Health Care System In Nigeria Research Articles

Physician-Suggested Innovative Methods for Health System Resilience amidst Workforce Emigration and Sociopolitical Unrest in Nigeria: A Survey-Based Study.

Physician emigration (the brain drain) and sociopolitical unrest significantly contribute to the instability of many low- and middle-income countries' healthcare systems. However, limited literature captures the locally driven and context specific suggestions to promote and sustain these health systems' resilience. Thus, the purpose of this study is to 1) understand the effects of physician emigration and sociopolitical unrest on Nigeria's healthcare system, and to 2) synthesize solutions suggested by Nigeria-trained physicians in the form of a resilience framework. An anonymous online survey was conducted among Nigeria-trained physicians. Respondents were recruited using convenience and snowball sampling methods via a WhatsApp group for Nigeria-trained doctors. Quantitative data were analyzed using Stata 17 and qualitative themes were coded by two independent researchers. The final sample included 49 Nigeria-trained physicians-35 physicians practicing in Nigeria and 14 emigrated physicians. All of the physicians currently practicing in Nigeria have considered emigrating, with 79% of them having concrete plans to emigrate in the next five years. Among emigrated physicians, factors such as remuneration (92%) and socioeconomic state of the country (92%) contributed to their decision to emigrate. Suggestions to enhance health system resilience fell into six broad themes: 1) policy and politics, 2) funding and resources, 3) organization and structure, 4) training and education, 5) research and primary health, and 6) health for peace initiatives. The healthcare system is currently unstable and vulnerable due to physician emigration and sociopolitical unrest. To develop and implement solutions to mitigate these issues, capturing the locally trained physicians' perspectives are critical. While each country's healthcare system is unique, countries with similar strains can adapt this model for resilience building. Future studies should focus on adapting the model in different countries with policy-level action points.

Appraisal of the Liability of Health Care Practitioners and Facilities for Medical Negligence in Nigeria: A Case Study of Plateau State, Nigeria.

The healthcare system in Nigeria has recorded unimaginable and unsatisfactory performance in quality health care delivery. There is need to promote the awareness of medical negligence due to the fact that at some point in life, one has fallen victim of medical negligence, but as a result of ignorance it was swept under the carpet. Medical negligence is not synonymous with doctors only but extends to nurses, laboratory scientists, laboratory technicians and other paramedics and the health care institutions in general. This research therefore, examined the level of awareness of the legal remedies for medical negligence against healthcare practitioners and facilities in Plateau State, Nigeria; the extent to which the residents of Plateau State are aware and willing to prosecute legal actions for medical negligence where committed by health care practitioners and also investigate the factors which hinder persons from enforcing their rights through legal means. The survey research method was employed. A sample size of 384 respondents was drawn from the population of study using the Wimmer and Dominick on-line sample size calculator using a confidence level of 95% and precision level of 5%. Findings showed that most of the sampled respondents are not aware of the remedies available to patients in the event of medical negligence caused by healthcare practitioners and facilities. The study therefore recommended among others that, the government and other agencies in the private sector should be proactive in educating the populace on their rights to quality health care services and the availability of legal redress for medical negligence.

Disparity in Catastrophic Healthcare Expenditures Across Households’ Income Groups in Nigeria: The Lens of Foster-Greer-Thorbecke Poverty Indices

