Health care services in Nigeria are organised at three levels: Federal, state and local levels.
3.2.1
Organisation at the Federal Level
The official “organs” of the health system at the federal level consists of the Federal Ministry of Health and the National Council of Health. We shall examine the organisation and function of each of them.
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The Federal Ministry of Health is headed by a minister and it has departments. They are:
• Department of Human Resources/Personnel Management
• Department of Finance and Supplies
• Department of Planning, Research and Statistics
• Department of Hospital Services
• Department of Primary Health Care and Disease Control
The following are the responsibilities of the Federal Ministry of Health.
1. Review of the National Health Policy and its adoption by the Federal Government
2. Devising a broad strategy for giving effect to the National Health Policy through the implementation by the federal, state and local governments in accordance with constitutional provisions.
3. Submission of a broad financial plan to the Federal Government for approval to give effect to the Federal component of the health strategy.
4. Formulation of a national health legislation as required, for the consideration of the Federal Government.
5. Acting as coordinating authority on all health work in the country with a view to ensuring prompt implementation.
6. Undertaking related epidemiological surveillance and report.
7. Promotion of an informed public opinion on matters of health.
8. Provision of support for state and local governments in developing strategies and plans of action.
9. Allocation of Federal resources in order to foster selected activities to be undertaken by state and local governments
10. Issuance of guidelines and principles to assist states prepare, manage, monitor and evaluate their strategies and related technical programmes, services and institutions.
11. Defining standards with respect to the delivery of health care, monitoring and ensuring compliance with them by all concerned.
12. Promotion of research that is relevant to the implementation of the National Health Policy and state health strategies.
13. Promotion of cooperation among scientific and professional groups as well as non-governmental organisations in order to attain the goals of this Policy.
14. Monitoring and evaluating the implementation of this Policy on behalf of the Federal Government.
International Health
The Federal Ministry of Health shall set up an effective mechanism for the coordination of external cooperation in health and for monitoring the performance of the various activities. Within the overall foreign policy objectives, this international health policy shall be directed towards:
• Ensuring technical cooperation on health with other nations of the region and the world at large.
• Ensuring the sharing of relevant information on health for the improvement of international health.
• Ensuring cooperation in international control of narcotic and psychotropic substances.
• Collaborating with United Nations Agencies, African Union, West African Health Community and other international agencies on bilateral and/or regional and global health care improvement strategies, without sacrificing the initiatives of national, community and existing institutional and other infrastructural arrangements.
• Working closely with other developing countries, especially the neighboring states within the region which have similar health problems, in the spirit of technical cooperation among developing countries, especially with regard to the exchange of technical and epidemiological information.
• Sharing of training and research facilities and the coordination of major intervention programmes for the control of communicable diseases.
The National Council on Health
The National Council on Health is composed of the following members:
1. The Honorable Minister of Health
2. The Honorable Commissioner s of Health (states) 3. The Technical Committee and
4. The Expert Panels
The following are the functions of the National Council on Health:
The National Council on Health shall advise the Government of the Federation with respect to:
• The development of national guidelines
• The implementation and administration of the National Health Policy
• Various technical matters on the organisation, delivery and distribution of health services.
The Technical Committee
The Technical Committee shall be composed of:
The Federal and State Permanent Secretaries of Health The Directors of the Federal Ministry of Health
The Professional Heads in the State Ministries of Health Representative of the Armed Forces Medical Services
Director of Health Services, Federal Capital Territory, Abuja
Function of the Committee
Advise the Council on health matters.
The Expert Panels
The Technical committee shall set up as required, appropriate programme expert panels including the representatives of health related ministries namely: Agriculture, Rural Development and Water Resources, Education, Science and Technology, Labour, Social Development, Youth and Sports, Works and Housing, National Planning and Finance.
Health related bodies
1. National Institute of Medical Research 2. Medical schools
3. Schools of allied health professionals
4. Professional health associations, e.g. The Nigerian Medical Association, The National Association of Nigerian Nurses and Midwives, The Pharmaceutical Society of Nigeria, among others
Non governmental organisations (NGOs)
3.2.2 Organisation at the State Level
Today in Nigeria, there are 36 states and the Federal Capital Territory, Abuja with many types of health administration. In most of the states, the management sector for health lies with the Ministry of Health while in very few it is the Health Management Board.
The State Ministry of Health
Organisation: The State Ministry of Health is headed by an Honorable Commissioner, while in the Health Management Board there is a governing board with an Executive Secretary. The Commissioner is the political head of the Ministry while the Permanent Secretary is the administrative/accounting officer. There are Directors managing the affairs of each Directorate and they are assisted by Deputy and Assistant Directors.
Functions: The State Ministries of Health direct and coordinate health work within the state via:
• Ensuring political commitment
• Ensuring economic support
• Winning over professional groups
• Establishing a managerial process
• Public information and education
• Financial and material resource provision
• Intersectoral action
• Coordination within the health sector
• Organising primary health care in communities
• Logistic system
• Health manpower recruitment and retraining
• Priority health programmes
• Health technology
SELF ASSESSMENT EXERCISE 2
Draw an organogram of the health structure in your state stating their specific functions.
3.2.3 Organisation at the Local Government Level
There are 774 Local Government Areas in Nigeria with various health facilities operating on the hinges of primary health care.
The Local Government headquarters coordinate the activities of the health facilities providing manpower, funds, logistics and control. The LGAs are headed by elected Chairmen during the political era with council members. The Supervisory Councillors are also appointed to oversee various aspects of the local governments’ activities including health and social services. The Health Department is always headed by a Primary Health Care Coordinator.
Functions of the Local Government
• Provision and maintenance of essential elements of primary health care: environmental sanitation, health education, etc.
• Designing and implementing strategies to discharge the responsibilities assigned to them, under the Constitution and to meet the health needs of the local community under the general guidance, support and technical supervision of state ministries.
• Motivation of the community to elicit the support of formal and informal leaders.
• Devising local strategy for health activities.
Examine this illustration which provides an overview of health care delivery system at the three levels of health care i.e. primary, secondary and tertiary levels. As you know a full range of primary health care (first level contact of the individual, family and community health system) is being rendered through the agency of primary health centers
Secondly, health care is being provided through the establishment of cottage and general hospitals where all basic specialty services are being made available.
Tertiary care is being provided at teaching and specialist hospitals where super specialty services including sophisticated diagnosis specialised therapeutic and rehabilitative services are available.