Improving Primary Health Care Delivery in Nigeria: Evidence from Four States

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World Bank Publications, Apr 28, 2010 - Business & Economics - 120 pages
This paper, based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity, aims at understanding the performance of primary health care providers in four states in Nigeria. As possible ways to improve performance, the paper concludes that clearly defining lines of responsibility, implementing performance-based financing of local governments and providers, and collecting, analyzing, and sharing information are some options that can help realign incentives and improve accountability in the service delivery chain and service provision. 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.
 

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Contents

3 Status of Primary Health Care Services
11
Table 31 Health Facility Type by LGA Type
12
Table 32 Basic Information from All States in
13
Table 33 Primary Health Care Facilities Infrastructure and Amenities across States in
14
Table 34 Percentage of Facilities Offering Basic Services across States
15
Table 36 Percentage of Facilities Having Basic Pharmaceuticals and Vaccines in Stock across States
17
Table 37 Average Staffing of PHC Facilities across States and Across Type of Ownership
18
Table 38 Average Staffing of Public Health Facilities across Facility Type
19
Table 310 Average Staff in Basic Health Centers across Type of LGA
20
Table 311 Percentage of Facilities Offering Exemption and Waivers across States
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Table 313 Percentage of Facilities Offering Basic Services across Type of Facility and across Type of LGAs
22
Table 314 Percentage of Facilities with Basic Equipment across Type of Facility and Type of LGA
23
Table 316 Basic Information on PHC Facilities across Public and Private Ownership in
25
Table 317 Percentage of Facilities with Basic Equipment across Public and Private Ownership
26
Figure 32 Percentage of Facilities Having Basic Pharmaceuticals and Vaccines on Stock across Public and Private Ownership
27
Table 318 Availability of Basic Health Services in Nearest Facility across States in
28
Table 320 Household Satisfaction with Nearest PHC Facility across Facility Ownership and across Type of LGA in
29
Table 322 Percentage of Households near a PHC Facility Visited by Facility Health Personnel across States Type of Ownership and Type of LGA
30
Table 323 Reason for Health Facility Worker Visit across States in
31
Table 325 Household Utilization of Nearest Health Facility across Type of LGA in
32
4 Division of Responsibilities among Government Levels
33
Figure 41 Government Agencies with Responsibilities in PHC in Cross River
35
Table 41 Level of Government or Agency that Provided the Health Facility Building in
37
Table 42 Main Agency Responsibility for the Maintenance of Equipment and Buildings across States
38
Table 43 Main Supplier of Medical Consumables Drugs and Equipment to PHC Facilities across States
40
5 ClientsPolicy Makers
43
Table 51 Changes in the Actual Distribution of Federation Account Revenues across Three Government Levels in
44
Table 58 Real Growth Rate of Cross Rivers LG Expenditures in 200506 in
54
The Bangalore Experience
57
Table 59 Cross River Local Governments Expenditure 2005
59
Table 510 Kaduna Local Government Expenditure 2005
60
6 Policy MakersProviders
61
Table 62 Health Care Personnel Sampled by Gender across States
62
Table 63 Characteristics of PHC Personnel across States and across Type of Facility Ownership
63
Table 65 Highest Level of Education Completed by PHC Staff Interviewed State Comparison
64
Table 66 Average Salary of PHC Personnel across Type of Facility Ownership
65
Table 68 Salaries and Fringe Benefits State Comparison in
66
Table 69 Average Salary of Public PHC Personnel across Type of LGA
67
Table 610 Criteria for Promotion of Staff in
68
Table 612 Obstacles in Doing Job across Rural and Urban Areas in
69
Table 614 Percentage of Personnel Who Are Fulltime Employees and Supplement Their Salary
70
Table 615 Activities to Supplement Salaries of Health Staff across States in
71
7 ClientsProviders
74
Table 71 Percentage of Health Facilities with a Functioning Health ManagementDevelopment Committee and Gender of Committee Members across ...
75
Table 72 Frequency of Meetings of Health Committees across States
76
Table 74 Final Decision on Health Facility Managerial Issues in
77
Example of Facility Health Committee Role in Improving the Condition of PHC Facilities
78
Box 72 Experience with Vouchers for Health Services
79
References
81
Appendixes
85
Table B1 Employment and Occupation of Household Survey Respondents
88
Table B2 Housing Characteristics of Household Survey Respondents
89
Table B3 Household Survey Respondents Proximity to Nearest Health Facility
90
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Founded in 1944, the World Bank Group is one of the world's largest sources of development assistance. The Bank is now working in more than 100 developing economies, bringing a mix of finance and ideas to improve living standards and eliminate the worst forms of poverty. For each of its clients, the
Bank works with government agencies, nongovernmental organizations, and the private sector to formulate assistance strategies. Its country offices worldwide deliver the Bank's program in countries, liaise with government and civil society, and work to increase understanding of development issues.

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