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This is the complete lecture note for COM513 Public Health Administration and Management, National Health Policy, Healthcare Financing and Health System. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: COM 513 Course title: Public Health Administration and Management, National Health Policy, Healthcare Financing and Health System Course credit load: 2 Units Series 1: History and Organisation of the Nigerian Health System • Part 1.1: Early History of Health Services Administration in Nigeria o Sub Part 1.1.1: Pre-colonial and colonial era health services o Sub Part 1.1.2: Health services administration at independence o Sub Part 1.1.3: Post-independence developments in health services administration • Part 1.2: Evolution of Health Services Administration in Nigeria o Sub Part 1.2.1: The primary health care era o Sub Part 1.2.2: Decentralisation of health services administration o Sub Part 1.2.3: Contemporary health services administration in Nigeria • Part 1.3: The Nigerian Health System o Sub Part 1.3.1: Components of the Nigerian health system o Sub Part 1.3.2: The three tiers of government in health service delivery o Sub Part 1.3.3: Public and private sector roles in the health system • Part 1.4: Organisation of Health Services in Nigeria o Sub Part 1.4.1: Organisation of health services at federal level o Sub Part 1.4.2: Organisation of health services at state level o Sub Part 1.4.3: Organisation of health services at local government level Introduction Every patient who walks into a Nigerian health facility today, whether a small rural health post or a large teaching hospital, is stepping into a system whose current structure reflects more than a century of historical development, from missionary dispensaries through colonial administration, to today's complex, multi-tiered federal health system. Picture a health planner tasked with
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS understanding why responsibility for a single patient's care might be shared across a local government health centre, a state hospital, and a federal teaching hospital, all within the same health system. Understanding how this system developed historically, and how it is organised today, is the essential foundation for everything that follows in this course. The aim of this Series is to equip you with a clear understanding of the history of health services administration in Nigeria and the organisation of the Nigerian health system and its health services. This Series begins with the early history of health services administration in Nigeria, before turning to its evolution over subsequent decades. Next, we examine the Nigerian health system, before concluding with the organisation of health services across its three tiers of government. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: describe the early history of health services administration in Nigeria, from the pre-colonial era to independence • SLO 1.2: describe post-independence developments in health services administration • SLO 1.3: describe the primary health care era and decentralisation of health services administration in Nigeria • SLO 1.4: describe contemporary health services administration in Nigeria • SLO 1.5: describe the components of the Nigerian health system • SLO 1.6: describe the roles of the three tiers of government and the public and private sectors in health service delivery • SLO 1.7: describe the organisation of health services at federal and state level, and • SLO 1.8: describe the organisation of health services at local government level. 1.1 Early History of Health Services Administration in Nigeria 1.1.1 pre-colonial and colonial era health services From traditional healing to early colonial medical services Before the establishment of formal colonial administration, health care within the territories that now constitute Nigeria was provided principally through traditional medicine, practised by
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS local healers using indigenous knowledge of herbal remedies and traditional healing practices passed down through generations within specific communities. The colonial era introduced Western-style medical services, initially concentrated around missionary dispensaries and hospitals, and, subsequently, colonial government medical services established principally to serve colonial administrators, military personnel, and workers within colonial commercial enterprises, meaning early formal health services were neither comprehensive nor equitably distributed across the general population. Fill in the blank: The colonial era introduced Western-style medical services, initially concentrated around ________ dispensaries and hospitals. 1.1.2 health services administration at independence At independence in 1960, Nigeria inherited a health system characterised by significant urban-rural disparity, with formal health facilities concentrated in major towns and cities, and considerably limited health service coverage across the country's extensive rural areas, reflecting the uneven pattern of colonial-era health service development. The newly independent Nigerian government inherited responsibility for expanding health service coverage nationally, a substantial undertaking given the limited existing infrastructure and workforce, and immediate post-independence health policy generally focused on gradually extending formal hospital-based services to a wider population, a strategy later reconsidered as discussed in the next Part of this Series. Fill in the blank: At independence in 1960, Nigeria inherited a health system characterised by significant urban-rural ________. 1.1.3 post-independence developments in health services administration Following independence, Nigeria's health services administration underwent successive reorganisation, including administrative changes accompanying the creation of additional states, discussed further in relation to the current federal structure later in this Series, each new state generally establishing its own ministry of health and associated health administration structures. Health services administration during this period was additionally shaped by successive National Development Plans, setting out broader national priorities within which health sector investment and administration were situated, reflecting health's position as one component within Nigeria's wider post-independence national development agenda.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Fill in the blank: Health services administration following independence was shaped by successive National Development ________. Figure 1.1: A missionary-era medical dispensary building with a nurse attending patients outside. Pilot questions 1.1 1. Describe how health care was provided before formal colonial administration was established. (Linked to SLO 1.1) 2. Describe the early colonial era health services and whom they principally served. (Linked to SLO 1.1) 3. Describe the health system Nigeria inherited at independence in 1960. (Linked to SLO 1.1) 4. Explain why early post-independence health policy focused on expanding hospital-based services. (Linked to SLO 1.1) 5. Describe how the creation of additional states affected health services administration after independence. (Linked to SLO 1.2)
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.2 Evolution of Health Services Administration in Nigeria 1.2.1 the primary health care era A shift from hospitals toward community-based care Following the 1978 Alma-Ata Declaration, which established primary health care as the recommended global strategy for achieving health for all, Nigeria formally adopted primary health care as its national health strategy, marking a deliberate shift away from the earlier hospital-centred approach discussed in the previous Part of this Series. This shift emphasised expanding basic, accessible health services, including immunisation, maternal and child health services, and health education, closer to where people actually lived, particularly in underserved rural communities, reflecting a deliberate strategic prioritisation of broad population coverage over concentrated, specialist hospital care alone. Fill in the blank: Following the 1978 Alma-Ata Declaration, Nigeria formally adopted primary health care as its national health ________. 1.2.2 decentralisation of health services administration A central feature of Nigeria's adoption of primary health care was the decentralisation of health services administration, transferring principal responsibility for primary health care delivery to local government areas, discussed in an earlier related course, reflecting a belief that health services could be more effectively and responsively managed closer to the communities they served. This decentralisation established the essential administrative foundation for the current three-tier system of health service responsibility, discussed further later in this Series, with local government generally responsible for primary health care, state government generally responsible for secondary health care, and federal government generally responsible for tertiary health care and overall national health policy. Fill in the blank: Decentralisation transferred principal responsibility for primary health care delivery to local government ________. 1.2.3 contemporary health services administration in nigeria Contemporary health services administration in Nigeria continues to operate within this broad three-tier framework, though ongoing reform efforts continue to address persistent challenges,
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS including inconsistent coordination between tiers of government and variable quality and coverage of primary health care services across different states and local government areas. Recent decades have additionally seen growing attention to formal health system strengthening initiatives, improved health information systems, discussed in relation to disease surveillance in an earlier related course, and enactment of the National Health Act, discussed further in a later Series of this course, each representing continued evolution of Nigeria's health services administration. Fill in the blank: Recent decades have seen growing attention to formal health system strengthening initiatives and improved health information ________. Table 1.2: Comparing the hospital-centred and primary health care eras of Nigerian health administration. Feature Hospital-centred era Primary health care era Main focus Concentrated hospital-based services Broad, accessible community-based care Geographic emphasis Urban centres Underserved rural communities Administrative responsibility Centralised Decentralised to local
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