NATIONAL HEALTH POLICY

National health policy can simply be defined as a framework for the plan of action developed by
government to enable its citizens achieve a state of complete physical, social and mental wellbeing and
not the mere absence of disease of infirmity (FMOH, 2004). Health policy serves as a point of reference
in providing sound foundation for planning, organization and management of the nation's overall health
care system.

RATIONALE FOR THE NATIONAL HEALTH POLICY

The rationale for the national health policy is to provide federal, state, local government health
institutions and other health related non-governmental organizations a formal framework for
appropriate national direction in health development.

The goal of the national health policy shali be a level of health that will enable all Nigerians to achieve
socially and economically productive lives, the national health system shall be based on primary health
care.

Primary health care remains the corner stone of the national health policy and has been identified as a
strategy for achieving health for all Nigerians. As long-term policy and within available resources, the
federal government shall provide a level of health care for all citizens to enable them to achieve socially
and economically productive lives.

Within the overall fundamental obligation of government of the federation and the nations socio-
economic development, the goal of the national health policy shall be to establish a comprehensive
health care system based on primary health care that is promotive, protective, preventive, restorative,
curative and rehabilitative to every citizen of the country within the available resources so that
individuals and communities are assured of productivity, social wellbeing and enjoyment of living (MOH,
1988).

GOVERNMENT POLICY DEVELOPMENT ISSUES AND MANAGERIAL TOOLS HEALTH

HEALTH INFORMATION

The effective management of health services demands the establishment of a national health
information system. Basic demographic data are essentials for planning and monitoring of health
services. Simple but efficient information system shall be established and supported to grow both in
quality and quantity.

HEALTH MANPOWER DEVELOPMENT

Ministries of health shall ensure that medical, nursing, public health and other schools of health sciences
under their jurisdiction include in their education programmes, the philosophy of "health for all", the
principles of primary health care, and the essentials of the managerial process for national health
development and to provide appropriate, practical training in these areas. In similar manner, effort shall
be made to involve technical workers in other sector having a bearing on health. The selection, training
and development of health manpower shall reflect the national objectives with particular emphasis of
the primary health care approach appropriate policies shall be avoided to secure a more equitable
distribution of health personnel throughout the country.

HEALTH TECHNOLOGIES

The most appropriate health technologies shall be selected for us at all levels of the health care system.
Particular care shall be taken to identify the most cost effective's technologies and maintain them at the
highest level of efficiency. In order to reduce importation of supplies, indigenous manufacturing
capabilities shall be fostered in the spirit of self-reliance.

The policy on national health technologies shall be directed ensuring the selection, development and
application appropriate technology at each levels of health care. Appropriateness shall be judge on the
basis of effectiveness, safety, the ability of the community to pay for it, and the availability of expertise
to utilize and maintain the technology. A systematic assessment shall be made of health technology
being considered for use in each priority programme. This shall include measures for health promotion,
disease prevention, diagnosis, therapy and rehabilitation.

WELFARE STATE SYSTEM

About 7% of the GNP of Norway is devoted to health and a very high percentage of this support, about
80% comes from social insurance and government health revenues. Hospital and medical care is
extended to entire population of Norway and the patient pays nothing except low charge for special
amenities, such as private hospital room outside the hospital medical care requires about 20% payment
on the first three (3) visits and none for continuing treatment or chronic illness. There are no charges for
prisoners or the very poor.

Primary care is regarded as the unique responsibility of a general medical practitioner who is aided by
nurses but virtually and maternity cares are delivered in hospitals by nurse midwives and adequate
public health clinics are available for preventive and promotive cure. Specially trained nurses do most of
the work in the clinics with doctors in periodic attendance the quality of services rests on governmental
control of training institutions.

A SOCIALIST SYSTEM

The economic support of soviet health services is derived from the general government revenue which
comes from the production of all commodities. Only about 4% of the GNP is spent on health through a
unified ministry of health.
The soviet constitution's guarantee completes preventive and therapeutic health care to everyone as a
public services. Doctors are turned out of medical schools at a faster rate than population growth and
their institutions are directly under the control of the ministry of health.

Much emphasis is placed on child health care and pedestrian are regarded as general practitioners for
children rather then a specialists. All the health facilities are owned and operated by the central ministry
of health and primary health care is provided to the general population at polyclinics in the cities or
health centers in the rural areas.

