Abstract
This study examined local government and health care delivery. In Nigeria, local government is the third tier of government whose major responsibility is to provide adequate services to the rural inhabitants. Health care delivery is a very important function which the local government is meant to provide to the people at the grass root and which delivery ought to be ample, efficient and constant. The local government is very fitting for this function bearing in mind its proximity to the people. Though, amid these lofty goals, the practice of primary health care is constrained as the objective of primary health care in Nigeria was to provide easily reached health for all. Regrettably, this is still to be attained in Nigeria and to be unrealistic in the coming decade.
The research objectives were to; examine the impact of local government powers and responsibilities in the provision of primary health care services; assess the constitutionally vested responsibilities of local government on health care delivery; identify the challenges affecting the quality of health care services; and to determine the measures through which local government can respond efficiently to the challenges of Health Care delivery in Ikenne local government area of Ogun State. This research work made use of qualitative source of data, through which data were gathered using journals, reports, articles, newspapers, treaties, textbooks and various statutes which would be obtained from online sources.
The findings showed that, lack of finance and adequate health care facilities, lack of community participation, lack of essential drugs and basic equipment, misuse and abuse of the scarce resources, lack of qualified and competent health workers and lack of welfare incentives for workers are the challenges affecting the quality of health care services in Nigeria. Lastly, the study found that, local government should be given free autonomy and be made independent; and the excessive interference of the state governors should be eliminated in order to allow the council heads to govern and manage their natural resources.
The study recommends that, provision of essential drugs and strengthening of the drug revolving fund should be a priority. The local government should be more inward-looking and aggressive in the area of internally-generated revenue, in order to reduce the reliance on the federation account in financing health programmes. Lastly, the Nigerian health policy makers should give top priority to the training of more rural health workers so as avoid the movement of rural health workers from the rural communities to the urban centres.
CHAPTER ONE
1.1. Background of the Study
In Africa, Nigeria is regarded as the most populous nation, with an estimated population of 170million (Amakom, 2016), 64percent of whom live in rural areas. In the pursuit of development at the grassroot level, local government was established to make available level of measurable services to rural dwellers. In Nigeria, local government is the third tier of government whose major responsibility is to provide adequate services to the rural inhabitants, (Adeyemo, 2015). Irrespective of the system of government all over the world, local government is established to make available efficient services at local level.
Local government as a change agent of development is to use the finance made available to them by both federal and state government and the internally generated revenue (IGR) to provide services that will improve the lives of the individuals at the grassroot level by initiating and attracting developmental projects such as the provision of good roads, water, and rural electricity; communal services like the construction of roads, bridges, and personal welfare in such area as education, housing, and health care service delivery system, (Adeyemo, 2015). The influence of local government is a function of its ability to promote sense of belongingness, wellbeing and oneness among the inhabitants. No matter what the mode of government is, local government has been fundamentally regarded as the path to, and guarantor of, national integration, administration and development, (Arowolo, 2014).
In actual sense, local governments are perceived as valuable instrument for rural transformation and delivery of social services, i.e. health care delivery. This is as a result of the proximity of local governments to the people and the relative ease with which they can interact and communicate with the local jurisdiction, (Adeyemo, 2015). The constitution guarantees the existence of system of democratically elected local councils and every state must pass legislation to institute same and provide for their structure, (Ebere, 2015). The research work on health care delivery in Ikenne local government is worth investigating bearing in mind the position of local government in any democratic society. This position appears to be especially true of the democratic case in Nigeria mainly because it has been established that, the worst democratic system of government is better than the most munificent military system of government, (Oshilaya, 2013). The concept of local government is to bring governance closer to the inhabitants in the grassroot for participation in governance, service delivery to improve socio-economic development and good governance, (Ogunna, 2014).
In Nigeria, the health care system is the responsibility of the three levels of government that consists of the federal, state and local governments with each level responsible for the coordination of tertiary, secondary and primary levels of health care delivery respectively though dependent on the immediate higher level for the provision of finance and policy direction, (Adeyemo, 2015). The past years in Nigeria, health service provision has been decentralized putting major health outcome responsibilities on the primary health care system, (Gupta, Gauria & Khemani, 2013). In Nigeria, a number of primary health services provided are delivered through the primary health care system and as a result, it is vital that services provided at this level of care are functional, available and used by those for whom it is provided, (Samihah & Adelabu, 2016). The National Primary Health Care Development Agency (NPHCDA) is the national body with the sole responsibility for providing a harmonized response to the accomplishment of high quality and sustainable primary health care services through partnerships and development of community based systems and infrastructures. However, the actual implementation of this role is still to be accomplished particularly with the terrible position of primary health clinics across the country probably due to lack of financing of the general health care system, (Samihah & Adelabu, 2016). Health services are as well provided through a range of health care providers like secondary, tertiary facilities and community health workers.
Health care delivery is a very important function which the local government is meant to provide to the people at the grass root and which delivery ought to be ample, efficient and constant. The local government is very fitting for this function bearing in mind its proximity to the people. Though, amid these lofty goals, the practice of primary health care is constrained as remarked by Amodu and Olapipo (2016), the objective of primary health care in Nigeria was to provide easily reached health for all. Regrettably, this is still to be attained in Nigeria and to be unrealistic in the coming decade. The primary health care in Nigeria which is expected to be the foundation of the country’s health care policy is at present catering for less than 40percent of the potential patients, (Gupta, et al., 2013)
Based on the above background, this research work will hope to contribute to the existing literature by exploring the developments in the most recent times of the government desire to tackle the menace of health care delivery in the country. Therefore, the study of health care delivery in Ikenne Local Government is crucial in order to assess the constitutional obligations of local government on health care service delivery in the grass root.
