Organization of Health System Based on Primary Health Care


Organization of Health System Based on Primary Health Care

You will learn definition and essential characteristics of health systems. You will also learn organization of health system structure at Federal, State and Local Government levels. And at the end we shall introduce you to the organizational structure based on Primary Health Care, which mainly focuses on rural health services.

At the end of this page, you should be able to:

·        Define the health system

·        List the characteristics of health system.

·        Describe the organizational structure of health system, at Federal, State and Local levels

·        Explain the roles and organization of National Primary Health Care Development Agency.


Meaning and Characteristics of Health System

Health system can be broadly defined as a coherent whole of many interrelated component parts, both sectoral and intersectoral, as well as community itself, which produces a combined effect on the health of the population. Health system should consist of coordinated parts extending to the home, the work place, the school and community.

If you try to understand the above definition you will be interested to learn what interrelated component parts are. The components of health system include concepts (e.g. health and disease), ideas (e.g. equity coverage, effectiveness, efficiency, impact), objects (e.g. Education sector, public works, animal husbandry, and agricultural sector etc).Health is a subject of overall socio-economic milieu of the community.

Structural Organization of Health System at Federal Level

The official "organs" of the health system at the Federal level consists of both the Federal Ministry of Health and The National Council of Health.

The Federal Ministry of Health

The Federal Ministry of Health as headed by a Minister. It is a political appointment. Currently, the Federal Ministry of Health has 5 directorates/departments. These include:-

 Department of Personnel Management

 Department of Finance and Supplies

 Department of Planning, Research and Statistics

 Department of Hospital services and

 Department of Primary Health Care and Disease control.

The following are the responsibilities of the Federal Ministry of Health

i) Take the necessary action to have review national health policy and its adoption by the Federal Government.

ii) Devise a broad strategy for giving effect to the national health policy through the implementation by Federal, State and Local Government in accordance with the provisions of the constitution.

iii) Submit for the approval of the Federal Government a broad financial plan for giving effect to the Federal component of the health strategy.

iv) Formulate national health legislation as required for the consideration of the Federal Government;

v) Act as coordinating authority on all health work in the country on behalf of the Federal

Government, with a view to ensuring the implementation of this national health policy.

vi) Assess the country's health situation and trends, undertake the related epidemiological surveillance and report thereon to Government.

vii) Promote an informed public opinion on matters of health; Support State and through them Local Government in developing strategies and plans of action to give effect to this national health policy,

viii) Allocate Federal resources in order to foster selected activities to be under taken by State and Local Governments in implementing their health strategies;

ix) Issue guidelines and principles to help states prepare, manage, monitor and evaluate their strategies and related technical programmes, services and institutions.

x) Define standards with respect to the delivery of health care, and monitor and ensure compliance with them by all concerned; health technology, including equipment, supplies, drugs, biological pro- ducts and vaccines, in conformity with WHO's standards; the human environment; and the education, training, licensing and ethical practices of different categories of health workers

xi) Promote research that is relevant to the implementation of this national health policy and state health strategies, and to this end, to establish suitable mechanisms to ensure adequate co-ordination among the research institutions and scientists concerned;

xii) Promote co-operation among scientific and professional groups as well as non-governmental organizations in order to attain the goals of this policy;

xiii) Monitor and evaluate the implementation of this national policy on behalf of Government and report to it on the findings;


International health

The Federal Ministry of Health sets up an effective mechanism for the co-ordination of external cooperation in health and for monitoring the performance of the various activities. Within the overall foreign policy objectives, this national health policy is directed towards: -

 Ensuring, technical co-operation on health with other nations of the region and the world at large;

 Ensuring the sharing of relevant information on health for improvement of international health.

 Ensuring cooperation in international control of narcotic and psycho-tropic substances;

 Collaborating with United Nation agencies, Organization of African Unity. West African Health Community, and other International Agencies on bilateral and/or regional and global health care improvement strategies without sacrificing the initiatives of international community, and existing institutional and other infrastructural arrangements;

 Working closely with other developing countries, especially the neighbouring states within the region which have similar health problems, in the spirit of technical cooperation among developing countries, especially with regard to the exchange of technical and epidemiological information;

 Sharing of training and research facilities and the co-ordination of major intervention programmes for the control of communicable diseases.