A TRANSITIONAL SYSTEM

The health services is most transitional countries of Latin America e.g PEO, reflect historical influences.
Traditional Indian healing practices are common especially in the rural areas while the Church of Spain
provides charitable hospitals care. North American influerīces promote public health programmes and a
European influence has disseminated social security. The private medical sector also thrives here
because there is a class of wealthy families mainly in the cities. Only about 3% of the GNP is allocated to
health. Health care is financed predominantly from security contributions and charitable donations.
About 20% of this revenue is devoted to organized programme for more than 75% of the population and
the rest for the affluent and social security beneficiaries.

General practitioners and few with about 80% of doctors being specialists. The USA is therefore training
more physician assistants and nurse practitioners are replacement for the doctor to provide primary
health care. The pattern of health care delivery is mostly private with most doctors working in their own
private offices even when services have been financed by government or spread through health
insurance.

THE THREE TIERS OF NIGERIAN HEALTH SYSTEM

The Nigerian health system is based on three levels or tiers of health care delivery:

1. The primary health cares are level or tiers is the first point of entry for individuals and communities
and the health care system is the responsibility of the local government. It takes care of common health
problems and involves health centers and clinics and appropriate personnel. It refers cases to secondary
or tertiary levels.

2. The secondary health care accepts referrals from the PHC level and is managed by the state
government. It uses appropriate personnel and involves general hospitals and specialist hospitals. It
refers causes to the tertiary and primary health care levels.
3. The tertiary health care provides highly specialize medical care supported by advanced diagnostic
services. It refers case to secondary and primary levels. It use appropriate personnel and includes
teaching, orthopedic and psychiatric hospitals. It is the responsibility of the federal government.

REASONS FOR THE THREE FIER SYSTEM

1. Commonest problems are treated or prevented by health workers adequately trained for the
purpose.

2. More serious cases are sent to places where more high trained specialists can deal with them.

3. It saves money and other resources.

COMMON SOURCES OF HEALTH CARE DELIVERY

1. Hospitals

2. Health centers and clinics

3. Maternities

4. Pharmaceutical centers

5. Chemist

6. Nongovernmental organizations

7. International health organization (WHO, UNICEF, IRS etc)

NATIONAL HEALTH POLICY

National health policy can simply be defined as a framework for the plan of action development of
government to enable the citizens of a country to achieve the state of complete physical, mental and
social well being and not merely the absence of disease of infertility. Infirmity (FMOH, 2004), national
health policy serves as a point of reference in providing sound foundation for planning, organization and
management of the nation are all health care system. However the attainment of desisted level of
health by any nation depend on its ability is produce a well concerned national health policy (NHP) that
will address the prevailing health problems affecting the nation.

RATIONAL FOR THE NATIONAL HEALTH POLICY

The rational for the national health policy is to provide federal, state, local government health
institutions and other health related and non governmental organizations a formed framework for
appropriate national direction in health development, the goal of the national health policy shall be a
level of health that will enable all Nigerians to achieve social and economical lives. The national health
system shall be based on primary health care. Primary health care remain the cover stone of the
national health policy and has been identified as a strategy for achieving health for all Nigerians.
As long-term policy are within available resources, the federal government provide a Level of the health
care for all citizens to enable them to achieve social and economically productive lives. Within the
overall fundamental obligation of government of the federal and the national socio economic
development. The &gal of the national health policy shall be to establish a comprehensive health care
that is promotive, preventive, protective, restorative and rehabilitative to every citizen of the country
within the available resources so that individuals and community are assured of productivity, social
wellbeing and enjoyment of living (FMOH, 1988).

CONTENT OF THE NATIONAL HEALTH POLICY

1. The federal, states and local government of Nigeria were by commit themselves and all the people to
intensive action to attain the goals of health for all citizens by the year 2000 and beyond that is the-level
of health that will be permit them to lead socially and economically productive lives at the high possible
level.

2. All government of the federation are convinced that the health of people not only contribute to better
quality of lives but it's also essential for the sustained economic and social development of the country
as a whole.

3. The people of the nation have the right to participate individually and collectively in the planning and
implementation of their health care. However this is town duty.

4. PHC is the key to attaining the goal of health for all the people of this country.

5. All government and the people are determined to formulate strateging and plans of actions including
action to be taken by the local government country and sustained PHC in accordance with this national
policy.

