Health Care Patterns and Planning in Developing Countries

By Rais Akhtar | Go to book overview

each BHU also offer the services of the HCs. That there are twenty HCs does not mean that there are only twenty outlets for the kind of services provided by HCs. The hierarchical nature of health care facilities implies that such services are also available in the higher order centres. If the situation were otherwise, then some lower order health care services would not be available in and around higher order service centres.


CONCLUSIONS

Health care provision in Nigeria is characterised by two main problems: the problems of limited resources and inadequate spatial organisation of facilities. The first problem relates to acute shortages of physical facilities, equipment and personnel, while the second relates to the spatial pattern of available facilities. The problem of spatial organisation manifests itself in different forms including interstate variations in the levels of provision and urban--rural disparities. In addition, there is the problem of a poorly developed primary care sector which is an aspect of medical deprivation in rural areas. These problems have dictated the strategies adopted by the government for their solution. The BHSS is the cornerstone of government policy in this regard. With its emphasis on primary health care, the scheme represents a two-pronged attack on Nigeria's health care delivery problems. By focusing on lower order health care facilities, many more such facilities can be provided from limited funds than higher order facilities. Indeed, it is an attempt to rectify the bias toward hospital development from which urban centres have benefitted disproportionately. This will go some distance in reducing the problems of limited health care resources and urban-rural disparities in the provision. The BHSS, which is essentially a hierarchical spatial system, is capable of addressing the problem of spatial organisation. However, the equality of treatment of the LGAs implicit in the scheme is likely to create problems of equity in the spatial distribution of health care resources in the country. The need for health care varies in space, and therefore the organisation of provision should reflect this variability. The quantity of health care resources in each BHU (or LGA) should reflect the level of need in each BHU. The BHUs do not need to contain exactly the same number of PHCS, HCs and MHCS. Their numbers should vary according to the population size of the BHUs or some other index of need. Finally, the Nigerian experience highlights the need for a review of the administrative arrangements for health care provision in the country. Centralised control, or lack of it, has made no difference to the spatial patterns of provision. What is needed is some policy of positive discrimination in favor of disadvantaged areas.


NOTES
1.
A. L. Joseph, and D. R. Phillips, Accessibility and Utilization: Geographical Perspectives on Health Care Delivery, Harper and Row, London, 1984.

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