The National Council of Health

The National Council of Health is composed of the following members:

 The Honourable Minister of Health (Chairman)

 The Honourable Commissioners for Health (States)

The following are the functions of the National Council of Health

The National Council on Health advises the government of the Federation with respect to:

 The development of national guidelines.

 The implementation and administration of the national health policy and

 Various technical matters on the organization, delivery, and distribution of health services.

The council is advised by the Technical committee.

Technical committee

The Technical Committee of the National Council on Health is composed of:

 The Federal and State Permanent Secretaries (M.O.H)

 The Directors of Federal Ministry of Health

 The Professional heads in the state Ministries of Health.

 A representative of Armed Forces Medical Services;

 Director of Health Services, Federal Capital Territory, Abuja.


Expert panels

a. The Technical committee usually set up as required, appropriate programme expert panels including the representatives of health related Ministries such as:

 Agriculture, Rural Development and Water Resources

 Education

 Science and Technology

 Labour

 Social Development, Youth and Sports

 Works and Housing

 National Planning

 Finance

b. Health related bodies

 National Institute of Medical Research ii. Medical Schools

 Schools of allied health professionals

 Non-governmental organizations

 Professional associations (Health) e.g. NMA, NANNM, PSN, among others

Structural Organization of Health System at State level

At present there are 36 States and the Federal Capital Territory, Abuja and has many types of health administration. In all the states, the management sector for health lies with the Ministry of Health while in some states, Health management Board also participates in the management.

State Ministry of Health Organization:

The state Ministry of Health is headed by an Honourable Commissioner, while in Health Management Board, there is governing Board with an Executive Secretary. The Commissioner is the Political head of the Ministry while the Permanent Secretary is the administrative head. There are Directors manning the directorates assisted by Deputy and Assistant directors.

Functions: The State Ministries of Health directs and co-ordinates authority on health work within the State via:

 Ensuring political commitment ii. Ensuring economic support

 Winning over professional groups

 Establishing a managerial process

 Public information and education

 Financial and material resources provision

 Intersectoral action

 Coordination within the health sector

 Organizing primary health care in communities

 Federal system

 Logistics system

 Health Manpower recruitment and retraining

 Priority health programmes.

 Health technology.

 Structural Organization of Health System at Local level

There are 774 Local Government Areas in Nigeria with various health facilities operating under the hinges of primary health care (PHC).

The Local Government Headquarters coordinates the activities of the health facilities providing manpower, funds, logistics etc. The Local Government is headed by elected Chairmen with council members. Supervisory councilors are also appointed to oversee various aspect of Local Government activities including Health and Social Services. The health department is always headed by a Primary Health Care Coordinator.

Functions of the local government .Provision and maintenance of essential elements of primary health care: environmental sanitation; health education

i. Design and implement strategies to discharge the responsibilities assign to them under constitution and to meet the health needs of the local community under the general guidance, support and technical supervision of state health Ministries.

ii. Motivation of the community to elicit the support of formal and informal leaders.

iii. Local strategy for Health activities. Examine this illustration, which provides an overview of health care delivery system at the three levels of health care i.e. primary, secondary and tertiary levels. As you know a full range of primary health care (first level contact of individual, family and community health system) are being rendered through the agency of primary health centers.

iv. Secondary Health Care is being provided through the establishment of Cottage, General Hospitals where all basic specialty services are being made available.

v. Tertiary care is being provided at Teaching and Specialist Hospitals where super specialty services including sophisticated diagnosis, specialized therapeutic and rehabilitative services are available.

Structural Organization of Health System Based on Primary Health Care Agency

As a signatory to the Alma-Ata Declaration, the Federal Government of Nigeria is committed to achieve the goal of Health for All through primary health care approach. Keeping in view the goal of "Health for All" by 2000 AD and beyond, the National Health Policy laid down plans of actions for reorienting and shaping the existing rural health infrastructure within the frame work of various year plans. The establishment of primary health centers in our country in 1986 under the National Primary Health Care Development Agency has been a valuable national asset in our efforts to increase the outreach of our health system based on primary health care.

