Improving access, quality and efficiency in health care delivery in Nigeria: a perspective

Providing equitable access to health care for every Nigerian is central in the country's National Health Act. But the Nigerian Health System ranks poorly in terms of access and quality just as the country also ranks poorly on Transparency International's Corruption Perception Index. The problem of lack of access to quality health care is linked with wasteful use of primary care services at referral centres. In the rural communitieswhere the burden of disease morbidity and mortality is high, efficient health expenditure and service utilization is plagued by the absence of adequately functioning Primary Health Centers (PHCs), poor or inadequate cost sharing schemes and due to corrupt practices in the health sector. In order to curb these issues, policy options such as revamping the PHC and prioritizing the delivery of a basic minimum package of health care are useful to consider. Furthermore, the implementation of strong actions to tackle corruption in the health sector will improve access to care and health outcomes and it does not incur extra financial investment. This is achievable through improvement in public financial management and limiting corruption by making right choices in resource allocation towards pro-poor interventions. Similarly, well designed package of services and prioritization of primary care making best use of human resource will be beneficial. This is relevant to the Nigerian health system, leveraging the country's decentralized administration and strengthening community health committees' role in ensuring accountability and transparency at the PHCs. Finally, considering the role community health committees play in driving demand in rural communities, the National Primary Health Care Development Agency (NPHCDA) can coordinate the development of a joint action plan for health care delivery between these committee(s) and each respective PHC facility. This will promote efficient use of resources and facilitate access to quality health care at each facility.