By A.B.

Sani FON KKB SON KT

Structure of Health Care Delivery in Nigeria

Introduction

 Nigeria became an independent sovereign state within the Commonwealth of Nations in

October 1960, and an automatic member of the World Health Organization.
 The country started with one central and three regional governments in 1960, and has grown to
one central and 36 state government, plus the Federal Capital Territory of Abuja.
 Health is a fundamental human right
 Most sensitive developmental issue on the socioeconomic compact scale
 A good health system delivers quality services to all people, when and where they need them
The exact configuration of services varies from country to country, but in all cases requires the
following:
 A well-trained and adequately paid workforce;
 A robust financing mechanism
 Reliable information on which to base decisions and policy;
 A well maintained facilities and logistics to deliver quality medicines and technologies.
 Health is on concurrent list of the 1999 Constitution, each of the tier of government has
concomitant responsibility for providing health services “The Federal Ministry of Health, every
State Ministry of Health and every local government shall establish such health services as are
required under this Act.” Draft National Health Bill for the Federal Republic of Nigeria, 2006.
 Nigerian health system is pluralistic which includes orthodox, alternative and traditional health
care delivery systems operating alongside each other.

Principle and scope

 The principle and a system-wide strategy underpinning our health care system is primary health
care philosophy
 Primary health is the essential health care based on practical, scientifically sound and socially
acceptable methods and technology made universally accessible to individuals and families in
the community through their full participation and at a cost that the community can afford to
maintain at every stage of their development in the spirit of self-reliance and self-
determination.
 The scope include preventive, curative and rehabilitation care.

The basic principles include:

1. Equity
2. Inter-sectoral collaboration,
3. Community participation,
4. Appropriate technology.
5. 2 way referral system

Components of the National Health System

a. The Federal Ministry of Health;

By A.B.Sani FON KKB SON KT
b. The Ministry of Health in every state and the Federal Capital Territory Department
responsible for Health;
c. Parastatals under the federal and state ministries of health;
d. All local government health authorities;
e. The ward health committees;
f. The village health committees;
g. The private health care providers;
h. Traditional health care providers; and
i. Alternative healthcare providers.

Structure/ Levels of Health Care Delivery in Nigeria

Administrative Service structure Person in charge

levels
• Federal government • Tertiary Health services • Minister of Health
• State government • Secondary Health Services • Commissioner of Health
• Local government • Primary Health Services • Medical Officer of Health
• Private sector • Private health services • Private providers

The Nigerian healthcare system is organized into primary, secondary and tertiary healthcare levels.

 The Local Government Areas (LGAs) are responsible for primary healthcare,
 The State Governments are responsible for providing secondary care while
 The Federal Government is responsible for policy development, regulation, overall stewardship
and providing tertiary care.

The LGA level is the least funded and organized level of government and therefore has not been able
to properly finance and organize primary healthcare, creating a very weak base for the healthcare
system.

Departments/Units of federal ministry of Health

The federal ministry of health has 7 departments:

1. Health Planning,
2. Research & Statistics,
3. Public Health,
4. Family Health,
5. Hospital Services,
6. Food and Drug Services,
7. Information and communication technology, and Procurement

Agencies of FMoH

1. National Health Insurance Scheme

2. National Agency for Food and Drug Administration and Control
3. National Primary Health Care Development Agency
4. Nigerian Institute of Medical Research
By A.B.Sani FON KKB SON KT
5. Several teaching hospitals and federal medical centers across the country
6. Professional Regulatory bodies

National Primary Health Care Development Agency (NPHCDA)

 NPHCDA is a parastatal of Nigeria’s Federal Ministry of Health. Its mandate is to develop

national primary health care (PHC) policy and support states and LGAs to implement them.
 The NPHCDA’s vision and purpose is to make Nigerians healthy. In pursuance of this aim, the
Agency has seven corporate goals.
1. Goal 1: Control preventable diseases
2. Goal 2: Improve access to basic health services
3. Goal 3: Improve quality of care
4. Goal 4: Strengthen institutions
5. Goal 5: Develop a high-performing and empowered health workforce
6. Goal 6: Strengthen partnerships
7. Goal 7: Engage communities

Hospitals Management Board

 This is the a parastatal of the State Ministry of Health.

