TQM Strategies and health care deliveries: lessons from Nigeria

• Author: Olawale Ibrahim Olateju/Raheem Olasupo Akewushola/Oludare Tolulope Adeyemi
• Position: Department of Business Administration and Management Technology Lagos State University, Lagos, Nigeria/Department of Business Administration and Management Technology Lagos State University, Lagos, Nigeria/Dimension Consult Limited, Lagos, Nigeria
• Pages: 132-141

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1. Introduction

The organization of health services in Nigeria is pluralistic and complex. It includes a wide range of providers in both the public and private sectors: private for profit providers, NGOs, community-based organizations, religious and traditional care providers. The National Health Policy (1998) is based on the national philosophy of social justice and equity. Primary Health Care (PHC) is the cornerstone of the health system. The policy provides for a health system with three levels: primary, secondary and tertiary. The policy also spells out the functions of each tier of government and provides for the establishment of the advisory National Council on Health chaired by the Federal Minister of Health (the

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Minister of State for Health and State Commissioners of Health are members). Other organs set up by the policy include the State Health Advisory Committees and Local Government Health Committees. Their potential has not yet been fully realized. As part of the health sector reform process, there is a need to review the functions of these organs in order to maximize their use. According to the National Health Policy, the federal government is responsible for policy formulation, strategic guidance, coordination, supervision, monitoring and evaluation at all levels. It also has operational responsibility for disease surveillance, essential drugs supply and vaccine management. In addition, it provides specialized health care services at tertiary health institutions (university teaching hospitals and federal medical centres). These serve as referral institutions for the secondary health facilities. At the lower level, the states and LGAs share responsibility for health care. States largely operate secondary health facilities (general hospitals and comprehensive health centres), providing mostly secondary care and serving as referral level for the LGAs which provide the essential elements of PHC. Operationally, the decentralized health structures of the federal government are in the states, while those of states are in the LGAs. Some states build and operate tertiary facilities or specialist hospitals. While the federal government is responsible for the management of teaching hospitals and medical schools for the training of doctors, the states are responsible for training nurses, midwives and community health extension workers (CHEWs). The LGAs provide basic health services and manage the PHC facilities which are normally the first contact with the health system. Some parastatals exist within the health system. The National Agency for Food and Drug Administration and Control (NAFDAC), National Primary Health Care Development Agency (NPHCDA), National Programme on Immunization (NPI), Nigerian Institute for Medical Research (NIMR) and National Action for Prevention and Control of AIDS (NAPCA) were created to deal with priority health issues. WHO (2007).

2. Statement of Problem

The Organization of Health service in Nigeria is Pluralistic and complex. It includes a wide range of providers in both the public and private sectors. Private for profit providers, NGOs, community based organization, religious and traditional care providers. The National Health Policy provides for a health system with tree levels: primary, secondary and tertiary. The policy also spells out the functions of each tier of government and provides for the establishment of the advisory National Council on Health (the Minister of State for Health chaired and State Commissioner of Health are members). Other organs set up by the policy include the State Health Advisory Committees and local Government Health Committees. Their potential has not yet been fully realized. Realizing the functions of these organs maximize their

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use. The problems identified by this work are listed below;

1. The various participants, the Government, public-private partnership (PPPs) that have been bestowed with the responsibility of providing health care delivery have no clear composition and documentation and therefore, there is need to understand their composition and direction in order to carry out effective evaluation of their activities. It is also necessary to established the extent to which the composition and direction is comparable.

2. The sectorial performance vis a vis find allocation and industry expectation in a TQM model cannot be ascertained.

3. The contribution of the various activities of the regulatory bodies and the parastatals on health care delivery cannot be ascertained.

4. The various participants in the health sector have not address the vital statistics, in health care delivery. This has led to improper planning and evaluation of health care delivery, vital statistics has not been well documented, consequently leading to improper planning and evaluation of health care delivery.

3. Limitation of Study

This study examines the TQM strategies and health care delivery in Nigeria. The study identifies manpower training, activities of the Regulatory bodies and parastatals bestowed with health care and the life expectancy of an average Nigerian. This study only considers the relationship between the budget estimate on capital expenditure and recurrent expenditure on the life expectancy of an average Nigeria because the life expectancy at birth depends on the activities of the various participant in the health sector.

Operationalization

The degree of health care delivery depends on the direction and composition of the private, public and international bodies bestowed with health care delivery, vital statistics record, activities of the regulatory bodies and parastatal and resources allocation. This illustrated as follows; HCD = f ( PPI C+D + VS + RP +RB + RE + µ) Where

HCD = Health Care Delivery

PPI C+D = Private Public and International...