6. All government agreed to corporate and commit themselves in a spirit of partnership and service to
ensure primary health care for all citizens since the attainment of health by people in any state directly
concerns and benefit every other state in the federation.

7. The federation undertaken:

To provide policy, guidance and strategies support to state in their effort at establishing health system
that are PHC and an accessible to all their people.

To provide incentives is selected health field to the best of the economic ability to promote the
endeavor.

To coordinate state effort in order to ensure a collected nationwide health system.

In collaboration with the state government to undertake the overall responsibility for monitoring and
evaluation of implementation of the health system.

All government accept to exercise political which to mobilized and use all available health resources
nationally.

GOAL FOR THE NATIONAL HEALTH POLICY

The attainment of all Nigerians by the year 2000, a level of health that will enable them to achieve
socially and economically productive lives, health for all Nigerians by the year 2000.

FUNDAMENTAL PRINCIPLE UNDERLYING THE NATIONAL HEALTH POLICY

The national philosophy of social justice and equality as enunciated in the second national development
plan (1990–1974).

2 STRATEGIES FOR ACHIEVING THE GOAL OF THE NATIONAL HEALTH POLICY The primary health care
approach (which is promote, protective, preventive, restructive and rehabilitative) this approach
include:

1. Education concerning prevailing health problems and the method of preventing and controlling them.

2. Promotion of food supply and proper nutrition.

3. Adequate supply of safe water and basic sanitation

4. Maternal and child health care including family planning.

5. Immunization against major infection diseases.

6. Appropriate treatment of common diseases and injuries.

7. Provision of essential drugs and supplies.

8. Prevention and control of local epidemic and endemic diseases.

ROLES OF PHC IN THE CURRENT NATIONAL HEALTH POLICY

Since the goal of national health policy is attainment of health by the 2000 for all *Nigerians. The PHC
strategies is the only possible means of achieving because its aims of equitable distribution of health
care. PHC also puts health delivery and management in the hand of the people and emphasize
community participation and self reliant in link with the principle of social justice and equity.

PHC DOES ALL THE ABOVE BECAUSE:

1. It take into account the economic condition of the nation.

2. Using appropriate technologies which can be supported by the country at every phase of

their development.

3. It harness the expontise of all related social sector to solve the health of the country.

4. Address the main problems in the community of the people.

5. Promote maximum community and individual or self reliance and participating in the planning,
organizing, operation and control of PHC, making fullest use of local, state and federal government and
other available resources.

6. Develop through appropriates education and information the ability of the community to participates.

NATIONAL POPULATION POLICY *

National population policy is an official statement by the government which will provide a framework
and appropriate guideline for examine and solving national population problems in a collective and
realistic manner.

RATIONAL FOR THE NATIONAL POPULATION POLICY

1. High infant mortality rate.

2. High maternal mortality rate due to high fertility rate.

3. High population growth rate.

4. Negative impact of high population growth rate in development these are reasons why the
government head to give guidelines on dealing with population problems.

MAIN GOAL FOR NATIONAL POPULATION POLICY Important

→To improve the standard of living and the quality of life of the people of Nigeria.

→ To improve the health and welfare of Nigeria especially through preventing, promotive health and
illness among high risk groups of mothers and children.

→ To achieve lower population growth rates through reduction of birth rate by voluntary fertility
regulation method that are compatible with the attairiment of economic and social goals of the nation.

To achieve a more even distribution of population between urban and rural area.

STRATEGIES FOR ACHIEVEMENT THE GOAL OF THE NATIONAL POPULATION POLICY

Promoting, family and fertility regulation.

Maternal and child health. Prelude farmory plen

Roles and responsibility of man in the family.

Roles and status of women in development involving women in the national development is essentially
for reducing fertility.

Child and youth programme.

Population, education and information.

Special distribution of the population.

Population data collection, training and research.

INTRODUCTION

TRAINING: is concerned with reading specific and immediately in able skills. It provide general
information on used to developed knowledge for future long term used. Training is a learning process
whereby people acquired skills, concepts attitudes or knowledge to aid in the achievements of goals.
Effective training can bring about higher productivity and fever mistakes.

A health worker who feeds competent and fulfilled because he is well trained is better able to help other
peoples to solve their own problems. Thereby achieving one of the goals of PHC in Nigeria the health
worker is responsible for ensuring the junior staffs have the appropriate skills, attitude and knowledge
that enables them to effectively provide primary health care service on the country.

