LOCAL GOVERNMENT AND HEALTH CARE DELIVERY: A STUDY OF IKENNE LOCAL GOVERNMENT AREA (2015-2020)
This research seeks to highlights the recent activities of Local Government in health care delivery. The study reveals the connection between local government and the sustenance of primary health care in Nigeria. The study traced the historical antecedent of health service delivery from the colonial era to the present day. It identifies the major contradictions in the management of primary health care implementation. Using a local government as a case study. They include employment or shortage of qualified personal, finance, inadequate transportation, inaccessibility to communities, lack of maintenance culture, political instability, high degree of leadership turn-over. For the sustainability of health care service delivery at the grassroots, the study recommends increase financial allocation, community mobilization, improved health education, policy consistency and provision of qualified health workers. The major focus of the project is the examination of the local government primary health care delivery in Nigeria that shall be adequately examined. At the end of the project, there should be summary to finding as to how the primary health care delivery has succeeded in improving the health at the grass root, their shall be conclusion and summary.
1.1 Background to the Study
Local governments are potentially effective instrument for rural transformation and delivery of social services i.e. health care delivery. This is because of local governments proximity to the people and the relative ease with which they can communicate with the local jurisdiction. The constitution guarantees the existence of system of democratically elected local councils and each State must enact legislation to establish same and provide for their structure.
The project topic health care delivery in the local government is worth research considering the position of local government in any democratic society. This position seems to be particularly true of the democratic situation in Nigeria especially since it has been argued that the worst democratic system of government is better than the most benevolent military system of government.
Democracy is thus a form of governments in which the highest premium is placed on the participation of the individual in government. Local government system within the three tiers of government brings governance to the citizen at the grass roots. This is mutates in agreement with the doctrine of federalism, which is enshrined in the Nigeria constitution.
Thus, in this project I shall consider local government as an organ of third tier of government within the Nigeria federal structure outside the central government that are concern with administrative function in the grass root. This is to bring out clearly the essential features of local governments as competent institution in the discharge functions constitutionally assigned in their own right.
Health care delivery is a very essential function which the Local Government is expected to give the people at the grass root and which delivery ought to be adequate, efficient and consistent. The Local Government is very suitable for this function considering its proximity in its closeness to the people. The project work hope to contribute to the existing literature as the topic by exploring the developments in the most recent times of the government desire to tackle the menace of variety of sickness prevalent in our society.
The study of health care delivery in the Local Government therefore is based on the constitutional involvement of basic necessities to the populace particularly with regard to health.
1.2 Statement of the Problem
Over 20years after the introduction and implementation of the primary health care system in Nigeria, the country is yet to witness the much desired impact of promoting and protecting health, preventing diseases and reducing mortality, morbidity, and disabilities associated with illness (Christandolus, 2012).There is a high prevalence of preventable and curable diseases in rural Nigeria despite the fact that the Nigerian government has adopted the primary health model as a strategy for providing efficient, cost effective and quality health care service as close to the community as possible. In 2014, demographers reported the life expectancy at birth of 53.66years for females and 51.63years for males. The infant mortality and maternal mortality rates according to the UN-inter-agency group for child mortality estimation are; 82% in 2010, 79% in 2011, 77% in 2012, 74% in 2013, 72.97% per 1000 live births in a given year which is one of the highest in the world (Health Survey, (2014). Nigeria has the 10th highest maternal mortality rate ratio (MMR) in the world according to UN estimates with 630 women dying per 100,000 birth, a higher proportion than in Afghanistan and Haiti, and only slightly lower than in Liberia or Sudan (Obasi,2013). An estimated 40,000 women die each year and another 1million to 1.6 million suffer from serious disabilities from pregnancy and birth related causes annually (WHO, UNICEF and World Bank, 2012).
The delivery of health care services in rural areas has continued to be a major problem as evidenced by high level of morbidity and mortality rates. Over 65% of Nigerian people who live in rural areas are most neglected and deprived of modern health care services as well as other infrastructural necessities that are essential to maintenance and promotion of good health (Omotosho, 2010).
According to the Ogun state strategic health development plan 2010-2015 (2010), although the specific health indices of the state were not readily available, it is unacceptably high as were the health indices of the rest of the country. The health of the state is characterized by inequitable distribution of resources, decaying infrastructure, poor management of human resources for health, weak referral systems, poor coverage with high impact cost-effective interventions, lack of effective integration and poor supportive supervision. Despite decentralization and integration of the health system and considerable investment in the health sector over the years, available evidence suggests that health services throughout the state are delivered through a weak health system. Consequently, it is unable to provide basic cost-effective services for the prevention and management of common health problems especially at the LGA and ward levels of which Ikenne local government is one of them.
1.3 Aims and objectives
This project work intends to dwell into the assessment of Local Government as a legal entity in the democratic government of Nigeria, this is with the view to determine the extent and limit to which it is duty bound to provides proper health care delivery to the citizen within its constitutional limitation.
Thus the specific aims of the project include:
- To examine Local Government as an aims of government in Nigeria commencing with:
- To highlight the constitutionally vested duties, responsibilities, and obligations of Local Government administration.
- To highlight the structural arrangement of Local Government including its revenue generation and means. This is important considering the enormous fund required to executive health care delivery to the populace.
- To examine and highlight Local Government powers and duties in the provision of primary health care delivery in Nigeria, and the legal basis.
- To highlight by way of conclusion, the summary of all discourse provide some suggestions to further improve the Local Government’s ability in providing health care delivery to local people.
1.4 The scope of study
Proper Local Government administration in the Nigeria political society is very important in the achievement of good governance, sustenance of democracy and equal distribution of democratic dividend to Nigerians.
It is instructive to emphasis the fact without scintilla of doubt Local Government is closer to the people at the grass root and their participation in democratic governance cannot be taken for granted. Thus, the project work is limited in scope to the examination at the health care delivery as one of the many responsibilities constitutionally vested on Local Government in Nigeria. The project will critically examine the several duties of Local Government from historical origin, legal basis, and most importantly the provision of health care to the people at the grass root.
The approach intended to be adopted in this project is to take into consideration primary and secondary sources. Reliance shall be placed on Textbooks, articles in journals and internet and law reports.
1.6 Literature review
It is instructive to note hat a lot of literatures abounds on the Local Government in Nigeria evolution, functions, and structure, the health care delivery within Local Government inclusive several of these write up shall be consulted in the case of writings the project.
Though no mention is made about, the health care function of Local Government. She concluded that for Local Governments to act as agents of development at the grass roots, their share of total public expenditure should be substantially increased.
Kunle Awotokun, examines Local Government in Nigeria and its reforms since 1976 as a bedrock socio economic and political development. This paper tried to expose the contradictions and how the 1999 constitution undermined peoples aspirations as well as the efficacy of grass roots governance.
Ola (1984) examines the historical evolution, functions and administration of Local Government in Nigeria. It gives an assessment of Local Government functions within the three tiers of governance in the Federal Republic of Nigeria.
Nwabueze B.O.8 Federalism in Nigeria under the Presidential Constitution look at the Nigeria Federal Structure including the Local Government within the constitution of Nigeria.
Alex Gboyega(1991), protecting Local Governments from Arbitrary State and federal interference. What prospects from the 1990? Is also very good piece of literature that examines the various developmental stages and reforms of Local Government in Nigeria. It examines the various interference in the autonomous existence of Local Government particularly during the military area.
Local Government and health care delivery receives considerable attention from both the Federal and State Government in order for Local Government to discharge their functions effectively. Considering the importance of health in our society, the examination of the delivery to the grass root by the Local Government is thus very important. This shall be thorough examined in the preceding chapters.