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STATE GOVERNMENTS AND THE PROVISION OF HEALTH SERVICES IN NIGERIA

Nigeria is a federal country of 36 States – federating units, which have
considerable economic and political autonomy. It has been noted that on a year by
year basis, some of the States in Nigeria have resources well above the annual
budgets of many countries in the sub-Saharan Africa (SSA).  Yet, health indicators
of Nigeria although with some geographical variation are one of the worst in the
sub-region.

Whereas the 1979 Constitution placed Health on the concurrent list of
responsibilities with the exception of a few services made exclusive to the federal,
it also still assigned specific responsibilities to States and Local Government Areas
(LGAs). The 1999 Constitution however was virtually silent on this. Each level of
government is largely autonomous politically and in terms of financing and
managing health services under its responsibility. The Commissioner of Health is
only answerable to the State Governor who is the Chief executive Officer of the
State.

In principle, State governments are responsible for secondary hospital care and
supporting LGAs to provide primary health care - state planning, operational
support, coordination, monitoring and training. State hospitals are under-utilised
due to so many reasons that are systemic - weak referral mechanisms, the
unmotivated and under-qualified staff, the payments required of patients when
seeking care, the lack of functioning equipment, medical supplies and drugs. This is
due as much to the lack of management systems (e.g. preventive maintenance
systems for buildings and equipment, drug supply system) as to lack of resources.

However, despite all these problems many State governments are doing good
things but not doing them right; and they are also not doing the right things that
can re-vitalise their health systems. States behave in this manner due to a number
of reasons. They derive their powers from the constitution, giving them legitimacy
to exercise control over resources allocated to them – how to use them and in what
ever manner they deem fit. The Federal Ministry of Health (FMoH) has little or no
influence over health service delivery in the States because rather than providing
oversight the FMoH micro-manages the nation’s health system. The States also
have to respond to the needs and demands of their immediate environment. But
most profoundly, the States do no have the capacity to absorb the huge resources
allocated to them – to plan and implement health programmes for their people.

To reverse these negative trends and improve the health status of Nigerians, three
actions are suggested. Efforts should be concentrated at working at the State level
by engaging State governments. The role of FMoH should be redefined to become a
‘resource’ for the States rather than executing health programmes. Finally, a
‘change movement for better healthcare’ needs to be fired up, possibly through
‘political action’.

Meanwhile here is some good story from Nasarawa State: Innovative PHC Model
from Nasarawa State
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