Improving Primary Health Care Delivery in Nigeria

Mike_I5

Description

This paper, based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity, aims at understanding the performance of primary health care providers in four states in Nigeria. As possible ways to improve performance, the paper concludes that clearly defining lines of responsibility, implementing performance-based financing of local governments and providers, and collecting, analyzing, and sharing information are some options that can help realign incentives and improve accountability in the service delivery chain and service provision.
This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharma-ceuticals, Governance and Service Delivery, and Infrastructure and ICT.

Sujets

• Accountability
• Health
• Nigeria
• Sexually transmitted disease
• Public health
• Immunodeficiency
• Governance
• Poverty reduction

Informations

• Publié par: world-bank-publications
• Publié le: 28 avril 2010
• Nombre de lectures: 38
• EAN13: 9780821383117
• Langue: English

Extrait

WORLD BANK WORKING PAPER

AFRICA HUMAN DEVELOP

Improving Primary Health

Care Delivery in Nigeria

Evidence from Four States

THE WORLD BANK

EMTN

NO. 187

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PW1_78w_be3_1--801p.WORLD BANK WORKING PAPER NO. 187

ImprovingPrimaryHealth
CareDeliveryinNigeria

EvidencefromFourStates
Africa Region Human Development Department

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PW1_78w_be3_1--801p.Contents

Foreword....................................................................................................................................
ix
Acknowledgments....................................................................................................................
x
AcronymsandAbbreviations................................................................................................
xi
ExecutiveSummary...............................................................................................................
xiii
PrimaryHealthCareDeliveryinFourStates..............................................................
xiii
UnderstandingthePerformanceofPrimaryHealthCareintheStates...................
xvii
DivisionofResponsibilityamongGovernmentLevels.............................................
xvii
Citizens/ClientsPolicyMakers....................................................................................
xviii
PolicyMakersProviders..................................................................................................
xx
ClientsProviders.............................................................................................................
xxi
PossibleWaysForward..................................................................................................
xxii
1.Introduction............................................................................................................................
1
Objectives.............................................................................................................................
2
ConceptualFramework......................................................................................................
3
Methodology.......................................................................................................................
5
2.Context....................................................................................................................................
7
HealthOutcomesandAccesstoHealthServicesinNigeria.........................................
7
ContextinStatesIncludedintheStudy...........................................................................
9
3.StatusofPrimaryHealthCareServices...........................................................................
11
OrganizationofthePrimaryHealthCareSystem........................................................
11
SurveyResults...................................................................................................................
12
InfrastructureandAmenities..........................................................................................
13
ServicesAvailable.............................................................................................................
14
EquipmentandMedicalSupplies...................................................................................
15
Pharmaceuticals................................................................................................................
16
HealthPersonnel...............................................................................................................
17
ExemptionandWaiverPrograms..................................................................................
20
EducationandPromotionActivitiesofPHCServices.................................................
30
ServiceCharges.................................................................................................................
31
4.DivisionofResponsibilitiesamongGovernmentLevels............................................
33
LawsandPoliciesInformingtheDivisionofResponsibilitiesfortheDeliveryof
PrimaryHealthCare.................................................................................................
33
DivisionofResponsibilitiesinPractice..........................................................................
34
PoliciesandGuidelines....................................................................................................
34

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Contents

PersonnelTraining............................................................................................................
36
HealthCarePersonnelManagement.............................................................................
36
Infrastructure:ConstructionandMaintenance.............................................................
37
ProcurementandDistributionofPharmaceuticalProducts.......................................
39
Supervision........................................................................................................................
41
PossibleWaysForward....................................................................................................
41
5.ClientsPolicyMakers........................................................................................................
43
LocalGovernmentRevenuesandResponsibilities......................................................
43
PublicFinancialManagement.........................................................................................
46
LocalGovernmentCivilService.....................................................................................
49
LocalGovernmentHealthExpenditure.........................................................................
50
LocalGovernmentAccountabilityforServiceDelivery..............................................
54
PossibleWaysForward....................................................................................................
55
6.PolicyMakersProviders....................................................................................................
61
CharacteristicsofHealthPersonnel...............................................................................
62
EducationLevel.................................................................................................................
63
IncentivestoProviders.....................................................................................................
64
MechanismstoRewardandDisciplinePHCPersonnel..............................................
67
OtherNegativeIncentivesFacedbyPHCPersonnel...................................................
68
HealthPersonnelCopingMechanisms..........................................................................
70
PossibleWaysForward....................................................................................................
71
7.ClientsProviders.................................................................................................................
74
Increa