Improving Primary Health Care Delivery in Nigeria
122
pages
English
Documents
2010
YouScribe est heureux de vous offrir cette publication
122
pages
English
Documents
2010
YouScribe est heureux de vous offrir cette publication
This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharma-ceuticals, Governance and Service Delivery, and Infrastructure and ICT.
WORLD BANK WORKING PAPER
AFRICA HUMAN DEVELOP
Improving Primary Health
Care Delivery in Nigeria
Evidence from Four States
THE WORLD BANK
EMTN
NO. 187
ES
R
I
E
S
PW1_78w_be3_1--801p.WORLD BANK WORKING PAPER NO. 187
ImprovingPrimaryHealth
CareDeliveryinNigeria
EvidencefromFourStates
Africa Region Human Development Department
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ISBN:9780821383117
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ISSN:17265878DOI:10.1596/9780821383117
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PW1_78w_be3_1--801p.Contents
Foreword....................................................................................................................................
ix
Acknowledgments....................................................................................................................
x
AcronymsandAbbreviations................................................................................................
xi
ExecutiveSummary...............................................................................................................
xiii
PrimaryHealthCareDeliveryinFourStates..............................................................
xiii
UnderstandingthePerformanceofPrimaryHealthCareintheStates...................
xvii
DivisionofResponsibilityamongGovernmentLevels.............................................
xvii
Citizens/ClientsPolicyMakers....................................................................................
xviii
PolicyMakersProviders..................................................................................................
xx
ClientsProviders.............................................................................................................
xxi
PossibleWaysForward..................................................................................................
xxii
1.Introduction............................................................................................................................
1
Objectives.............................................................................................................................
2
ConceptualFramework......................................................................................................
3
Methodology.......................................................................................................................
5
2.Context....................................................................................................................................
7
HealthOutcomesandAccesstoHealthServicesinNigeria.........................................
7
ContextinStatesIncludedintheStudy...........................................................................
9
3.StatusofPrimaryHealthCareServices...........................................................................
11
OrganizationofthePrimaryHealthCareSystem........................................................
11
SurveyResults...................................................................................................................
12
InfrastructureandAmenities..........................................................................................
13
ServicesAvailable.............................................................................................................
14
EquipmentandMedicalSupplies...................................................................................
15
Pharmaceuticals................................................................................................................
16
HealthPersonnel...............................................................................................................
17
ExemptionandWaiverPrograms..................................................................................
20
EducationandPromotionActivitiesofPHCServices.................................................
30
ServiceCharges.................................................................................................................
31
4.DivisionofResponsibilitiesamongGovernmentLevels............................................
33
LawsandPoliciesInformingtheDivisionofResponsibilitiesfortheDeliveryof
PrimaryHealthCare.................................................................................................
33
DivisionofResponsibilitiesinPractice..........................................................................
34
PoliciesandGuidelines....................................................................................................
34
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PW1_78w_be3_1--801p.iv
Contents
PersonnelTraining............................................................................................................
36
HealthCarePersonnelManagement.............................................................................
36
Infrastructure:ConstructionandMaintenance.............................................................
37
ProcurementandDistributionofPharmaceuticalProducts.......................................
39
Supervision........................................................................................................................
41
PossibleWaysForward....................................................................................................
41
5.ClientsPolicyMakers........................................................................................................
43
LocalGovernmentRevenuesandResponsibilities......................................................
43
PublicFinancialManagement.........................................................................................
46
LocalGovernmentCivilService.....................................................................................
49
LocalGovernmentHealthExpenditure.........................................................................
50
LocalGovernmentAccountabilityforServiceDelivery..............................................
54
PossibleWaysForward....................................................................................................
55
6.PolicyMakersProviders....................................................................................................
61
CharacteristicsofHealthPersonnel...............................................................................
62
EducationLevel.................................................................................................................
63
IncentivestoProviders.....................................................................................................
64
MechanismstoRewardandDisciplinePHCPersonnel..............................................
67
OtherNegativeIncentivesFacedbyPHCPersonnel...................................................
68
HealthPersonnelCopingMechanisms..........................................................................
70
PossibleWaysForward....................................................................................................
71
7.ClientsProviders.................................................................................................................
74
Increa