Nigerian Health System

Introduction:

Nigeria, with a population exceeding 200 million, grapples with significant healthcare challenges. The
Nigerian health system comprises public and private sectors, with variations in accessibility, quality, and
affordability.

Key Challenges:

1. Inadequate Funding: Insufficient budget allocation to healthcare results in limited resources for
infrastructure, equipment, and personnel. Over-reliance on out-of-pocket payments exacerbates
disparities in access to care.

2. Infrastructure Deficiencies: Shortages of hospitals, clinics, and medical facilities, especially in rural
areas, hinder access to healthcare services. Insufficient medical equipment and outdated facilities
contribute to suboptimal patient care.
3. Healthcare Workforce Shortages: Nigeria faces a shortage of skilled healthcare professionals,
including doctors, nurses, and specialists. Brain drain, where qualified personnel emigrate in search of
better opportunities, further strains the healthcare system.

4. Disease Burden: Communicable diseases like malaria, tuberculosis, and HIV/AIDS remain prevalent,
placing a significant burden on the healthcare system. Non-communicable diseases such as diabetes,
hypertension, and cancer are on the rise, necessitating improved prevention and management
strategies.

5. Health Inequities: Disparities in healthcare access exist along socio-economic, geographic, and ethnic
lines. Vulnerable populations, including women, children, and those living in poverty, face greater
challenges in accessing essential healthcare services.

Government Initiatives:

➤ National Health Insurance Scheme (NHIS): Established to improve access to quality healthcare and
provide financial risk protection to Nigerians. Aims to achieve universal health coverage by enrolling
individuals in various health insurance programs.

Primary Healthcare Revitalization: Emphasis on strengthening primary healthcare services to deliver

essential health interventions, including immunization, maternal care, and disease prevention.

➤ Health Sector Reform Programs: Government-led 'initiatives aimed at enhancing healthcare delivery,
infrastructure development, and health workforce capacity building.

The Nigerian healthcare system operates at different levels, ranging from primary to tertiary care. Here's
an overview:

Primary Healthcare Level:

Primary healthcare services are the foundation of the Nigerian healthcare system.

• Typically provided through primary health centers (PHCs), dispensaries, and community health
workers.

• Focus on preventive and basic curative services, including immunizations, maternal and child health,
family planning, and treatment of common illnesses.

Secondary Healthcare Level:

• Secondary healthcare facilities include general hospitals, district hospitals, and comprehensive health
centers.
Offer more specialized medical services and facilities compared to . primary care centers.

Provide diagnostic services, emergency care, minor surgeries, and treatment for a broader range of
medical conditions.

Tertiary Healthcare Level:

• Tertiary healthcare facilities are the highest level of healthcare provision in Nigeria.Includes teaching
hospitals, specialist hospitals, and federal medical centers.

Offer advanced medical care, specialized treatments, complex surgeries, and medical research and
training.

Serve as referral centers for complex cases from primary and secondary healthcare facilities.

Overall, while Nigeria has established healthcare infrastructure at various levels, challenges such as
inadequate funding, infrastructure deficiencies, and workforce shortages affect the quality and
accessibility of care across the system. Efforts to

strengthen healthcare delivery at all levels are essential to improve health outcomes and ensure
universal access to quality care for all Nigerians.

Health System

Define of Health System

A health system is a network of organizations, institutions, resources, and individuals involved in

delivering healthcare services to meet the health needs of a population. It encompasses all activities,
structures, and functions aimed at promoting, maintaining, or restoring health, as well as preventing and
treating illnesses or injuries. This includes healthcare providers, facilities, financing mechanisms,
regulatory bodies, health workforce, information systems, and policies designed to ensure access to
quality healthcare services for individuals and communities.

Define of Health

Health is a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity, according to the World Health Organization (WHO). It encompasses not only the
absence of illness or injury but also the ability to cope with daily life challenges, maintain satisfying
relationships, and contribute effectively to society. Health is a dynamic concept that involves a balance
of physical, mental, and social factors, influenced by individual lifestyles, genetics, environmental
conditions, and access to healthcare services.

Components of health
1. Physical Health: Refers to the overall condition of the body and its ability to perform physical activities
without limitations. Includes factors such as nutrition, exercise, access to clean water, sanitation, and
hygiene practices.

2. Mental Health: Encompasses emotional well-being, cognitive function, and the ability to cope with
stress, adversity, and everyday challenges. Includes access to mental healthcare services, social support
networks, and strategies for promoting mental resilience.

