Every material on this site is authentic and was extracted from the complete available project.Click to GET IT NOW
MS-WORD DOC || CHAPTERS: 1-5 || PAGES: 87 || PRICE: ₦3000
THE ROLE OF LOCAL GOVERNMENT IN PRIMARY HEALTH CARE SERVICES IN IBONO IBOM
1.1 BACKGROUND OF THE STUDY
The concept of Primary Health Care (PHC) was formulated by 134 Countries at a meeting in Alma Ata on 12th September 1978 to offset the idea of “Health for All by the year 2000’’; as initiated by Dr Halfdam Mahler a former Director-General of World Health Organization (WHO) in search for improved health globally. The conference was organized under the auspices of the world Health Organization (WHO) and the United Nations Children fund (UNICEF) with the aim that PHC shall provide general health services of preventive, promotive, curative and rehabilitative nature to the population – as the entre point of the health care system. The Alma Ata Declaration stressed health as a fundamental human right and stated that health care must be accessible, affordable and socially relevant to meet the needs of the people.
The conference also identified PHC as the strategy for achieving health for all by the year 2000 with the following components: health education, nutrition and food supply, water and sanitation, immunization, maternal and child health including family planning, control of endemic diseases, treatment of common ailments and essential drug supply. However, countries were free to add to the list based on their individual experiences, and Nigeria added two more components namely - mental health and oral health. And the PHC strategy was based on five principles as follows: universal coverage, community participation, use of appropriate technology, intersectoral collaboration for health and focus on prevention.
Meanwhile, PHC forms an integral part of the Nigerian social and economic development; and is the first level contact of the individual and the community in the national health system. Thus, bringing health care as close as possible to where people live and work and contributes the first element of a continuing health care process (Akinsola,1993). And in the 1999 constitution of the federal republic of Nigeria, health is on the concurrent legislative list; by implication the three tiers of government are vested with the responsibilities of promoting health.
According to the constitution, the federal, state and local governments shall support in a co-ordinate manner, a three - tier system of health care viz:
Primary health care-for local government administration, secondary health care -for state government administration, tertiary health care-for federal government management.
It therefore implies that the provision of PHC is largely the responsibilities of local governments with the support from federal and state ministries of health / international agencies and within the pivot of national health policy. However, these functions and responsibilities of local government relevant to health services as contained in the Fourth schedule of the 1999 constitution of the Federal republic of Nigeria section 7 (1) C specified
- The establishment and maintenance of cemeteries, burial ground and homes for the destitute or infirm
- Establishment, maintenance and regulation of slaughter houses, slaughter slabs, markets, motor parks and public convenience;
Provision and maintenance of public convenience, sewage and refuse disposal
- Registration of all births, deaths
- Control and registration of movement and keeping of pets of all description, restaurants, bakeries and other places of sale of food to the public.
The above functions are supposed to be the sole responsibilities of local governments’ primary health care. But currently, the role of local government as provider of PHC services leaves a lot to be desired especially in Ibiono Ibom L.G.A. This is borne on the fact that the operation of PHC services in Akwa Ibom State and Ibiono Ibom local government in particular has not been very successful as planned due to mode of service organization, availability of drugs, attitude of staff to patients / clients, traditional beliefs / taboos, terrain and topography of the Local Government Area, paucity of health staff and facilities as well as socio-political challenges.
Moreover, this division of roles and responsibilities between the three tiers of Government particularly between states and local governments is complex and not always clear, undermining the accountability relationships between citizens, policy makers and providers
This therefore calls for synergy between stakeholders at the local government level (health professionals, council administrators, philanthropists etc.) as well as clearly defined lines of responsibilities amongst the three tiers of government plus donor agencies interested in PHC Services.
This is based on the fact that the level of sophistication at PHC level depends on the socio – economic development of the people.
And PHC seeks to address the common health problems of the people within a specific community example Ibiono Ibom Local Government Area. Health facilities at the PHC level include dispensaries, clinics, Health centres and comprehension health centre and (currently known as primary health care base in some Local Government Areas).
1.2 STATEMENT OF THE PROBLEM
The Local Government Authority is the custodian of Primary Health Care (P.H.C) and is responsible for the provision and maintenance of services within its area of jurisdiction. Thus, legally the 774 local government councils in Nigeria have assumed full scale responsibility for planning and setting objective for P.H.C services. In Akwa Ibom State the actual implementation of P.H.C programme started in 1987 during the regime of president Ibrahim Babangida under the ministerial leadership of Prof. Olikoye Ransome-kuti. During this period, necessary strategies were put in place and all the local government areas of each state was actively involved with the Federal State and voluntary agencies supplying equipment, funds, manpower and material resources needed for effective implementation of P.H.C programmes.
Currently, the role of the state government as provider of P.H.C services is limited. The state government is now responsible for interpreting the federal government policies on Health Policies. Since the shift of P.H.C role to the local government councils the level of funding for Health is obviously un satisfactory in some councils within the state. For instance, in Ibiono Ibom Local government area there is still wide gap between what could be regarded as optimum P.H.C and the actual services rendered to the people. For although the local government council is running her P.H.C services in accordance with the principles and framework of the National Health Policy, there exist some problems ranging from lack of infrastructural facilities, scarcity and uneven distribution of resources, finance, political instability, manpower (insufficient medical personnel) as well as socio – economic and environmental challenges
Moreover, the level of community participation / involvement in PHC management is low in Ibiono Ibom L.G.A. as in other LGA’S in Nigeria, despite the fact that it is the cornerstone of PHC programme. In addition, liaison between the PHC development committees i.e. village development communities and the local government area PHE management is not thorough as planned. Also, the irregular accessibility to many communities in Ibiono Ibom local government area due to natural topographical conditions like excessive flooding during rainy seasons, hilly and mountainous terrain of the landscape as well as strange trado-cultural beliefs have impeded smooth implementation of PHC programmes in some hard-to- reach communities. Moreover, there is Lack of timely training and retraining of health staff, low motivation, supervision and evaluation of PHC programmes and paucity of health data collection by field service delivery personnel; these are cogs in the wheel of PHC implementation in the study area. Thus, the challenges facing the Local Government in PHC implementation are legion and inexhaustible. In the light of the above, the researcher is motivated to undertake a study on the role of local government in primary health care services in Ibiono Ibom local government area, Akwa Ibom state