 The primary mandate is to provide health care services through the management of Secondary
Health facilities.
 The board is headed by a chairman and four other members representing NMA, PSN,
NANNM, MHWU.

Departments of HMB

 Department of Medical Services

 Department of Diagnostic Services
 Department of Planning Research and Statistics
 Department of Pharmaceutical Services
 Department of Nursing Services
 Department of Finance and Administration

State Primary Health Care Board

The composition of the governing board may vary from State to state but essentially constitutes

• The Chairman
• Representatives of health professional groups
• Representative ministries of health, local government, finance and economic planning
• Representative of traditional medicine board

Functions of State Primary Health Care Board

 Advocacy to LGA policy makers and opinion leaders

 Sensitization of community members
By A.B.Sani FON KKB SON KT
 Community diagnosis and generation of baseline data
 Institution of planning and evidenced base PHC implementation plans
 Personnel auditing
 Inventory of PHC infrastructure
 Needs assessment
 Effective disease surveillance and promotion of two way referral system

Local Government Health Authority (LGHA)

 LGHA consist of: a part time chairman, 2 LGA residents, 1 representative of LGA private
providers, 1 representative of Traditional medicine board, and the Medical officer of Health.
 They are responsible to the PHC board and their functions include:
• Setting out targets in line with policies and overall objectives
• Implementing development plan
• Supervising and monitoring management committees
• Staff discipline
• Approving ward operational plans
• Ensuring co-ordination and integration of health services

Ward Health /Development Committee (WHC/WDC)

The WHC/WDC is composed of a part time chairman, 3 community representatives, and the officer in
charge of the Health facility management team.

WHC/WDC report to the LGHA and the functions include:

• Assisting the MOH in the day to day management of the health facility
• Suggesting proposals(overall planning, expansion, development and maintenance of
health institutions in the ward, revenues and expenditures of the facility, purchase of
stores, furniture and equipment.

Health Facility Management Team (HFMT)

 The HFMT comprises the officer in charge, all health of units, all heads of inter-related
units(accounts, engineering, agricultural, education etc)
 LGA Human Resource for PHC include:
• Medical Officer of Health
• LGA departmental staff
• PHC facilities staff
• LGHA
• WDC/WHC
• Community based providers
• Private Primary

National Council on Health

 The Council is the highest-decision making-body in the country’s health sector.

By A.B.Sani FON KKB SON KT
 It comprises health ministers, state commissioners for health, heads of Federal Ministry of
Health’s agencies, permanent secretary in the Federal Ministry of Health and other leading
figures in the country’s health sector.
 The Chairman of the Council is the Minister of Health, Prof. Isaac Adewole,

Functions of National Council on Health

• Provision of appropriately trained staff at all levels to meet the population health care needs
• Identify shortages of skills, expertise and competence within the national health system and
prescribe
strategies to resolve the shortages
• Provide education and training of healthcare providers & health workers in the Federation to
improve
their skills, expertise and competence
• Prescribe strategies for recruitment and retention of healthcare personnel within the Health
Care system
• Prescribe circumstances under which healthcare personnel may be recruited from other
countries to provide health services in the Federation

National Health Act

• This Act provides a framework for the regulation, development and management of a national
health system and set standards for rendering health services in the federation, and other
matters connected therewith, 2014.
• The NHA 2014 is a 29-page document with 7 parts and 65 sections.

Arrangement of the ACT

• PART I - Responsibility for health and eligibility for health services and establishment of
national health system
• PART II - Health establishments and technologies
• PART III - Rights and obligations of users and healthcare personnel
• PART IV - National health research and information system
• PART V - Human resources for health
• PART VI - Control of use of blood, blood products, tissue and gametes in humans
• PART VII - Regulations and miscellaneous provisions

Roles of the federal government in the following

1. Patient care:

- Ensure pt received quality care by employment of skilled personnels.

- Ensure provision of equipments and drugs.

2. Health infrastructure:

a. build health facilities

b. renovation of health facilities
c. provision of accessible roads for referrals
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d. provision of ambulance for referrals system

3. Human resources:

- employment of adequate personnel in all the helth facilities

- training and retraining
- students of federal institutions e.g son.

