The Nigerian National health

policy and structure

BY
Dr. EJIKEM PATRICIA
COMMUNITY MEDICINE
RHEMA UNIVERSITY
 Introduction
Health policy is a decision and legal regulations made by the
government at the national and international scale
determining who and how to provide health services.
It deals with the organization, financing and delivery of
health care services to the citizens .
It is Defined by the world health organization as the
decision, plans, and actions that are undertaken to achieve
specific health care goals within a society.
 Nigerian national health policy
The Nigerian National Health Policy represents the collective will of
the governments and the people to provide a comprehensive health
care system.
 It describes the goals, structure, strategy and policy direction of the
health care delivery system in Nigeria.
 It also defines the roles and responsibilities of the three tiers of
government without neglecting the non-governmental actors.
Its long-term goal is to provide the entire population with adequate
access not only to primary health care but also to secondary and
tertiary services through a well-functioning referral system.
 Nigeria national health policy historic
perspective
 National Health Act 2014.
The first legislative framework for the health system was the National Health Act
2014.
 The country has several sub-sectoral policies and plans;
The Reproductive Health Policy.
 the National Human Resources for Health (HRH)Policy and Plan.
 The National Health Promotion Policy.
 The Health Financing Policy, and the National Strategic Plan of Action for Nutrition,
amongst others.
There is an existing framework for the oversight of program implementation,
starting with the National
The National Health Policy 2016;
Established solid and evidence-based mechanisms and directions for Nigeria to
significantly improve the health status of its citizens to enable them lead fully healthy
and fulfilling lives.
 The policy is geared towards ensuring that Nigeria successfully implements current
national and global priorities such as the Sustainable Development Goals, Universal
Health Coverage, Vision 20.2020.
 It will also provide an operational platform for the National Health Act 2014.
The policy was developed with the active participation of diverse health system actors
and People from both the public and private sectors.
 The policy directions were guided by evidence generated from the situational analysis
of the health sector in Nigeria.
• The National Health Policy 2019;
• The revised national health policy 2019 contribute to achieving
Nigeria's national health policy commitments.
• To deliver health care that is preventive, promotive, protective,
restorative and rehabilitative to every citizen of the country.
WHY HEALTH POLICY?
Poor Health coverage.
It is estimated that no more than 35 % of the population has access to
modern health care services .
 Rural Communities and the urban poor are not well served.
The orientation of the services is inappropriate with a disproportionately high
investment on curative services to the detriment of preventive services .
The management of the services often shows major weaknesses resulting in
waste and inefficiency which leads to failure to meet targets and goals.
 Provision of fragmented health care services different levels of governments,
voluntary organizations and other agencies.
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Poor community involvement at critical points in the decision making
process, they are unformed on matters affecting their health resulting being
unable to make rational choices .
Lack of basic health statistics which is a major constraint at all stages of
planning, monitoring and evaluation of health services.
Inadequate financial resources allocated to the health services, especially. to
some priority areas in other to function effectively.
The basic infrastructure and logistic supports are often defective owing to
inadequate maintenance of buildings medical equipment and vehicles.
Unreliable supply of water and electricity; and the poor management of
drugs, vaccines and supplies system.
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The goal of the national health policy shall be to establish a comprehensive
health care system based on primary health care.
Health care that is promotive, protective, preventive, restorative and
rehabilitative to every citizen of the country within the available resources.
To ensure that individuals and communities are assured of productivity,
social well-being and enjoyment of living.
 The mobilizing target. Is to guaranteed minimum health care package for all
Nigerians.
 The governments of the Federation shall provide a level of health care for all
citizens to enable them to achieve socially and economically productive lives.
COMPONENTS OF NATIONAL HEALTH
POLICY
The National Health policy includes.
 The political, economic, social, and cultural determinants of health.
 The lifestyle determinants, which have been the most visible types of public
interventions.
 The socializing and empowering determinants, which link the first and second
components of a national health policy.
A clear- cut indicators to be used for each component and for each intervention.
The feasibility of this approach depends to a large extent on the political will of
the national authorities and the broad understanding of the actual determinants
of health.
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The health system shall:
Reflect the economic conditions, socio-cultural and political characteristics of the communities.
It shall apply the relevant results of social, biomedical, health system research and public health
experience in making the policy
The policy shall address the main problems in the communities, providing promotive, preventive,
curative and rehabilitative services accordingly.
The policy , in addition to the health sector, shall involve the coordinated efforts of all other sectors.
Eg. agriculture, animal husbandry, food industry, education, housing, transportation, public works,
communications, water supply and sanitation.
Promote maximum community and individual self-reliance and participation in the planning,
organization, operation and control of primary health care.
Making full use of resources of Local, State and Federal Governments as well as other available
resources.
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 Governments of the Federation shall devise appropriate mechanisms
for involving the communities in the planning and implementation of
services on matters affecting their health. eg WDC, Accredited groups,
armed forces and associations.
STRUCTURE OF THE NIGERIAN
HEALTH SYSTEM
National Health Care System shall be developed at three levels:
Primary Health Care level.
 Primary Health Care shall be the entry point of the health care
system.
It shall provide general health services of preventive, curative,
promotive and rehabilitative services to the population.
 The provision of care at this level is largely the responsibility of Local
Governments with the support of State Ministries of Health and
within the overall national health policy.
Secondary Health Care level
The Secondary health care level shall provide specialized services to patients referred
from the primary health care level.
Functions through out-patient and in-patient services of hospitals for general medical,
surgical, pediatrics, obstetrics and gynecology patients and community health services.
It shall also serve as administrative headquarters supervising health care activities of
the peripheral units.
 Secondary health care shall be available at the division and zonal levels as defined by
the authorities of the State.
 Adequate specialized supportive services such as laboratory, diagnostic, blood bank,
rehabilitation, and physiotherapy shall be provided.
Tertiary Health Care level.
Tertiary health care, which consists of highly specialized services, shall be
provided by teaching hospitals and other special hospitals which provide care for
specific disease conditions or specific group of patients.
 Care should be taken to ensure that these are evenly distributed geographically.
 Appropriate supporting services shall be incorporated into the development of
these tertiary facilities to provide effective referral services.
 Selected centers shall be encouraged to develop special expertise in the
advanced modern technology thereby serving as a resource for evaluating and
adapting these new developments in the context of local needs and
opportunities.
National Health System Management