The Nigeria health care system seems to have continue in the downturn trend as a result of the decay in public health care system and this have continued to drive the rising health care financed by out-of-pocket expenditure health hence, the study examined the disparity in Catastrophic Healthcare expenditures across Households income groups in Nigeria using the Nigeria Health and Demographic Survey 2018. The study employed the Foster-Greer-Thorbecke indices and the logit model. Findings from the study showed that some household and individual characteristics are associated with catastrophic health expenditure in Nigeria. Many households experience catastrophic health payments due to factors such as age, education of household head, health insurance status, geo- political zone, type of health facilities visited, and type of illness suffered. Governments are yet to find fair and innovative ways of financing the health system so as to reduce the financial burden of out-of-pocket payments on households and individuals in Nigeria. There is also urgent need for increased financial protection as well as insurance coverage through small credit and rural households’ contribution scheme as an alternative to the National Health Insurance Scheme to enhance health financing option that could reduce the huge private health cost of out-of-pocket expenditure. There is need for pressure on the legislature to provide a bill that disallow health care tourism for public office holders abroad as way of checkmating the better health care system in Nigeria. Keywords: Health care, Inequality, Income groups, private health cost, households DOI: 10.7176/JESD/13-20-03 Publication date: October 31 st 2022

English

Herbal medicine is an important age-long resource for healthcare. The aim of this study was to determine the development of herbal medicine in relation to compliance to regulatory guidelines and product development in pursuance of the integration of herbal medicine into the healthcare system in Nigeria. Using Imo State as a case study, a cross-sectional investigation was conducted among the Traditional Medicine Practitioners (TMPs) using questionnaires. One Hundred TMPs were administered with questionnaires to determine relevant demographic details, information relating to regulatory guidelines and the quality of finished products. Ninety-eight of the questionnaires were returned completed. Of these, 72% of the TMPs were male. The dominant age of the TMPs was between 25 to 65 years. Over 80% of the TMPs were literate having a minimum of secondary school education. About 86% of the TMPs are herbal medicine practitioners. All the TMPs claimed knowledge of the existence of National Agency for Food and Drug Administration and Control (NAFDAC) as the regulatory authority for herbal medicine. Only 5% had any contact with the agency in relation to product registration, while only 1% of the products owned by the TMPs had NAFDAC registration number. Also, 97% of the TMPs produced only extemporaneous products for their patients, and only 6% have any knowledge on the formulation of some conventional dosage forms. Of the 300 herbal medicines owned by the TMPs, only 8% were presented in conventional dosage forms with appropriate packaging. The few number of herbal medicines registered with NAFDAC reflects the low level of development of herbal medicine in Nigeria. This makes the products unsafe for integration into the healthcare system at the present stage. Key words: Traditional medicine practitioners, herbal medicine development, regulation.

The effect of health promotion on primary health care services: an analysis of primary health care policy

Health promotion is the best way to prevent mental illness and other illnesses in the community. However, the high rate of corruption and embezzlement of funds has impeded the effectiveness of health promotion in Primary health care system in Nigeria. More so, health promotion is the best way to alleviate diseases and prevent diseases. However, nearly all the health care workers are aware of the benefits of health promotion but to implement it is the problem. The aim: to examine the effect of health promotion on primary health care service through the analysis of Primary Health Care policy. Method: this study was guided by a pragmatic paradigm. The pragmatist paradigm is highly essential to this study because it emphasizes the link between action and truth. It is also ideal for this study as it advocates for mixed methods that are in line with ethnographic research approach to provide the best understanding of a research problem. Furthermore, pragmatic paradigm was adopted for this study and this paradigm encourages the study to combine two research methods (qualitative and quantitative) to achieve quality research findings. In this study a non-experimental, exploratory-descriptive design was used to analyse the quantitative aspect of the national health policies on primary health care service delivery in Nigeria. While ethnographic method analysed the qualitative aspect of the study perfectly. Result: out of three hundred respondents, majority of them revealed that bad leadership is the main reason why health promotion is not effective. While majority of the participants opined that we lack good leaders. The study hereby emphasized more on why the Government is not working on the effectiveness of health promotion in PHC and the findings showed that bad leadership is the main factor that is causing the ineffectiveness of health promotion in PHC and when the respondents were questioned on what to do to ensure a more effective health promotion in the community, majority (34.7 %) of the respondents opined that the community members should be involved actively at every stage while (33.3 %) of the respondents revealed that there is need for active involvement of other essential sectors in formulation and implementation of PHC policy to ensure a permanent change. Conclusion: all things considering, this study shows that poor health promotion in Primary health care is having negative effect on the health of children, adolescents, adults, and old ones. This study here by recommends that the policy makers and the government should eradicate corruption and embezzlement of funds in all sectors especially in primary health care

Diabetes/Dementia in Sub-Saharian Africa and Nigerian Women in the Eye of Storm.

In the next few years, the prevalence of diabetes mellitus (DM) is projected to dramatically increase globally, but most of the cases will occur in low-to-middle-income countries. Some of the major risk factors for diabetes accelerate the development of dementia in African-Americans, thus leading to a higher prevalence of dementia than Caucasians. Sub-Saharian Africa women have a disproportionately two-to-eight fold increased prevalence of dementia. In the eye of this storm, Nigeria holds the highest number of diabetics on the African continent, and its prevalence is rising in parallel to obesity, hypertension, and the population's aging. The socio-economic impact of the rising prevalence of DM and dementia will be huge and unsustainable for the healthcare system in Nigeria, as has been recognized in developed economies. Here, we analyze the current situation of women's health in Nigeria and explore future perspectives and directions. The complex interplay of factors involved in diabetes and dementia in Nigerian women include key biological agents (metabolic syndrome, vascular damage, inflammation, oxidative stress, insulin resistance), nutritional habits, lifestyle, and anemia, that worsen with comorbidities. In addition, restricted resources, lack of visibility, and poor management result in a painful chain that increases the risk and burden of disease in Nigerian women from youth to old ages. Heath policies to increase the ratio of mental health professionals per number of patients, mostly in rural areas, foment of proactive primary care centers, and interventions targeting adolescents and adult women and other specific mothers-children pairs are strongly required for a sustainable development goal.

People living with mental disorder in Nigeria amidst COVID-19: Challenges, implications, and recommendations.

COVID‐19 has become a global public health obstacle. This disease has caused negligence on mental health institutions, decreased trust in the healthcare system and traditional and religious beliefs, and has created a widespread stigma on people living with mental health illness, specifically in Nigeria. The increase of COVID‐19 cases that have exhausted the healthcare system in Nigeria have brought further negligence to people living with mental disorder, thus increasing the burden of the disease on these patients. Overall, this article considerably highlighted the need for equal accessibility to healthcare resources, as well as the requirement of proper attention and care for mental health patients in Nigeria. This article discusses the challenges that surfaced because of the COVID‐19 pandemic on people living with mental illness and their implications, as well as suggesting necessary actions and recommendations.

Nigeria's financing of health care during the COVID-19 pandemic: Challenges and recommendations.

An analysis of the financing of Nigeria's health‐care system in response to coronavirus disease 2019 (COVID‐19) pandemic was conducted. Nigeria projected that it would need US$330 million to control its COVID‐19 pandemic. However, it raised more than US$560.52 million, of which more than 90% came from the private sector and the donor/philanthropist community. The pooled COVID‐19 fund is mainly being expended on temporary public health and clinical care measures, with little invested to strengthen the health system beyond the pandemic. The poor turn‐around time for COVID‐19 test results and the stigma associated with the disease results in most persons with mild to moderate symptoms seeking care from alternatives to the health‐care institutions designated for COVID‐19 health care. The huge out‐of‐pocket expenses, and the inability of most Nigerians to earn money because of measures instituted to contain the pandemic, will likely cause many Nigerians to become economically impoverished by the COVID‐19 pandemic. COVID‐19‐related commodity procurement was least responsive to the needs of those most in need of care and support. The government needs to institute several fiscal policies. Immediate response to ease the financial impact of COVID‐19 require inclusion of COVID‐19 management in health insurance packages and an increase in domestic government health spending.

Establishing a Local Diagnostic Reference Level for Bone Scintigraphy in a Nigerian Tertiary Hospital

It is of vital importance to optimize the radiation dose to patients undergoing radionuclide bone scanning. This is one of the most common nuclear medicine procedures in many parts of the world, including Nigeria, and the current study was performed as part of a national survey to establish diagnostic reference levels (DRLs) for common nuclear medicine procedures in Nigeria in order to optimize their use. Nuclear medicine was only recently introduced to the health-care system in Nigeria, with only 2 centers presently conducting these procedures. Methods: A retrospective, cross-sectional study was performed in the nuclear medicine department of a tertiary hospital in southwest Nigeria to determine the preliminary local DRL for radionuclide bone scanning. One hundred and nine patients who met the study criteria were included. Data were obtained from June 2017 to March 2019 and were analyzed to obtain the third quartile of the distributed administered activity and achievable dose (anthropometric variables and radiation dose to bone surface). Results: The mean administered activity, achievable dose, and DRL were 833.98 ± 106.93, 832.5, and 895.4 MBq, respectively. The calculated preliminary local DRL was larger than values reported in studies done in Sudan, the United Kingdom, and Australia or by the International Commission on Radiological Protection. Conclusion: The preliminary DRL from this first-of-its-kind study in Nigeria was high because of practitioners' lack of experience. However, the values were still within the international best-practice range, which when optimized will go a long way toward reducing medical exposure without compromising image quality.

Therapeutic Plants Used for Typhoid Fever Treatment in Kaduna State Nigeria

For ages, medicinal plants play a significant role in the effective, affordable, and safe healthcare system. Medicinal plants continue to play an important role in Nigeria's healthcare system, which serves more than 70% of the country's population. For pharmaceutical exploration and conservation, it is important to document the use of medicinal plants in a specific region across time. The study's goal was to find out which plants were used to treat typhoid illness in Kaduna state. The in-depth interview guide was utilized in conjunction with an expert method and non-random probability sampling. The study discovered and recorded 31 plant species from 25 families that are used by Kaduna residents to cure typhoid diseases. Plants with a 0.45 value of relative frequency citation were documented. The highest relative frequency of citation (0.9) and fidelity level (90%) are found in Garcinia mangostana, Senna alata, Moringa oleifera, and Hibiscus sabdariffa, respectively. In Nigeria, traditional medicinal knowledge is guarded by elderly people. The study discovered plant species that could be used as a potential source of anti typhoid in Nigeria.

Neglect of common infectious disease outbreaks during the COVID-19 pandemic: an impending crisis in Nigeria?

Infectious diseases are major challenges of healthcare system in Nigeria. The coronavirus disease-19 (COVID19) pandemic has disrupted many systems including healthcare at all levels by creating disparities in the treatment, prevention, resource allocation and control of diseases in Nigeria. Premised on the foundation of circulating news and fact-checking platforms, this paper provides empirical evidence on varying perceptions on COVID-19 pandemic and apparent neglect of other infectious diseases while giving a critical analysis andcomparison between them.
 Keywords: COVID-19; infectious diseases; neglect; Nigeria 
 
 French title: Négliger les flambées de maladies infectieuses courantes pendantla pandémie COVID-19: une crise imminente au Nigeria?
 Les maladies infectieuses sont des défis majeurs du système de santé au Nigeria. La pandémie de coronavirus19 (COVID-19) a perturbé de nombreux systèmes, y compris les soins de santé à tous les niveaux, en créant des disparités dans le traitement, la prévention, l'allocation des ressources et le contrôle des maladies au Nigéria. Fondé sur la diffusion d'informations et de plates-formes de vérification des faits, cet article fournit des preuves empiriques sur les différentes perceptions de la pandémie de COVID-19 et la négligence apparente d'autres maladies infectieuses tout en fournissant une analyse critique et une comparaison entre elles.
 Mots clés: COVID-19; maladies infectieuses; négligence; Nigeria

