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Effects Of Public Sector Reform On Health Service Delivery
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A great deal of attention in development research and policy circles has
recently focused on the efficacy of public expenditures in providing
basic services to poor people, and on how actually making services work
for the poor is constrained by weak incentives of public agents (World
Development Report 2004, Fosu and Ryan, 2004). In this context,
decentralization to locally elected governments has been explored as a
means of strengthening incentives of public providers for improved
service delivery (Bardhan, 2002). How accountable are locally elected
governments for the delivery of local public services? Hence, this
research will investigate the Effects of Public Sector Reform on Health
Service Delivery in Lagos State, with a special reference to the elderly
in Ojo LGA.
1.2 Statement of Problem
It is important to note
that, the health sector in any economy forms the backbone of its growth
and development. Factors affecting the overall Nigerian health system
performance include: inadequate health facilities and structures, poor
management of human resources, poor motivation and remuneration,
inequitable and unsustainable health care financing, skewed economic and
political relations, corruption, illiteracy, decreased government
spending on health, high user fees, absence of integrated system for
disease prevention, surveillance and treatment, inadequate access to
health care, shortage of essential drugs and supplies and inadequate
health care providers.
Bilateral and multilateral assistance, and
government spending on health (26.40 billion Naira or 26% of total
annual budget for 2004) have not translated into enhanced health status
of average Nigerians. Policy reversals and other inconsistencies over
the years tend to undermine some health reforms of the past. Strategies
developed for the effective implementation of national health programs
in the three tiers of government (federal, state, and local government)
are poorly implemented due to the politics of federalism (autonomy and
resource control). High disease burden and population explosion have
culminated in a vicious cycle of poverty, insecurity and uncertainty.
While some contend that there are perverse incentives at the local level
to misallocate public resources, others maintain that the problem is
lack of adequate resource transfers to local governments to finance
their expenditure responsibilities (Ekpo and Ndebbio, 1998; The World
Bank, 2002).
The federal budget in recent years has included programs
of facility construction in local governments. However, there are no
established rules or policies for the provision of financial assistance
from the higher tiers of government, and it is not clear how well any
assistance that is forthcoming is coordinated with LGA budgets and plans
for primary health services. Therefore, this study will intensively
consider the Effects of Public Sector Reform on Health Service Delivery
in Lagos State, with reference to the elderly in Ojo LGA.
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