National Health Policy Thrust in Relation to Health Information Management. A Concise Review

ABSTRACT

The National Health Policy thrust represents the collective will of the governments and people of this country to provide a comprehensive health care system that is based on primary health care. It describes the goals, structure, strategy and policy direction of the health care delivery system in Nigeria. It defines the roles and responsibilities of the three tiers of government without neglecting the non-governmental actors. Its long-term goal is to provide the entire population with adequate access not only to primary health care but also to secondary and tertiary services through a well-functioning referral system. Unfortunately, most nation states have taken "health policy" to mean "medical care policy." Medical care, however, is only one variable in a nation's health equation. The article describes what the main components of a national health policy should be, including (1) the political, economic, social, and cultural determinants of health, the most important determinants of health in any country; (2) the lifestyle determinants, which have been the most visible types of public interventions; and (3) the socializing and empowering determinants, which link the first and second components of a national health policy: the individual interventions and the collective interventions. The author discusses the indicators that should be used for each component and for each intervention. The feasibility of this approach depends to a large degree on the political will of the national authorities and the broad understanding of the actual determinants of health. A good first step is the National Health Policy plan developed by the Swedish social democratic government. This article builds on and expands on that model.

INTRODUCTION

MAJOR THRUSTS OF NATIONAL HEALTH POLICY

THE MAJOR THRUSTS OF THE NATIONAL HEALTH POLICY RELATE TO:

- NATIONAL HEALTH SYSTEM AND MANAGEMENT
- NATIONAL HEALTH CARE RESOURCES
- NATIONAL HEALTH INTERVENTIONS
- NATIONAL HEALTH INFORMATION SYSTEM
- PARTNERSHIPS FOR HEALTH DEVELOPMENT
- NATIONAL HEALTH RESEARCH
- NATIONAL HEALTH CARE LAWS
- NATIONAL HEALTH SYSTEMS AND MANAGEMENT

(a) The goal of the national health policy shall be to establish a comprehensive health care system, based on primary health care that is promotive, protective, preventive, restorative and rehabilitative to every citizen of the country within the available resources so that individuals and communities are assured of productivity, social well-being and enjoyment of living.
(b) Guaranteed minimum health care package for all Nigerians shall be the mobilizing target. As a long-term policy and within available resources, the governments of the Federation shall provide a level of health care for all citizens to enable them to achieve socially and economically productive lives.

Health System Based On Primary Healthcare

The health system, based on primary health care, shall include as a minimum:-

- An articulated programme on information, education and communication (IEC), which should also include specific programmes on school health services;
- Promotion of food supply and proper nutrition;
- An adequate supply of safe water and basic sanitation;
- Maternal and child health care, including family planning. In this context, family planning refers to services offered to couples to educate them about family life and to encourage them to achieve their wishes with regard to: preventing unwanted pregnancies; securing desired pregnancies; spacing of pregnancies; and limiting the size of the family in the interest of the family health and socio-economic status. The methods prescribed shall be compatible with their culture and religious beliefs.

- Immunization against the major infectious diseases;
- Prevention and control of locally endemic and epidemic diseases;
- Appropriate treatment of common diseases and injuries;
- Provision of essential drugs and supplies;
- Promotion of a programme on mental health; and
- Promotion of a programme on oral health.

The health system shall:

- Reflect the economic conditions, socio-cultural and political characteristics of the communities as well as the application of the relevant results of social, biomedical, health system research and public health experience;
- Address the main problems in the communities, providing promotive, preventive, curative and rehabilitative services accordingly;
- Involve, in addition to the health sector, all related sectors and aspects of state and community development, in particular agriculture, animal husbandry, food industry, education, housing, transportation, public works, communications, water supply and sanitation and other sectors, and demand the coordinated efforts of all those sectors;
- Promote maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making full use of resources of Local, State and Federal Governments as well as other available resources; and
- To this end, develop, through appropriate education and information, the ability of communities to participate.

Community Involvement

(a) Governments of the Federation shall devise appropriate mechanisms for involving the communities in the planning and implementation of services on matters affecting their health.
(b) Such mechanisms shall provide for appropriate consultations at the community level with regard to local health services on the basis of increasing self-reliance. The traditional system and community organizations (cultural and religious associations) shall be fully utilized in reaching the people.
(c) The Federal and State Ministries of Health shall consult accredited groups and associations which represent the various interests within the society, including the various professional associations.
(d) The Armed Forces and Police Barracks are usually not taken care of by the Local Government Areas where they are situated. The Ministry of Defence and

Police shall therefore be responsible for the health care of the citizens living in such communities.

Levels of Care

National Health Care System shall be developed at three levels viz:

Primary Health Care

i. