CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Health care services are one of the cardinal services any government must provide for its citizenry. In both the developed and developing countries, a large proportion of the nation’s wealth is channeled to health. For instance, the world health reports (2005) gave Nigerian government expenditure on health as a percentage of her gross domestic products (GDP) for the year 2001 to be 5.3 percent, year 2002 to be 5.0 percent and year 2003 to be 4.7. This is to buttress the fact that the Nigerian government health care service expenditure are very significant in relation the the gross domestic product. But surprisingly our health care delivery have been next to zero, this as many say have led to medical tourism.

No organization functions well without adequate funding and our hospitals aren’t left out. Every public hospital which receives funds against approved annual work plans shallmaintain separate bank accounts and separate books of accounts in respect of funds received for its programs. The mission of every public hospital in Nigeria is to servethe health care needs of people in its communities 24 hours a day, seven days a week. Thetask of its medical staff is to care and to cure. The extent to which a hospitalachieves this objective depends to a greater extent on the application of basic hospitalfinancial rules, guidelines and accounting policies.

Public teaching hospitals in Nigeria are medical centers that provide clinical education and training to future and current health professionals. Teaching hospitals are often affiliated with medical schools and work closely with medical students throughout their period of matriculation, and especially during their clerkship (internship) years.

Adequate redistribution of funds in public hospitals is mostly handled by the government and this goes through a lot of procedures and processes.

In ensuring effective allocation of funds across departments for the smooth running of hospitals, the budget for each department mush have to be reviewed to ensure equity and transparency in the allocation of recourses. This budget examination would also help in monitoring these funds when they are eventually deployed.

In many countries, the Ministry of Health pays directly for some resources used in public hospitals (e.g stationery, vehicle maintenance, salaries). However, sometimes, the ministry cannot determine the specific spending levels by hospital. In this case, one will need to estimate the allocated amounts in line items oneself, preferably, in consultation with officials at the hospital and the ministry.

STATEMENT OF THE PROBLEM

The inadequate allocation of funds across departments of government or public hospitals has led to a whole lot of problems with our public health sector. Cases of fraud and over expenditure in our public hospitals has been a cause for concern, the general poor performance of public hospitals has led to medical tourism which has resulted in our country loosing substantial amount of money that would have improved our economy. Equally, cases of under-funding of our hospitals have been common especially in our government/public hospitals.

OBJECTIVES OF THE STUDY

The following are the objectives of this study;

1. To identify expenditure heads in public teaching hospitals in Nigeria.
2. To examine whether funds are adequately distributed across expenditure heads in Nigerian public teaching hospitals.
3. To place emphasis on the importance of adequate allocation of funds across the different expenditure heads in Nigerian public teaching hospitals.
4. To evaluate the use to which funds are appropriated for in the Nigerian public teaching hospitals.

RESEARCH QUESTIONS

1. What are the expenditure heads in public teaching hospitals in Nigeria?
2. Are funds adequately distributed across expenditure heads in Nigerian public teaching hospitals?
3. How important is adequate allocation of funds across the different expenditure heads in Nigerian public teaching hospitals?
4. Are funds distributed used for the purpose to which they are allocated in Nigerian public teaching hospital?

RESEARCH HYPOTHESIS

1. Funds are not adequately distributed across expenditure heads in Nigerian public teaching hospitals.
2. Funds are effectively distributed across expenditure heads in Nigerian public teaching hospitals.

SIGNIFICANCE OF THE STUDY

This study contributes to knowledge and could serve as a bench mark or guide for other work or study. It avails public teaching hospitals with information about proper allocation of funds to the expenditure heads in public hospitals to enhance performance thereby reducing medical tourism.

SCOPE OF THE STUDY

The study is on allocation of funds across expenditure heads in Nigerian public teaching hospitals using the Lagos university teaching hospitals (LUTH) as a case study.

LIMITATIONS OF THE STUDY

The study was limited by a number of factors but the most prominent are;

Financial constraint: Insufficient fund tends to militate against the efficiency of the researcher in sourcing for the relevant materials for the study, literature or information and in the process of data collection or generation (internet, questionnaire and interview).

Time constraint:  The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

BACKGROUND OF THE LAGOS UNIVERISTY TEACHING HOSPITAL

Lagos University Teaching Hospital (LUTH) is a hospital in Idi-Araba, Surulere, Lagos State. The hospital was established in 1962 and is affiliated with the University of Lagos, College of Medicine.

LUTH employs thousands of workers and they range from the highly specialized consultant doctors to cleaners, and all work in unity to ensure that the patient has a memorable experience during their treatment and rehabilitation in the hospital. But Alas! The experience, while always memorable, isn’t always savory and thus to the common man, the hospital is a recipient of mixed reviews. Some believe that LUTH is the pinnacle of Nigerian medical science and thus is Nigeria’s last beacon of hope to the ailing and to the deathly ill. Well, that belief isn’t entirely unfounded as LUTH currently boasts, by a wide margin, of the highest amount of specialist doctors in any Nigerian hospital and thus patients are guaranteed knowledgeable professionals in their search for resolution of specific illnesses. Others believe LUTH to be the devil’s own receptacle, hence the saying; “You only go to LUTH for treatment when you are ready to die”. To the average observer of the Accident and Emergency department of LUTH, which is often the main point of entry into the hospital, there appears to be an awful amount of death going on as every other half-hour, you see a corpse getting wheeled out and all you see is either the bustle of the relatives of those hanging on to life by a thread or the sorrow of relatives who have just lost a loved one. The truth about any hospital is that not all the patients that come in are going to leave alive and what every hospital does is to maximize the chances of survival of their patient.

At LUTH, there’s the caste system of seniority with each level being firmly under the next; Consultant, Senior Registrar, Junior Registrar, House Officer, Medical Student. Doctors go on rounds (in groups) everyday, checking up on each patient that has been placed in care of their units but due to the sheer amount of patients remitted to each unit, these doctors are unable to spend more than just a few minutes at each patient’s bedside. All they check for are the basics; stability of the patient, improvements or new devolvement and then they make their comments in case notes. The Consultant Ward rounds are worse as most Consultants are more interested in discussing the patients and ‘tackling’ the knowledge of the junior doctors, as opposed to actually checking up on the patient. So what a Consultant round often yields is just a confirmation of the observation of resident doctors and nothing more. At night, there often are doctors from each unit ‘on call’ in each ward but in reality, only a House Officer is present and this persons sole job is to disturb his superior only when the patient’s case has gotten out of hand and often at death.

Luth is the largest Teaching Hospital in Nigeria with 761 beds and with the College of Medicine of the University of Lagos in the training of hundreds of Medical, Dental, Pharmacy and other Science Students.  The hospital has produced thousands of Nurses, Laboratory Technologists, Health Records Officers and Para-Medical Cadres.

DEFINITION OF TERMS

TEACHING HOSPITAL:A teaching hospital is a hospital or medical center that provides clinical education and training to future and current health professionals. Teaching hospitals are often affiliated with medical schools and work closely with medical students throughout their period of matriculation, and especially during their clerkship (internship) years.

FUND ALLOCATION:Sum of money set aside and earmarked for a specified purpose

ALLOCATION: The action or process of allocating or sharing out something.

EXPENDITURE: Payment of cash equivalent for good or services or a charge against available funds in settlement of an obligation as evidenced by an invoice, receipt, voucher or other such document.