Functions of the Primary Health Care Agency.

(a) Support to health policy

i. Review existing health policies, particularly as to their relevance to the development of PHC and to the integrated development of health services and health manpower, and propose changes when necessary.

ii. Prepare alternatives for decision makers at all levels based on scientific analysis, including proposals for health legislation;

iii. Conduct studies on health plans for PHC at various levels to see whether they are relevant to the national health policy, feasible and multi-sectoral

iv. Promote the monitoring of PHC implementation at various levels;

v. To stimulate the development of PHC technical on an equitable basis in all LGAs, for  example technical support to implementation of selected PHC components as required. This assistance will be provided strategically to enhance orderly development, for example, to improve upon or introduce new skills required for the services or to integrate new components into them;

(b) Resources mobilization

i. To mobilize resources nationally and internationally in support of the programmes of the Agency.

ii. To conduct or commission studies on resource mobilization for health and issues of cost and financing, with particular reference to equity.

(c) Support to Monitoring and Evaluation

i. Monitor the development of the nation's PHC programme so that it keeps as much as possible within the guidelines set out for its development in the National Health Policy and PHC Guidelines and Training Manuals;

ii. Develop guidelines and design frame works for periodic evaluation of primary health care at various levels;

iii. Monitor the monitoring and evaluation process nationally, with particular respects to the development of capabilities of LGA level to analyze and make use of monitoring and evaluation data for management decision making.

(d) Technical support

i. Provide technical support to the preparation of a health manpower policy, including manpower projections to enable development of a PHC manpower plan;

ii. Provide advocacy and support for the orientation of medical undergraduate education, and the education of other health professionals, towards PHC.

(e) Organization of Health System

i. To identify orientation and continuing education needs of PHC manpower, including medical, organize programmes to meet these needs, using Schools of Health Technology as a resource;

ii. To support directly the strengthening of the Schools of Health Technology.

iii. Support to the village health system: In view of the importance of this level of the national health system in extending coverage, the Agency should:

iv. Pay special attention and provide maximum support to the training deployment, logistic support and supervision of village health workers and TBAs: the relationship between these workers and their communities and the mechanisms which link

these workers to the other levels of the health system;

v. Pay special attention to the involvement of women and grass-root women's organization in the village health system.

(f) Health system research (HSR)

i. Promote and support problem-oriented HSR as a tool for finding better ways for the provision of essential care as a component of health for all, in particular the introduction of HSR in the LGA health system and the support of the other levels of this efforts.

ii. To undertake or commission HSR operations research into the functioning of PHC programmes;

iii. To respond to request from government and other agencies in organizing special studies by mobilizing experts who will respond rapidly and in-depth to guide legislative and administrative action.

(g). Technical collaboration

i. To stimulate universities, NGOs and international agencies to work with LGAs in nurturing their capacity for problem solving;

ii. To develop LGA capacity to seek technical collaboration including from other LGAs in developing and implementing their PHC programmes;

iii. To promote collaboration with other sectors at all levels in the development and support of LGA primary health care system;

iv. To monitor the collaboration for PHC between the international agencies and government

at all levels;

v. Promote and organize both the sharing of experience of the Agency with the world community (publications, reports, etc) and the collection of all relevant information from other countries and international organizations and disseminate it to all interested parties;

vi. Promote maximum support to all its efforts by networking and creating formal and informal collaboration with relevant Nigerian and international institutions.

vii. Promotion of PHC: All activities carried out by the Agency will be promoting PHC.

Specifically, however, the Agency should

a) carry out advocacy at the level of community leaders, mass media and NGOs, to promote PHC, making particular efforts to ensure that elected officials and party functionaries are continually oriented towards PHC and health for all;

b) Re-orientate health professionals towards PHC by means of conferences, seminars, and other meetings;

c) Support the documentation of PHC through commissioning of case studies, reviews, books, articles, newsletters and other media productions as appropriate;

d) Establish Resource centers to serve as national and zonal depositories of information on PHC implementation;

e) Organize seminars, reviews and other meeting to promote PHC and share experiences in implementation, with a view to strengthening LGA health systems;

f) Provide annual reports which are widely disseminated on the status of PHC implementation nation-wide.

