ORGANIZATION AND FINANCING OF PRIMARY HEALTH CARE IN NIGERIA: PROBLEMS, ISSUES AND ALTERNATIVE APPROACHES

1.1 Introduction

Healthcare financing can be defined as the mobilization of funds for healthcare services (Oyefabi, Aliyu & Idris, 2014). In other words, it is the provision of money, funds or resources to the activities designed by government to maintain people’s health. These activities encompass the provision of medical and related services geared toward maintaining good health, especially in the aspect of disease prevention and curative treatment. The concept of health care financing succinctly deals with the quantity and quality of resources a country expends on health care. This is proportionate to the country’s total national income. The amount of resources earmarked for health care in a country is said to be a reflection of health value placement vis-à-vis other categories of goods and services (Metiboba, 2012).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

1.2 Background of Study

Health is one of the most important factors that determine the quality of human capital, a necessary factor for economic growth. In line with the above, a consensus of opinion have been formed among researchers recognizing health as a public good, the demand and supply of which cannot be left at the mercy of invisible hands or profit maximizing individual as well as on considerations of utility maximizing conduct alone . Hence, the need for the government to play a major role in delivering good and qualitative healthcare services that is accessible and affordable for the teeming population. The recognition of the importance of the above led the World Health Organisation (WHO) to propose at the 2010 World Health Assembly, issues that will address financing of health, which will ensure qualitative and affordable healthcare services (Ataguba and Akazili, 2010).

The pattern of health financing is therefore intricately connected and indivisibly linked to the provisioning of health services (Rao, Salvaraju, Nagpal & Sakthivel, 2009 & Riman & Akpan, 2012). The duo, Riman & Akpan argued that the definition of health care financing cannot be narrowly conceived and confined to raising enough resources to fund health care needs of people alone, but also entails the questions of affordability and equitable access to health care services by them, including guaranteed financial risk protection.

In consonance, Metiboba (2012) contended that when it comes to analyzing health care financing, it is fraught with some nuances since some types of health care services are skewed towards benefitting groups and the community collectively. Worth mentioning here are vaccination against certain communicable diseases, control of malaria and environmental sanitation. Other issues that make analysis of health care financing problematic are public expenditures on food, clothing, shelter and education. The mutually reinforcing trajectory of relationships that exist between the aforementioned survival needs also makes health care financing analysis a difficult one.

One of the intricate issues and nuances associated with the analysis of health care financing is the identification of health care expenditure given the demarcation between preventive and curative health care services. The proposed integration of traditional medicine practitioners into the mainstream formal health sector will further pose a challenge to the analysis of health care financing as argued by Metiboba (2012).

Despite this improvement in health spending, the country still lagged behind compared to other countries in the continent. Statistics have shown that the country’s public expenditure on health as a percentage of GDP is 4.1 percent against 4.6 percent African average and over 6.3 percent in developed countries. With these efforts, Nigeria overall health status or sector performance outcomes have not been so encouraging. According to Yaqub (2010), the country overall health performance was ranked 187th among the 191 member states by the World Health Organisation (WHO) in 2000.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Problems, Issues and Alternative Approaches of Organization and Financing of Primary Health Care.

1.3 Statement of Problems

Investigation revealed that in the last decade, Nigerian economy has metamorphosed from the level of million naira to billion naira and postulating to trillion naira on the expenditure side of the budget. This will not be surprising if the economy is experiencing surplus or equilibrium on the records of balance of payment. Better still, if there are infrastructures to improve health within the system or life expectancy so that there will be enough work force. All these are not there, yet we always have a very high estimated expenditure on health. This indicates that something is definitely wrong either with the way government expands budget or with the ways and manners it has always been allocated to each sector of the economy.

Unfortunately, the rising government expenditure on health has not translated to very good rate of life expectancy, as Nigeria ranks among the nation with poor life expectancy rate and high death rate as compared to the fiscal cash been pumped into the health sector. Across the country, there are several cases of poor state of hospitals, some general hospital are well below standard or lack the needed facilities at one point in time to carry out her duty, it dilapidated infrastructure has led to the short life expectancy among Nigerians (WHO, 2005). It is on this note that the main thrust of this study is to evaluate the Impact of Health Care Financing on Economic Growth in Nigeria.

1.4 Aim and Objectives of Study

The aim of the study is to scrutinize the Problems, Issues and Alternative Approaches of Organization and Financing of Primary Health Care in Nigeria. In achieving this aim, the following specific objectives were laid out as follows:

1. To investigate the factors affecting the financing of primary health care in Nigeria.
2. To determine whether the health services that are available are affordable to those that need health services.
3. To empirically investigate federal government health funding and its impact on economic growth in Nigeria.
4. To evaluate the long-run relationship between federal government health funding and economic growth in Nigeria.
5. To maintain and ensure adequate flow of funds for the smooth running of the scheme and the health sector in general.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Are there factors affecting the financing of primary health care in Nigeria?
• Is there any long-run relationship between federal government health funding and economic growth in Nigeria?
• Is there adequate flow of funds for the smooth running of the scheme and the health sector in general?
• What is the health services that are available are affordable to those that need health services?
• To what extent does federal government health funding impact on the economic growth in Nigeria?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: Federal government health funding does not have significant impact on economic growth in Nigeria.
• H1: Federal government health funding has significant impact on economic growth in Nigeria.

Hypothesis Two

• H0: There are no significant factors affecting the financing of primary health care in Nigeria
• H1: There are significant factors affecting the financing of primary health care in Nigeria

1.7 Significance of Study

This study is relevant in the following ways;

1. Scholars: Scholars will benefit from this study as it would provide a fore knowledge of happenings in the health sector in Nigeria and also serve as a basis for further research.
2. Government: Lastly, it would serve as a wakeup call to government so that efficiency and effectiveness will be ensured in the disbursement of funds to the health sector.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

1.8 Scope of Study

The scope of the research is focused on the assessment of the Problems, Issues and Alternative Approaches of Organization and Financing of Primary Health Care in Nigeria.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Definition of Terms

Health Care Financing: Healthcare financing can be defined as the mobilization of funds for healthcare services (Oyefabi, Aliyu & Idris, 2014). In other words, it is the provision of money, funds or resources to the activities designed by government to maintain people’s health.