ABSTRACT

This research seeks to highlights the recent activities of Local Government in health care delivery. The study reveals the connection between local government and the sustenance of primary health care in Nigeria. The study traced the historical antecedent of health service delivery from the colonial era to the present day. It identifies the major contradictions in the management of primary health care implementation. Using a local government as a case study. They include employment or shortage of qualified personal, finance, inadequate transportation, inaccessibility to communities, lack of maintenance culture, political instability, high degree of leadership turn-over. For the sustainability of health care service delivery at the grassroots, the study recommends increase financial allocation, community mobilization, improved health education, policy consistency and provision of qualified health workers.

          This report presents findings from a survey of 252 primary health facilities and 30 local governments carried out in the States of Kogi and Lagos in Nigeria in the latter part of 2002. Nigeria is one of the few countries in the developing world to systematically  decentralize the delivery of basic health and education services to locally elected governments.

          ITS health policy has also been guided by the Bamako Initiative to encourage and sustain community participation in primary health care services. The survey data provide systematic evidence on how these institutions of decentralization are functioning at the level local governments and community based organizations – to deliver primary health service.

          The evidence shows that locally elected governments indeed do assume responsibility for services provided in primary health care facilities. However, the service delivery environments between the two States and strikingly different. In largely urban Lagos, public delivery by local governments is influenced by the availability of private facilities and proximity to referral centre in the State. In largely rural Kogi, primary health services are predominantly provided in public facilities but with extensive community participation in the maintenance of service delivery. The survey identified on issue which is highly relevant for decentralized policies – the non-payment of health staff salaries in Kogi which is suggestive of problems with local governments are heavily dependent on fiscal transfers from higher tiers of government.

          Traditionally, local government is the government established at the local level to carry out specific functions.

          It is more closer to the people thus often described as the “government at the grassroots level”. Local government as a concept with the three tier of governance as generally conceived as government at the local level exercising power through elected representative council establish by law to so exercise function jurisdictional allotted.  

          Thus, this project work present to examine local government as the closet arm of government with the realm of providing health care to the grass root. To achieve this object attempt there is need for proper foundation.

          Definition of local government with its project, the historical foundation of local government system in Nigeria and the status of local government vis-à-vis the basic constitutional provision shall be explored.

          The major focus of the project is the examination of the local government primary health care delivery in Nigeria that shall be adequately examined. At the end of the project, there should be summary to finding as to how the primary health care delivery has succeeded in improving the health at the grass root, their shall be conclusion and summary.