Spatial Aspects of Health Care Provision in Nigeria
S. I. OKAFOR
This chapter examines the existing levels and patterns of health care provision in Nigeria and then discusses the strategy which the government has adopted in order to minimise spatial imbalances in the country's health care delivery system. Many factors influence health care delivery systems and resultant spatial patterns in nation-states. They include the degree of centralised control of provision and the policies on health care provision. 1 The first factor affects the responsiveness of health care delivery systems to local needs. It is held that local control ensures that health care provision meets local needs. At the same time it could cause disparities in the quantity and quality of provision between different areas. This is largely because different areas have different tax bases, 2 and therefore variations in the internal revenues of different areas are often reflected in variations in the quantity and quality of health care services. Centralised control, on the other hand, can enhance equality of opportunity because funds and other resources are centrally disbursed and are not necessarily tied to local tax bases, but to level of need. However, where resources are insensitively allocated, centralised control results in a health care delivery system that is not very sensitive to local needs.
The second factor, policies on health care provision, often reflects a nation's economic and political ideology. In some capitalist countries such as the United States, state participation in health care provision is minimal. In such settings, the operation of the private market becomes the primary determinant of the patterns of provision. In the United States, for instance, affluent areas and neighbourhoods are very well served, whereas areas and neighbourhoods inhabited by racial minorities and the poor are often underprovided and deprived. In