COVID-19 and Depression from the Nigerian Perspective; A Mini Review

Context: The outbreak of the highly infectious COVID-19 has led to a global public health and economic crisis, especially in developing countries. Due to the global burden and spread and the high mortality rate of the virus, as well as an inadequate mental health care system in Nigeria, inhabitants often experience fear, depression, and anxiety that, if left unaddressed, may lead to long-term consequences. Although depression was a concerning issue in Nigeria before COVID-19, the pandemic has caused a surge in depression cases. This review highlighted the possible causes of depression among Nigerians during the COVID-19 pandemic and identified potential mitigating interventions to prevent depression. Evidence Acquisition: We searched PubMed for the articles published from January 2019 to September 2020 using the terms of “depression”, “COVID-19”, and “Nigeria”. The articles resulting from these searches and the relevant references cited in those articles were reviewed. Results: Nigerians are likely to fall into depression due to the challenges and limitations affecting the economy and development of Nigeria. Conclusions: During the COVID-19 struggle, providing sound mental health services for individuals is imperative to maintain nations’ mental health for a more rapid recovery across various measures of societal well-being post-COVID-19.

Delay in health-seeking behaviour: Implication to yellow fever outcome in the 2019 outbreak in Nigeria.

Yellow fever is a vaccine-preventable acute viral disease that can rapidly spread and cause serious public health impact. Delay in seeking health care from health facilities is a potential risk of prolonged disease spread. Therefore, this study assessed the delay in health-seeking behaviour and implications for yellow fever outcomes in the 2019 outbreak in Nigeria. Furthermore, the study examined the factors associated with delayed yellow fever vaccine uptake. A retrospective study was conducted from January to December 2019 using 137 cases recorded in the WHO database. The data were analysed using descriptive (frequency and percentages) and the Chi-square test. The results were significant at p<0.05. Results showed a low uptake of yellow fever vaccine (24.1%) among patients and a median total health-seeking delay of 7 [IQR 7, 9] days. The delay was more among the older age ≥40years (12 [IQR 12, 29]), females (8 [IQR 8, 11], and rural inhabitants 7 [IQR7, 9], particularly in Izzi LGA (9 [IQR 9, 16] than the other subgroups. Patients' location or place of residence was significantly associated with the yellow fever vaccine uptake (p<0.000*), and delay (p=0.003*). Conclusively, the low vaccine uptake was due to the delay in health-seeking behaviour. Thus, the healthcare system in Nigeria needs to intensify mass participation in immunisation programmes. Interventions that promote behavioural change towards immunisation are required. Also, health promotion campaigns to educate rural people on desirable health-seeking behaviour are needed.

The COVID-19 response in Nigeria: Adequate protection of a fragile healthcare delivery system

Background: The COVID-19 pandemic has impacted the healthcare system in Nigeria. The response of the government has been one that places the health and well-being of the people at its highest priority. This was evidenced by the instituted lockdown of the country soon after the first cases emerged. Specifific information on appropriate hygiene, safety, and security was provided through the Nigeria Centre for Disease Control (NCDC) and several health-based organizations. This provided a clear direction on what actions the citizens should take when they start to feel ill especially if they showed the classic symptoms of the disease. The purpose of this study is to review the impact of COVID-19 on the fragile healthcare system in Nigeria and proffffer recommendations. Methods:Areview of the COVID-19 response in Nigeria was hinged on highlighting the impact of the pandemic on the fragile healthcare system. Results: Recommendations and outlook were suggested to mitigate the impact of the pandemic on the fragile healthcare system in Nigeria. Conclusion: Reviewing and implementing new human resource policies in response to these changing circumstances and regulations is continually required. Continuous monitoring of the COVID-19 situation and understanding what guidance is being offered will be essential to the crisis management leadership team (task force) dedicated to leading the effort in Nigeria.