 The national health policy comprising of the goals, priorities, main directions
towards priority goals.
 these goals and priorities are suited to the social needs and economic conditions in
the different States and form part of national, social and economic development
policies.
The national health system management involves;
 Programming - the translation of these policies through various stages of planning at
the local, state and national levels into strategies to achieve clearly stated objectives.
 Programmed budgeting - the allocation of health resources by Governments of the
Federation for the implementation of these strategies;
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Plan of Action - describing strategies to be followed and the main
lines of action to be taken in the health and other sectors to
implement these strategies.
 Detailed programming - the conversion of strategies and plans of
action into detailed programs.
Detailed programming will specify objectives and targets and the
technology, manpower, infrastructure, financial resources, and time
required for their implementation through the health system;
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Implementation; the translation of detailed programs into action so
that they come into operation as integral parts of the health system.
 Implementations is the day-to-day management of programs and
the services and institutions for delivering them.
It also involves the continuing follow-up of activities to ensure that
they are proceeding as planned and scheduled;
Evaluation - of health development strategies and operational
programs in order to progressively improve the effectiveness and
efficiency of their implementation;
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Reprogramming; This is done with a view to improving the master
plan of action or some of its components.
Preparing new ones as part of a continuous managerial process for
national health development.
 Relevant health information - to support all these components at all
stages to ensure regular and wide dissemination of needed
information.
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Resources for health development are important as an indispensable
component for an effective and efficient health care delivery.
The appropriate and targeted applications of these resources,
(material and non-material) is very important.
They are required in the right mix (quality and quantity), at the right
places and in time in other to achieve the goals and objectives of the
National Health Policy.
National Health Manpower Development

Planning human resources for health shall include:

 Revitalizing and providing appropriate and quality human resources
for health care delivery at all levels
 Ensuring equitable distribution of human resources for health care
delivery between urban and rural and hard-to- reach areas
Promoting collaboration among human resources for health care
delivery at all levels.
 Ensuring adequate staff at all levels in line with health sector
development plans.
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Institutions for the training of traditional health practitioners are accredited
by a regulatory board.
The regulatory board, from time to time, reviews curricula for training of
traditional health practitioners and provides appropriate guideline towards
their integration into the mainstream of Health care system
Traditional health practitioners are to be retrained and certificated in order
to increase their skills and effectiveness in line with the regulatory
guidelines.
 Traditional health practitioners are instructed on how to make effective use
of the referral system of orthodox medical care. Monitoring and Evaluation
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Monitoring and evaluation.
These are fundamental activities aimed at ensuring the satisfactory
performance of the health care delivery system.
 The Human Resources for Health Development unit at all levels shall
be strengthened to perform their statutory functions.
The policy shall ensure that the Human Resources for Health
Development unit at federal, state and local government authorities,
in collaboration with other agencies, monitor and evaluate all health
care institutions within their area of jurisdiction annually.
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To ensure their compliance with human resources for health
development norms and sanctions imposed where appropriate.
 Monitoring and evaluation reports contribute significantly to
personnel training, placement and reward at all level