Organization of the Primary Health Care Development Agency.

To be able to perform its functions effectively, the Agency is an administratively autonomous Agency under the supervision of the Federal Ministry of Health. In addition, it has a Board of Directors. It has an Executive Director who heads the team responsible for guiding the development of the PHC system. He/she must therefore have' considerable experience in this area. There is also a Scientific Committee in the Agency in which various experts with relevant skills are represented. The composition and modalities for functioning of the scientific committee is prepared by the Executive Director and approved by the Board.

The Board.

The agency has a board to:

·        Receive reports on the state of development of the national PHC programme.

·        Approve the activities of the agency and its budget Have overall responsibilities for personnel matters.

·        Assist with the mobilization of funds.

The board consists of the following members:

i. A chairman, who will be a highly respected primary health care practitioner;

ii. The secretary, who will be the executive director of the agency;

iii. Director of PHC at the federal level

iv. A representative of the conference of provosts of college of medicine;

v. A representative of the conference of principals of community health officer's

 training institutions;

vi. A representative nominated by the National Association of Nigerian Nurses and Midwives;

vii. One State Ministry of Health representative from each PHC zone nominated by the National Council of Health in rotation to serve for a period of 3 years.

viii. One LGA representative from each PHC zone, nominated by the Conference of LGA Chairmen, in rotation to serve for a period of 3 years.

ix. A representative of the National Planning Commission;

x. A representative of NGOs working in PHC

xi. Representative of the National Commission for Women.

Structure of the Agency at Federal Level. .

The Agency has a small core of professional staff at the Federal Level. The Staff are expected to follow the guiding principles of team work. Moreover, the Agency has the ability to draw on outside expertise to the maximum extent possible.

Structure of the agency at Zonal level

The offices should collaborate with the State Ministries of Health to strengthen LGA PHC systems. To be effective in providing LGAs with technical assistance, it is proposed that the zonal offices be organized along the same lines as the LGA PHC Departments are currently organized.

The assistant coordinators will oversee the functions allocated to them as follows:

Family health services: Maternal and child health services including family planning and nutrition/growth monitoring promotion; Essential drugs and drugs revolving fund, medical stores, essential drugs and drugs revolving fund promotion; Health education, community mobilization, water and sanitation.

Promotion of health education: Development of the managerial process through establishment of committee and training of committee members at all levels so as to achieve the followings:

·        Promotion of water and sanitation projects;

·        Records monitoring and evaluation,

·        Collection, collation and analysis of monthly reports from all LGAs and States.

·        Promotion of feedback to those levels;

·        Writing periodic zonal report and widely disseminating the same;

·        Establishment and maintenance of zonal resource centre;

·        Serving as focal point support of PHC project formulation in LGAs in the zone

·  Coordination of the integration of EPI and diarrhea diseases, ARI and communicable diseases control programmes (guinea worm, TB and leprosy, onchocerciasis, chistosomiasis and AIDS) in the PHC systems in the zone.

The above organizational structure entails strengthening the zonal offices considerably. The resources needed at this level include personal, office accommodation, transportation and increased financial allocation to ensure that field work will go in the LGAs unhindered.


You learnt about the organization of health system. Health system is defined as coherent whole of many interrelated components pans, both sectoral and intersectoral as well as community itself, which produces a combined effect on the health of the population. Health system is organized at three levels; federal, state and local level. At the federal level official organs are, Federal Ministry of Health and National Council of Health. The federal Ministry of Health is headed by a Minister assisted administratively by the Permanent Secretary and has five departments, namely planning, research and statistics, personal management; finance and supplies, hospital services and primary health care/disease control. These departments are headed by directors.

At the state level, the health sector comprises State Ministry of Health and Health Management Board in some states. The State Ministries of Health is headed by a Commissioner, assisted by Permanent Secretary and Directors. At the local level, the head of department is the Primary Health Coordinator with assistants overseeing other areas such as immunization, AIDS/HIV, measurement and evaluation, nutrition. Lastly, you learnt the structural organization of health system based on national primary health care agency which focuses on primary health care.



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