CHAPTER ONE

INTRODUCTION

1.1   Background to the Study

The importance of public sector reform to health and the grand economy cannot be overstressed. The current drive to improve management in governments through public service reform programs to increase efficiency, effectiveness, and the delivery of quality service to the public is common to many African countries, including Nigeria. The public sector has, for long, enjoyed a pride of place, particularly since the post-industrial revolution era. Public administration moved away from being mere watchmen, to being the engine of the society and become the major provider of various services, including health service delivery. Generally, all societies have some forms of public service provisions for reasons of economics, risk, and moral responsibility (Omoyefa, 2008).

Governments, in many parts of the world, are structurally and constitutionally tied to the civil service, irrespective of the system of government (Olagboye, 2005). This according to Agagu (2008) explains why the relationship between the government and the public service in Nigeria endured in spite of the various forms of governments the country has been experimenting with since independence.

Almost all African countries are caught in the web of public sector reform. Good governance and efficient public administration are regarded as a wishful thought without public sector reform. Also, accountability, transparency, and merit-driven public service are thought to be unachievable except programs of public sector reform are drawn up. Efficiency, effectiveness, and responsiveness of government to the yearning of its citizens could only be gauged through the lenses of the public sector reform (Omoyefa, 2008).

African governments are, therefore, churning out policies on a daily basis. Not minding their relevance and positive impact on their people provided, these policies are part of the new public sector management in the name of public sector reform, not minding the fact that the public sector reform was suggested and imposed on the African countries by external interests. Public service reforms, which have taken place in Africa during the last two decades, are part of a global phenomenon that has touched all parts of the world – developed, developing, and countries in transition (Mutahaba & Kiragu, 2002).

While the African leaders innocently and ignorantly accepted the externally induced programs of reforming their public sector institutions as a way of bettering health service delivery, the developed countries that are propellers of donor agencies are interested in re-colonizing African countries through the back donors. It is a subtle way of neo-colonialism and consequent perpetual slavery without realizing it.

In Nigeria, for instance, the Public Sector Reform (PSR) has been on the agenda for a number of years. As noted by Obasanjo (2005) the context of health is rapidly changing. In advanced economies, health care systems are deemed financially unstable, while in emerging economies, they are still being shaped. These systemic changes result from the government pressure to contain the cost of health care. These costs have increased due to the growing number of ageing population and sophisticated technological advancement in medicine (in developed countries) and high unemployment rate, population explosion and poor accountability in developing countries. Concerns for affordability of health care are rife and there is a need to operate the health system in a more efficient manner. However, Nigeria is faced with the challenge of non-implementation public policies to develop a vibrant and sustainable health care delivery; so the future of health care seems uncertain.

A great deal of attention in development research and policy circles has recently focused on the efficacy of public expenditures in providing basic services to poor people, and on how actually making services work for the poor is constrained by weak incentives of public agents (World Development Report 2004, Fosu and Ryan, 2004). In this context, decentralization to locally elected governments has been explored as a means of strengthening incentives of public providers for improved service delivery (Bardhan, 2002). How accountable are locally elected governments for the delivery of local public services? Hence, this research will investigate the Effects of Public Sector Reform on Health Service Delivery in Lagos State, with a special reference to the elderly in Ojo LGA.

1.2   Statement of Problem

It is important to note that, the health sector in any economy forms the backbone of its growth and development. Factors affecting the overall Nigerian health system performance include: inadequate health facilities and structures, poor management of human resources, poor motivation and remuneration, inequitable and unsustainable health care financing, skewed economic and political relations, corruption, illiteracy, decreased government spending on health, high user fees, absence of integrated system for disease prevention, surveillance and treatment, inadequate access to health care, shortage of essential drugs and supplies and inadequate health care providers.

Bilateral and multilateral assistance, and government spending on health (26.40 billion Naira or 26% of total annual budget for 2004) have not translated into enhanced health status of average Nigerians. Policy reversals and other inconsistencies over the years tend to undermine some health reforms of the past. Strategies developed for the effective implementation of national health programs in the three tiers of government (federal, state, and local government) are poorly implemented due to the politics of federalism (autonomy and resource control). High disease burden and population explosion have culminated in a vicious cycle of poverty, insecurity and uncertainty. While some contend that there are perverse incentives at the local level to misallocate public resources, others maintain that the problem is lack of adequate resource transfers to local governments to finance their expenditure responsibilities (Ekpo and Ndebbio, 1998; The World Bank, 2002).

The federal budget in recent years has included programs of facility construction in local governments. However, there are no established rules or policies for the provision of financial assistance from the higher tiers of government, and it is not clear how well any assistance that is forthcoming is coordinated with LGA budgets and plans for primary health services. Therefore, this study will intensively consider the Effects of Public Sector Reform on Health Service Delivery in Lagos State, with reference to the elderly in Ojo LGA.

1.3   Objectives of the Study

The major objective of this study is to examine the Effects of Public Sector Reform on Health Service Delivery in Lagos State. While other specific objectives are:

1.    To investigate the effects of public sector reform on health service delivery in Lagos State.

2.    To determine the impact of public expenditure on primary health care service for      the elderly in Ojo LGA.

3.    To determine the impact of government policy on poverty reduction in Nigeria.

1.4     Research Questions

This research work shall be guided by the following research questions:

1.Is there any significant relationship between public sector reform and health service delivery in Lagos State?

2.  What is the effect of public expenditure on primary health care service for         the elderly in Ojo LGA?

 3.   Is there any significant relationship between government policy and     poverty reduction in Nigeria?

1.5    Research Hypotheses

The following under mentioned hypotheses will be tested in the course of the research study;

Hypotheses one

Ho:     There is no significant relationship between public sector reform and      health           service delivery in Lagos State.

Hi:     There is a significant relationship between public sector reform and         health           service delivery in Lagos State.

Hypotheses two

Ho:     There is no significant relationship between public expenditure and        primary health care service for the elderly in  Ojo LGA.

Hi:     There is a significant relationship between public expenditure and          primary health care service for the elderly in  Ojo LGA.

Hypotheses three

Ho:     There is no significant relationship between government policy and                                poverty reduction in Nigeria.

Hi:     There is no significant relationship between government policy and                                poverty reduction in Nigeria.