Covid-19 pandemic and The Nigerian primary healthcare system: The leadership question

Since the outbreak of the Covid-19 pandemic, the pathetic nature of the Nigeria healthcare system has become more glaring. In First World countries, the ravaging nature of the pandemic, marked by a high death toll, elicits trepidation among Nigerian citizens. What is more, these fears are not necessarily as a result of the lethal nature of COVID-19 but rather, they are consequent of certain conditions amongst which include: an inept and unconcerned leadership, accompanied by dilapidated health institutions characterized by poor working conditions and incentives. It is in lieu of these unhealthy conditions that the dreaded disease found its footing in the Nigerian environment. Against this background, this paper argues that the outbreak of Covid-19 pandemic in Nigeria, its local dispersion occasioned by paucity of medical personnel and supplies due to decades of neglect of health care system is worrisome. This study recommends an overhaul of the healthcare system with the aim of achieving a robust health care system for Nigerian citizens. Thus far, various scholars have focused on corrupt leadership practices of Nigerian leaders without a detailed and in-depth study on the nexus between the health sector and this failure. It is this obvious gap in scholarship that this present study sets out to fill. The paper adopts a qualitative approach which will be anchored on primary and secondary sources of historical methodology. Thus, its significance lies in its ability to bring to the fore the nexus between leadership failure in Nigeria and the neglect of primary healthcare system. It will also expose the vulnerability of the Nigerian rich and poor in the face of the global pandemic.

PRIMARY HEALTH CARE IN NIGERIA: AN APPRAISAL OF THE EFFECT OF FOREIGN DONATIONS

Primary Health Care (PHC) provides the most viable route towards achieving health related sustainable development goals (SDGs) and is crucial to the achievement of other SDGs. Given the importance of primary health care, nations across the world devote considerable effort and resources towards establishing and maintaining effective PHC systems. In Nigeria, domestic spending on the health sector has been declining while foreign donations towards improving primary health care have been on the increase. However, recent global trends and the imminent expiry of deadlines for a number of foreign donations point toward a not too distant future without foreign donations for health care system improvements. This constitutes a development challenge. Even though foreign donations have yielded some positive health outcomes, the effect of foreign donations on the primary health care system is unclear. The study set out to examine the amount and effect of foreign donations on the primary health care system in Nigeria. The paper combined qualitative methodology and analysis of literature to investigate the present state of primary healthcare, identify the setbacks to full development of primary healthcare in Nigeria and examined the effects of foreign donations on the primary health care system in Nigeria. The paper found that foreign donations have been increasing but have also led to the perpetuation of a non-committal attitude towards increasing domestic spending on health and the neglect of health system strengthening. Therefore, the paper recommends timely and steady increase in domestic funding for health along with the strengthening of the health system towards creating an effective primary health care system with or without foreign donations.

Traditional Health Healers, Mental Illness and Substance Abuse: A Study Among Hausa-Fulani of Jigawa State in Nigeria

ABSTRACT The traditional healers play a key role in healing the health problems of communities by using the parts of plants and animal products in Nigeria. The natives are in favour of traditional medicine in curing their health problems related to mental illness and drug addiction. Mental and drug abuse-related illnesses in some cultures are believed to be as a result of spiritual and family misfortune and only traditional healers have a solution. The study investigates the role of traditional healers in curing illnesses of local communities and drug addicts. An interview schedule was employed to collect data from mentally sick patients and focus group discussion was conducted with traditional healers to elicit the information. The present study revealed that the traditional health healers were well accepted by the communities. Hence, it is recommended that the integration of traditional healers in the conventional health care system in Nigeria is useful to make society healthier.

