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the implementation of PHC would advance health equity in all countries and promote human and natural development.86-87
Since the declaration of the MDGs in 2000, the National Primary Health Care Development Agency (NPHCDA) had programmed her activities towards achieving the MDGs. For instance in 2001 the Nigerian Government through the NPHCDA commenced the construction of 2000 model health centres as well as the rehabilitation of another 100 facilities.19 The Ward minimum Health Care Package (WMHCP) was introduced into the Nigeria health system in 2001. The set of interventions contained in this package helped to address health related problems that would result in substantial gains at low cost to government and its partners. This consists of six set of health interventions and services.
These include: (i) control of communicable diseases (Malaria, STI/ HIV/AIDS (ii) child survival, (iii) maternal and newborn care, (IV) nutrition, (V) non-communicable disease prevention and (VI) health education and community mobilization. These set of interventions were to be implemented within a stated time frame of 2007 - 2012. In July 2007 this package was harmonized with the integrated Maternal, Neonatal and Child Health (IMNCH) strategy document of the Federal Ministry of Health. 28,88 More recent initiatives implemented in the health system to achieve the MDGs included the Midwives Service Scheme, NPI with its revised immunization schedule, Maternal Newborn and Child Health programs, and various Educational Campaign Organizations. These programs are either funded by Governments at the different levels (either through Conditional Grant Schemes, SURE-P or other means), NGOs and Partner organizations.
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review was conducted with a focus of eliciting the limitations and challenges in the formulation of the MDGs, their structure, content and implementation. In the review, the authors divided the limitations into the following: limitations in the MDG development process, limitations in the MDG structure, limitations in the MDG content and limitations in the MDG implementation and enforcement.89 Of great interest is the limitation in the MDG implementation and enforcement where various authors agreed that the availability and reliability of data are the most frequent reported challenges with regards to implementation of MDGs and in the interpretation of progress reports. It was also noted by various authors that the global MDG targets were based on ‘little evidence of feasibility in low-income countries’.
It explains further that the health-related baselines from 1990 are often based on unreliable household surveys with no birth and death registries, health records or health statistics. For the educational MDG 2, Johnston found that data on school completion are difficult to obtain because enrolment data are usually collected at the beginning of the academic year, ignoring attendance and drop outs.90
Adeleye and Ofili opined that lack of intersectorial collaboration and the non-functioning health system is a major reason for the non-attainment of the MDGS in the Local Government level as the MDGs include the reduction of child death, improvement in maternal health, and combating HIV/AIDS, malaria and other major diseases. These all call for well-functioning health systems that are highly dependent on inputs from other sectors.
For example, optimal public power supply is required for the efficient maintenance of vaccine cold chains so as to maintain the potencies of vaccines to reduce child death and for blood banks to provide blood to save the lives of hemorrhaging women at delivery. Again, some other MDGs are also related to the health sector. For example, eradication of extreme poverty and hunger (associated with economic development and agricultural sectors) and
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ensuring a sustainable environment (associated with environmental sector) produce health benefits. 91
Maduabum argued that the MDGs Framework is not congruent with different Nigeria’s Development Agenda, a major challenge militating against the attainment of MDGs. He concluded that “building and strengthening of the core public sector capacity through the various reform agenda, are urgently needed to effectively deliver sustainable growth, reduce poverty and inequality and contribute meaningfully to the achievement of the MDGs”. 84 Poverty as outlined by Oshewolo is a major hindrance to the attainment of MDGs in Nigeria.
He further stressed that the Centre for Democracy and Development identifies the key challenges to poverty reduction and the attainment of the MDGs in Nigeria. He also observed that poverty eradication requires the transformation of the Nigerian economy towards the path of sustainable industrialization that is anchored on job creation and elimination of social inequality. This is not possible within the present context of insufficient public investment in the country. Over the years, there seems to have been a deliberate and continuing curtailment of public expenditure on social service such as education and health. Whereas UNESCO has set the benchmark that developing countries like Nigeria need to allocate 25% of their national budget on education, Nigeria’s budgets allocate between 10 – 12% only. Similarly, whereas WHO also recommended that 15% of national budget be allocated to health, the figure in the last decade has been less than 10%. This is further worsened by the fact that the actual release from the budget has been far less than the allocation. Additionally, effective utilization of the little that gets released is hampered by endemic corruption in the country.92 This was supported by Igbuzor as he posited that there is no doubt that the challenges of development and poverty eradication are enormous but in the last two decades, there has been a lot of discourse on what needs to be done to deal with the challenges. The UNDP has consistently argued that the Millennium Development Goals can be met if there is political
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will combined with good policy ideas which are then translated into nationally owned, nationally driven development strategies guided by good science, good economics and transparent accountable governance.82
Ajiye summarized the Challenges facing Millennium Development Goals in Nigeria (Nigerian Factors) as lack of human capacity and implementation, inadequate and unreliable data system, financial challenges in all ramifications, indiscipline and endemic corruption.
For the health related MDGs he identified the challenges as poor access to primary health care delivery system, high cost of health care, poverty and environmental factors such as malnutrition, unhealthy living conditions and lack of basic social services and inability to sustain routine immunization process to prevent polio and prevent re-infection of polio-free communities. Challenges specific to improving maternal health includes: harmful cultural practices in some rural communities, dearth of health personnel in rural areas and limited emergency obstetric care services.93
45 CHAPTER THREE
METHODOLOGY