4. Logistics and resource requirement:

- such as registers, forms, family planning registers etc.

5. Monitoring and evaluation:

- ensure the collection of data from all levels of health care

- analysis data and give feedback
- to organize training in m&e.

State ministry of health

1. Patient care: preventive, curative and rehabilitative care.

2. Health infrastructure: provision of health facilities, equipment and transportation. e.g.
Ambulance.
3. Human resource for health: employment of skilled and unskilled and Manpower development.

4. Logistic & resource requirement: planning/budgeting state liase with donor agencies.

5. Monitoring and evaluation:

- Monitor activities for qi

- Project monitoring for set objectives.

Local government responsibilities

Patient care:

- Provide facility
- Staffing
- Logistics
- Drugs and equipments
- Accomodation
- Sponsorship for training of staff e.g chews and basic midwives
- Monitoring and evaluation

Health infrastructure:

- Electricity – generator
- Water - well, borehole
- Human resources

Human resources:
By A.B.Sani FON KKB SON KT
- Staffing
- Capacity building

Logistics

- Transport
- Monitoring and evaluation by dphc & m & e officers.

Community

Patient care:

- Advocacy
- Mobilization & sensitization

Health infrastructure:

- Provide basic amenities e.g water borehole, generaor etc

- Acomodation for staff

Human resource:

- Employment of staff
- Sponsorship for training
- Provide security.

Logistics:

- Provide or make arrangement for transportation

- Co-operative groups
- Give out loans.

Monitoring:

- observation/provide information.

Development partners

Patient care:

- Provision of drugs and equipments

- Demand creation to patronage facilities by pregnant women
- Creating more awareness to pregnant women to patronise can – by giving incentives.

Infrastructure (health):

- Provision of buildings and renovation of existing ones

Human resource for health

- Capacity building through training and retraining.

By A.B.Sani FON KKB SON KT
- Employment of staff for sustanability

- Mentoring activities to local health commitees.

Logistics and resource requirement:

- Provision of vehicles for transportation plus referrals/supervision.

- Funds for resources (consumables and maintenance).

Monitoring and evaluation:

- Provide support staff for monitoring and evaluation.

- Train available staff for m&e exercises.

- Development of m&e tools

- Use of evidence based data for advocacy for more action on issues discovered during m&e.

Health financing

Health care in Nigeria is financed by a combination of:

• Tax revenue from the sale of oil and gas

• Out of pocket payments
• Donor funding
• Health insurance (private, public, social and community).

Social Health Insurance

 NHIS contribution represents 15% of basic salary

 The employer pays 10% and the employee pays 5%
 The package covers the contributor, a spouse, and four (4) biological children below age 18.
 Services under the NHIS are:
 Out-patient care including necessary consumables.
 Prescribed drugs.
 Maternity care up to four (4) live births.
 Preventive care.
 Hospital care up to 15 days per year.
 Consultations with specialists
 Eye examinations
 A range of prostheses (limited to artificial limbs produced in Nigeria)

National Health Insurance Scheme (NHIS)

• The National Health Insurance Scheme (NHIS) is a body corporate established under Act 35 of
1999 by the Federal Government of Nigeria aimed at providing easy access to healthcare for all
Nigerians at an affordable cost through various prepayment systems.
By A.B.Sani FON KKB SON KT
• NHIS is totally committed to securing universal coverage and access to adequate and
affordable healthcare in order to improve the health status of Nigerians, especially for those
participating in the various programmes/products of the Scheme
• NHIS is to provide social health insurance in Nigeria where health care services of contributors
are paid from the common pool of funds contributed by the participants of the Scheme.
• It is a pre-payment plan where participants pay a fixed regular amount. The amount/funds are
pooled, allowing the Health Maintenance Organisations(HMOs) to pay for those needing
medical attention. It is primarily a risk sharing arrangement which can improve resource
mobilisation and equity. It is indeed regarded as the most widely used form of health care
financing worldwide.
• NHIS also regulate private health Insurance operated by HMOs. HMOs should have a
hyperlink to the HMOs list on the site
• Health Insurance is social security system that guarantees the provision of needed health
services to persons on the payment of token contributions at regular intervals.