438 - Nigerian women are more susceptible to the impact of diabetes-and-dementia: State-of-art, Future perspectives and Directions

Among the preventable complications of diseases that require urgent effective health literacy programs in sub-Saharan Africa, crosstalk between diabetes and dementia stands out for women's health. Type 2 diabetes mellitus (DM2) in midlife is a recognised risk factor for dementia. This crosstalk is more significant in persons of African ancestry. Globally, the prevalence of DM will increase dramatically in the next few years with 75% of cases living in low-to-middle-income countries. Some major risk factors for DM2 accelerates the development of dementia in Africa-Americans, thus leading to higher prevalence of dementia compared to Caucasians. It is known that 58% of the global 46.8 million dementia subjects lives in economically developing countries. This proportion may reach 63% and 68% in 12 and 32 years' time, respectively. Females are 1.5 times likely to develop dementia, but sub-Saharan Africa women have a disproportionately two-to-eight fold increased dementia risk. In the eye of this storm is Nigeria which is home to the highest number of diabetics in Africa. Diabetes prevalence in the country is rising parallel to increased incidence of obesity, hypertension and rising population age. The socioeconomic impact of increasing prevalence of DM2 and dementia will be unsustainable for Nigeria healthcare system, given the experiences in developed economies. This study analyses the current situation of women's health in Nigeria, and explore future policy directions. The complex interplay of factors involved in the DM2-dementia crosstalk in Nigerian women include those due to biological processes (metabolic syndrome, vascular damage, inflammation, oxidative stress, insulin resistance and anaemia), nutritional habits and sedentary lifestyles. Other factors that predisposes Nigerian diabetic women to dementia are, restricted resources, lack of visibility and poor health management. They add up to increase the burden of disease in the Nigerian woman, irrespective of age. We advise urgent implementation of heath policies and actions that will increase ratio of mental health professionals / number of patients, especially in rural areas and the establishment of proactive primary healthcare centres. Importantly, interventions targeting adolescents and adult women, and others specific to mother- child interactions, are strongly needed in Nigeria and the sub-region for mitigating dementia in women.

Politics of Local Government Administration and the Challenges of Primary Healthcare System in Nigeria

The degree of decentralization among federalist countries differs and this invariably demonstrates the dynamics of federalism in practice. The idea of federal system of government demands that there should be constitutional division of powers among the different tiers of government. To this end, in Nigeria, the federal, state and local government have their powers embedded in the constitution. However, the Nigerian constitution created much incertitude which allows local government to merely operate based on the reserved rights, disposition, prescription and discretion of the higher tiers of government. These constitutional uncertainties have no doubt created intergovernmental challenges and conflicts on areas of; tax jurisdiction, revenue allocation, fund transfers, illegal removal of government officials, autonomy, and inconsistent local government elections among others. Beyond these plaints which have been expressed in copious literature, this study tries to take further steps in analyzing how Nigeria’s intergovernmental status has impeded the operation and performance of primary healthcare system, which has invariably brought about poor health outcomes in the country, as evident in her pitiable health indicators. This work therefore establishes a nexus between local government decision space and primary healthcare systems in the country.

Integration of eye care into primary healthcare tier in Nigeria health system: A case for Delta State

Primary Eye Care (PEC) provides the essential cares of the eyes and visual pathways at the Primary Health Care (PHC) level in order to prevent avoidable visual impairment and blindness. The aim of this study is to review the need for integration of PEC services into PHC in Nigeria healthcare system – with focus oF Delta State. A narrative review approach was used in evaluation of community needs, government and PHC facilities. Published literatures from around the world including in Sub-Saharan Africa and Nigeria was done through web search and Mendeley reference library. The evaluations show that there is ability and willingness to integrate PEC into PHC. Yet, there is observable mismatch in capacity vs. opportunity or a knowledge and attitude gap. In Delta State on Nigeria, there appears to be specialist Eye-care providers located in just 24% of the local government areas and absolutely none (zero %) at any PHC facility. In the rural communities, there is the barrier of affordances including problem of access, but the PHC staff can be equipped to provide basic services such as educational, preventive and referral services that non-governmental organisations have done. Therefore, integration of PEC into PHC at the community level is possible.