3. Social Health: Relates to the quality of interpersonal relationships social connections, and community
engagement. Involves factors such as social support systems, social cohesion, inclusivity, and access to
education, employment, and social services.

4. Environmental Health: Refers to the conditions and quality of the surrounding environment that can
affect human health. Includes access to clean air, safe drinking water, sanitation facilities, proper waste
management, and protection from environmental hazards such as pollution, toxins, and infectious
diseases.

5. Access to Healthcare Services: Encompasses the availability, affordability, and utilization of healthcare
services, including primary, secondary, and tertiary care. Includes access to healthcare facilities, trained
healthcare professionals, essential medicines, diagnostic services, and preventive care interventions.

6. Health Education and Promotion: Involves efforts to raise awareness, knowledge, and understanding
of health-related issues and behaviors.

Includes health education campaigns, disease prevention programs, and initiatives to promote healthy
lifestyles, preventive healthcare practices, and early detection of diseases.

7. Healthcare Infrastructure and Systems: Refers to the physical infrastructure, healthcare facilities,
equipment, technology, and organizational structures that support the delivery of healthcare services.
Includes health facilities, medical equipment, pharmaceutical supply chains, health information systems,
and regulatory frameworks.

Note:

Improving these components requires multi-sectoral collaboration, policy interventions, investment in

healthcare infrastructure, promotion of healthy behaviors, and addressing social determinants of health
to ensure holistic health and well-being for all Nigerians.

The National Health Policy in Nigeria

The National Health Policy in Nigeria provides a framework for guiding the development,
implementation, and evaluation of healthcare initiatives and strategies in the country. Some key
components of Nigeria's National Health Policy include:
1) Universal Health Coverage (UHC): The policy aims to achieve universal access to quality healthcare
services for all Nigerians, regardless of socio-economic status or geographic location. Emphasis is placed
on expanding health insurance coverage, strengthening primary healthcare services, arıd reducing out-
of-pocket healthcare expenditures.

2) Health Financing: The policy outlines strategies to mobilize and allocate financial resources for
healthcare, including increased government funding, innovative financing mechanisms, and public-
private partnerships. Efforts are made to improve the efficiency and equity of healthcare financing,
ensuring that resources are allocated effectively to address priority health needs.

3) Primary Healthcare Revitalization: Recognizing the importance of primary healthcare as the

foundation of the healthcare system, the policy prioritizes the revitalization and strengthening of
primary healthcare services. This includes expanding access to essential health services, promoting
community participation, and enhancing the capacity of primary healthcare facilities to deliver
comprehensive care.

4) Health Workforce Development: The policy focuses on strengthening the health workforce by
improving recruitment, training, retention, and deployment of healthcare professionals. Efforts are
made to address workforce shortages, enhance skills and competencies, and promote equitable
distribution of healthcare personnel across urban and rural areas.

5) Health Information Systems: The policy advocates for the development and utilization of robust
health information systems to support evidence-based decision-making, monitoring, and evaluation of
healthcare programs. This includes strengthening data collection, analysis, and reporting mechanisms at
all levels of the healthcare system to improve health outcomes and accountability.

6) Disease Prevention and Control: The policy prioritizes disease prevention and control efforts,
including immunization programs, infectious disease

surveillance, and public health interventions. Strategies are implemented to address priority health
challenges such as malaria, HIV/AIDS, tuberculosis, and emerging infectious diseases.

7) Health Infrastructure and Technology: The policy emphasizes the importance of investing in
healthcare infrastructure, facilities, medical equipment, and technology to improve the quality and
accessibility of healthcare services. Efforts are made to upgrade healthcare facilities, enhance medical
supply chains, and leverage technology for telemedicine, e-health, and health information management.

Overall, Nigeria's National Health Policy seeks to address the challenges facing the healthcare system
and achieve better health outcomes for all Nigerians through comprehensive, equitable, and sustajnable
healthcare interventions.
Nigerian Health Population

In January 2022, Nigeria had a population of over 200 million people, making it the most populous
country in Africa and the seventh most populous in the world. The population is diverse, with over 250
ethnic groups and various cultural, linguistic, and religious backgrounds. Nigeria's population is also
characterized by a significant youth bulge, with a large proportion of the population under the age of 30.
This demographic profile has implications for healthcare delivery, education, employment, and socio-
economic development in the country. For the most current population figures and demographic trends,
it's advisable to consult recent data sources or official statistics from the Nigerian government or
international organizations.

