Health Sector Reform in Nigeria: Organisational and Management Perspective

Abstract

Nigeria's health care system is in dire need of reform and this is well acknowledged. What are not so widely agreed upon are the modalities, content, and the pace of the necessary reform process. Health indicators such as Infant Mortality Rate (IMR) and Maternal Mortality Rates (MMR) are among the highest worldwide. Nigeria's health system ranked 187th out of 191 Member States of WHO in overall performance assessment conducted in 2000. Health sector reform is a sustained process of fundamental change in national health policy and institutional arrangements to improve health outcomes. This study reviews the health system in Nigeria with particular focus on the roles and responsibilities of the three tiers of government, human resource development, and coalitions in the health sector, as priority areas needing reforms in Nigeria. It looks at reform process including content and challenges in Nigeria and some African countries. The research methodology is based on library literature on the subject, as well as interviews with purposively selected candidates with experience in health care systems in Nigeria and health sector reform in other countries. The findings of the study include the fundamental flaw in the Constitution of Nigeria (1979, 1989 and 1999), which does not include health in the Concurrent Legislative List (Second Schedule part II). Also, Nigeria has no National Health Act and no comprehensive policy on human resources for health. The reform process in Nigeria is Federal Ministry of Health-based, and lacks a coalition of stakeholders to drive the process. The study therefore, called for a review and harmonisation of the numerous health policies in the health sector, into a revised National Health Policy. There should be a National Health Act to support this Policy. Changes in the organisational structure of the Federal Ministry of Health and some of its parastatals are also suggested. The study, however, notes that health sector reform is difficult to design, hard to "sell" to decision makers, and harder still to implement. This is a challenge the health sector must face in the coming years.