;

Hypotheses one

Ho: There is no significant relationship between health policy and national transformation in Nigeria.

Hi: There is a significant relationship between health policy and national  transformation in Nigeria.

Hypotheses two

Ho: There is no significant relationship between government financing and  health service delivery.

Hi: There is a significant relationship between government financing and health service delivery.

Hypotheses 3:

Ho: There is no significant relationship between primary health care service  and poverty alleviation in Lagos.

Hi: There is a significant relationship between primary health care service and poverty alleviation in Lagos.

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