1.2. Statement of Problems
Nigeria’s experience in local government administration, whether in military administrations or in democratic administration, has obviously showed that local governments in Nigeria are faced with daunting challenges in their pursuit to promote development and provides essential services to the rural inhabitants, (Kabiru, 2014).
It has been observed that, local government which is constitutionally created to be the nearest level of government to the people is not doing its bidding coupled with the fact that inhabitant population in it is deprived the benefits of its existence. Despite the constitutional vested responsibilities of local government in the provision of primary health care services, what has been observed so far is that, the local government has not been able to discharge its duties and responsibilities effectively. As a result, it is important to carry out a study to assess the factors limiting the activities of the local government towards primary health care service delivery.
Similarly, it has been observed that, despite the huge financial allocation for the health sector in the 2020 budget, majority of the primary health care in the country lacks the basic facilities and infrastructure; lack of necessary drugs; lack of motivation and salary; insufficient and unsustainable health care funding; among others. As a result, it is essential to carry out a study in order to examine the challenges confronting the quality of primary health care delivery in Nigeria.
In the view of the above, this study, therefore examines the essence of local government in provision of health care services. It as well look at the factors militating against the effectiveness of the health care delivery and recommends the ways of making local government a viable service delivery institution.
1.3. Research Objectives
This project work seeks to dwell into the assessment of local government on health care delivery in Ikenne Local Government Area of Ogun State. However, the specific objectives will be to:
- examine the impact of local government powers and responsibilities in the provision of primary health care services in Ikenne local government area of Ogun State
- assess the constitutionally vested responsibilities of local government on health care delivery in Ikenne local government area of Ogun State
- identify the challenges affecting the quality of health care services in Ikenne Local Government Area of Ogun State
- determine the measures through which local government can respond efficiently to the challenges of Health Care delivery in Ikenne local government area of Ogun State.
1.4. Research Questions
Based on the above research objectives, the following research questions will be poised for the study.
- What is the impact of local government powers and responsibilities in the provision of primary health care services in Ikenne local government area of Ogun State?
- To what extent are the constitutionally vested responsibilities of local government on health care delivery in Ikenne local government area of Ogun State?
- What are the challenges affecting the quality of health care service in Ikenne local government area in Ogun State?
- What are the measures through which local government can respond efficiently to the challenges of health care delivery in Ikenne local government area of Ogun State?
1.5. Significance of the Study
This study is undertaken mainly to understand the underlying factors that contribute to the efficiency of health care services.
The findings of this study will help the local government authorities identify the challenges to health services and to provide measures that will solve the barriers. Besides, the study will as well be of great importance to the relevant government authorities and policy makers to formulate policy that will facilitate free and quality health care services across the country.
In addition, the findings of the study will as well help the service providers at the facility level to develop strategies and action plans that will encourage an enhanced quality services. This study will help initiate the process of improving access to health care services thereby improving the overall health outcome for every individual in the state eventually.
The study will further be of great significance to the department as the findings of this study will contribute to the pool of existing literature on the subject matter.
Lastly, the findings of this study would therefore be of significance to other researchers as a secondary source of data, who might want to carry out future research on the study.
1.6. Scope of the Study
The research work is limited in scope to the examination at the health care delivery as one of the many responsibilities constitutionally vested on Local Government in Nigeria. This research will critically examine the several duties of Local Government from historical origin, legal basis, and most importantly the provision of health care to the people at the grass root. This study is confined to Ikenne Local Government Area of Ogun State for the period of 2015-2020.
1.7. Methodology of the Study
The methodology of this study will be qualitative in nature using primary and secondary sources of information. The primary source shall entail interview while the secondary sources shall be through journals, reports, articles, newspapers, treaties, textbooks and various statutes which would be obtained from online sources, and as well as from the databases of primary health care in Ikenne Local Government Area of Ogun State.
1.8. Operational Definition of Terms
Local Government: is defined as the lowest unit of administration to whose laws and regulation, the communities who live in a defined geographical area and with common social and political tiers are subjects
Health Care: is medical services provided for individual and community survival and development
Nurse: a trained person to provide care for the sick
Clinic: a medical facility such as a hospital especially one for the treatment and diagnosis of outpatients
Official: an office holder in the local government
1.9. Chapterization of the Study
This research work is divided into five main chapters with each chapter consisting of the following:
Chapter one will be the main introduction of the project and this will spell out the main aim and objectives of the research together with research background, research questions, research hypotheses, significance of the study, scope of the study, and definition of operational terms
Chapter two of this research work will have a review of the theories and literatures that are relevant to the research areas which have been carried out by various researchers in the topic area.
Chapter three of this research will examine the research methodology that will be used to carry out the study, such as research design, population, sample size and technique, method of data collection, validity and reliability, and method of data analysis.
Chapter four will provide the data analysis and interpretation of the data collected from the field.
Chapter five of the study will consist of the summary, conclusion and recommendations.