Rational for Health Population in Nigeria

The rationale for focusing on the health population in Nigeria stems from several key factors:

Public Health Impact: Improving the health of the population directly contributes to overall socio-
economic development and quality of life. A healthy population is more productive, economically active,
and better positioned to contribute to national growth and prosperity.

Human Rights and Equity: Access to healthcare is a fundamental human right, and prioritizing health
population ensures that all individuals have equitable access to essential healthcare services, regardless
of socio-economic status, geographic location, or demographic characteristics.

❖Disease Burden: Nigeria faces significant health challenges, including high rates of infectious diseases
such as malaria, HIV/AIDS, tuberculosis, and vaccine-preventable diseases. Addressing these health
issues requires targeted interventions to improve population health outcomes and reduce morbidity and
mortality rates.

Demographic Dynamics: Nigeria's large and rapidly growing population, combined with a high fertility
rate and significant youth bulge, underscores the importance of investing in population health.
Addressing the healthcare needs of a growing and youthful population is essential for sustainable
development and achieving national development goals.

Health Equity and Social Justice: Promoting health population entails addressing health disparities and
inequities, particularly among marginalized and vulnerable groups such as women, children, the elderly,
and people living in rural or underserved areas. Achieving health equity requires targeted interventions
to ensure that everyone has equal opportunities to attain optimal health outcomes.

* National Development Goals: Improving population health is integral to achieving broader national
development goals, including poverty reduction, education, gender equality, and economic growth.
Healthy populations are more resilient to shocks and better positioned to capitalize on opportunities for
social and economic advancement.

International Commitments: Nigeria is a signatory to various international agreements and

commitments related to health, including the Sustainable Development Goals (SDGs) and the Abuja
Declaration, which advocate for increased investment in healthcare and improved health outcomes for
all citizens.

In summary, the rationale for prioritizing health population in Nigeria is grounded in the imperative to
promote human well-being, achieve health equity, drive socio-economic development, and fulfill
international obligations to advance global health agendas.

Basic Health Services Scheme:

The Basic Health Services Scheme (BHSS) is a healthcare program aimed at providing essential
healthcare services to underserved and vulnerable ! populations, typically in rural or remote areas
where access to healthcare is limited. It focuses on delivering basic preventive, promotive, and durative

healthcare interventions, including immunizations, maternal and child health services, treatment of
common illnesses, and health education.

Rationale of Basic Health Services Stheme: The rationale behind the Basic Health Services Scheme
includes:

a. Equitable Access: To ensure that all individuals, regardless of their socio- economic status or
geographic location, have access to essential healthcare services. 1

b. Primary Healthcare Strengthening: To strengthen primary healthcare services as the cornerstone of

the healthcare system, addressing the majority of health needs at the community level. 1

c. Preventive Healthcare: To prioritize preventive and promotive healthcare interventions, which are
cost-effective and essential for improving population health outcomes. . !

d. Reducing Health Disparities: To address health disparities and inequities by targeting underserved
populations and marginalized communities with essential healthcare services.

e. Cost-effectiveness: To utilize limited resources efficiently by focusing on cost- effective interventions

that have the greatest impact on improving health outcomes, particularly in resource-constrained
settings.

Reasons for Failure of Basic Health Services Scheme:

The Basic Health Services Scheme may fail due to various factors, including
i. Inadequate Funding: Insufficient financial resources allocated to the program may limit its scope,
coverage, and effectiveness in delivering essential healthcare services.

ii. Weak Health Systems: Poor infrastructure, inadequate human resources, and weak health
information systems can hinder the implementation and sustainability of the program.

iii. Limited Community Engagement: Lack of community involvement and participation in program
planning, implementation, and monitoring may result in low utilization of services and poor health
outcomes.

iv. Quality of Care: Poor quality of healthcare services, including inadequate training of healthcare
providers, lack of essential medicines and supplies, and substandard facilities, can undermine the
credibility and effectiveness of the program.

v. Political Instability: Political instability, changes in government priorities, and policy inconsistency may
disrupt program implementation and lead to discontinuity of services.

vi. Social and Cultural Factors: Socio-cultural beliefs, practices, and attitudes towards healthcare may
influence acceptance and utilization of services, affecting the success of the program.