Health care in Nigeria is structured along, and administered through the universal three tiers: the primary level run by the local government, the secondary by the state and the tertiary by the federal government (FMOH 2005). The contribution of Nigeria’s health sector to the national economy remains poorly defined, and as a result Nigeria was ranked a dismal 187th position among the 191 United Nation member state (WHO 2000).Health care facilities are inadequate in Nigeria (Yohesor 2009) and this includes health centres, personnel and medical equipment. Moreso, the state of existing facilities is often deplorable due to lack of maintenance.
As Lee states:
‘A health care system is an organizational framework for the distribution or servicing of the health care needs of a given community. It is a fairly complex system of inter-related elements that contribute to the health of people-in their homes, educational institutions, in work places, the public (social or recreational) and the psychological environments as well as the directly health and health-related sectors.’ (Lee 2009: 1).
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However, with the many social and infrastructural problems confronting the country is the pursuit of the politically attractive tertiary health care which, arguably, has remained the only attractive area of the health system, to the detriment of other levels of care. The neglect of Nigeria’s health care, with special reference to the primary health care system, its maldistribution, will result in an inverted health care pyramid. By implication, rather than produce health for the people, would always have the threat to collapse on itself.
According to Asuzu (2003), Nigeria’s health care system has experienced past reforms, ranging from the traditional health care system that existed in the individual Nigerian communities and the ethnic groups before the era of colonization till date. Though Nigeria’s health care system is geared towards ensuring availability and accessibility of health care by Nigerians, yet the nation’s health care remains a major concern.
On the other hand, health care reform is the ‘process of improving the performance of existing systems of assuming efficient and equitable responses to future changes. It has also been defined as sustainable, purposeful change aimed at improving the health sector; health care reform is initiated by public or political action, is motivated by dissatisfaction caused by the failure to deliver outcomes and implemented on a sector wide level (Berman 1995). This presupposes that reforms might address the problems of poor quality of care, inefficiencies in the delivery of services, inequalities and limited access to health, level of accountability and insufficient responsiveness to client needs.
Globally, it would seem Non-governmental Organizations have undertaken a wide range of functions, including but not limited to, humanitarian assistance, developmental aid, and promotion of human rights and lobbying to protect the environment. In other words, the role of non-governmental (NGOs) might have been seen to expand. Capturing the essence of health NGOs, Gilson states: …..humanitarian assistance is ‘assistance given to meet the challenges of a humanitarian crisis, almost always includes provision of some type of healthcare, be it preventive action (such as providing shelter, clean water and sanitary facilities, immunization against epidemics) or management of emergencies (such as injuries from a disaster).’
Arguably, Nigeria is currently undergoing health sector reform aimed at achieving improved efficiencies in resource utilization, improved quality of health services as well as greater equity of access to health services. Jong-Chan (2002) asserts that given the strong influence they possess, NGOs remain the only sector that can empower the public to demand a stable national health program; NGOs should bring their experiences in health care reform to bear in order to strengthen their unique position in the health care system, independent of both governmental dominance and medical autonomy.
In the light of the above assertion, it would seem Non-governmental organizations (NGOs) have always been in the forefront of advancing novel ideas, and in encouraging and supporting governments to implement them. At a simple level, NGOs generally represent the ‘voice of the people’ at all levels- local, national and international, and have taken on roles such as advocacy, education and training (Ogunbekun, 2004:3), and have been active in monitoring and improving what has, or has not, been implemented or achieved. For example, NGOs have been in the front burner in promoting, developing and improving a comprehensive and holistic approach to health care services.
For change to happen, it would be necessary to collaborate with the relevant stakeholders in the health sector, whether they work in government, in administration, or as providers of the necessary services, to bring about needed change and improvement; also to ensure the people understand and support the changes which need to be made (Lorgen, 1998).
Moreso, health professional associations might be effective in working with health NGOs in improving health care delivery. Often, they seek the advice of health professionals regarding issues around health care, essentially because they know that medical ethics require physicians to provide objective advice on health issues, in the best interests of their patients (Pfeiffer 2003).
Health NGOs, together with health professionals, might also employ the skills and experiences that NGOs have garnered in putting information and messages across to the public in such a way that the public is able to understand and this will be necessary in improving health care.
The role or value of NGOs in advancing health is hinged on three premises, emerging from the research endeavour of George Washington University’s Centre for international Health:
Individual health and communities’ socio-economic development are intrinsically linked;
Well targeted health promotion activities can contribute not only to better health but can also enhance an individual’s social well-being ;
Local NGOs whose members are responsive to the communities they serve, are more likely to provide this linkage through fostering community empowerment.
Many NGOs are involved in training programmes which is a role they seem to have undertaken at all levels. Therefore, they are well-positioned to assist the relevant government departments in bringing about changes and improvement in health care system (Gilson 2003). It would follow that NGOs should be invited by governments to assist as partners in creation of awareness, mobilization and development of training programmes on health care reforms. Also, health NGOs seem to have the capacity to empower communities to act on their own behalf, equipping people to improve the ‘social and physical environments conducive for healthy lifestyles, and of health advocacy to enable policy makers to recognize and appreciate the necessity for improvements in health care conditions’ (Starfield 2011).
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Following the policy statement of World Health Organization’s 1978 Alma Ata Conference, also known as the Alma Ata Declaration, which proposed that ‘primary health care (PHC) be adopted for health planning and delivery, emphasizing on equity in health, disease prevention, and a comprehensive strategy to promote individual and community health’ (Rodriguez 2001), a health education strategy might suggest that within a socio-political context, health education aims to increase individual’s consciousness of his or her health status, and the causes and determinants of that status, thereby increasing the possibility for positive action.
As Asuzu (2003) points out … ‘NGOS act as catalyst by encouraging the various departments concerned with health to become actively involved in reform exercises…’ This would be effective if different NGOs work in synergy. For instance, in addition to health NGOs, there is involvement of other relevant NGOs such as women’s NGOs that concentrate on activities to improve the status of women and development NGOs whose centre of interest or activity is particularly on issues around development.
Health NGOs, arguably, are dependent on their mandate or project charter which is in tandem with the overall programmes of a health care system within which they operate. According to Ohanyido (2012), the roles of health NGOs are summarized below:
• work to ensure that the health services are efficient, effective, and accessible.
• work within the health system to ensure that the number of well-trained staff is available through capacity- building or advocacy to government etc.
• help ensure that the health information system is able to generate useful data on health determinants and health system performance, and also avoid creating parallel systems
• work with all stakeholders to ensure that there is access to medicines, vaccines, and medical technologies in an equitable fashion.
• strengthen health financing systems by exploring funding sources and advocating to stakeholders to raise adequate funds for health, and ensuring that people can access affordable services.
• strengthen the system by ensuring that the Leadership must guarantee effective oversight, regulation, and accountability.
Nonetheless, in order to work efficiently and effectively in improving health care system, health NGOs themselves must also be found to be accountable, transparent, and seem to be representing the interests of the people.
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