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ABSTRACT
AN APPRAISAL: LOCAL GOVERNMENT AND HEALTH CARE DELIVERY
ILORIN EAST LOCAL GOVERNMENT AS A CASE STUDY
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.
This report presents findings from a survey of 252 primary health facilities and 30 local governments carried out in the States of Kogi and Lagos in Nigeria in the latter part of 2002. Nigeria is one of the few countries in the developing world to systematically decentralize the delivery of basic health and education services to locally elected governments.
ITS health policy has also been guided by the Bamako Initiative to encourage and sustain community participation in primary health care services. The survey data provide systematic evidence on how these institutions of decentralization are functioning at the level local governments and community based organizations – to deliver primary health service.
The evidence shows that locally elected governments indeed do assume responsibility for services provided in primary health care facilities. However, the service delivery environments between the two States and strikingly different. In largely urban Lagos, public delivery by local governments is influenced by the availability of private facilities and proximity to referral centre in the State. In largely rural Kogi, primary health services are predominantly provided in public facilities but with extensive community participation in the maintenance of service delivery. The survey identified on issue which is highly relevant for decentralized policies – the non-payment of health staff salaries in Kogi which is suggestive of problems with local governments are heavily dependent on fiscal transfers from higher tiers of government.
Traditionally, local government is the government established at the local level to carry out specific functions.
It is more closer to the people thus often described as the “government at the grassroots level”. Local government as a concept with the three tier of governance as generally conceived as government at the local level exercising power through elected representative council establish by law to so exercise function jurisdictional allotted.
Thus, this project work present to examine local government as the closet arm of government with the realm of providing health care to the grass root. To achieve this object attempt there is need for proper foundation.
Definition of local government with its project, the historical foundation of local government system in Nigeria and the status of local government vis-à-vis the basic constitutional provision shall be explored.
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.
CHAPTER ONE
AN APPRAISAL: LOCAL GOVERNMENT AND HEALTH CARE DELIVERY
1.0 General Introduction
1.1 Introduction
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.1
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.2
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 mutadis in agreement with the doctrine of federalism, which is enshrined in the Nigeria constitution.
1See section of the Nigeria constitution 1999, Ebere D, The Federal Republic of Nigeria (International Association or centres for federal studies) pp. 1-2
2Oshilaya Owolabi S. et etal, Democracy and the Rule of law in Nigeria. The role of the Judiciary (F.H.L, Press 2008).
to the effect that, there exists three tier of government, the federal, states and local governments.3
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.
Chapter one of the project is devoted to the general introductions to the project topic “Local Government and Health Care delivery in Nigeria”.
Chapter two of the project examines the definitions of local government as well as the concept of health care within local government system is examined with reference to its constitutionally assigned functions part of which is the provision of primary health care to the people at the grass root.
Chapter three of the project examines the third tier of governance in Nigeria. The structure and function of local government will be examined in this chapter.
3The federal, the States, the executive section 5(1) and section 8(2) and section 7 for local government. The Nigeria constitution 1999 (the constitution shall simply refer to as the constitution). See Akanole J.O, Introduction to the constitution of Nigeria 1999 (MIJ publishers).
1.2 Background to the study
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.
1.3 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:
1. To examine Local Government as an aims of government in Nigeria commencing with:
(i) Highlighting some scholarly proffer definitions of Local Government.
4Provision of immunization of children against polio, manegitris, cough e.t.c.
(ii) The historical evolution of Local Government system as a legal entity in Nigeria.
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.
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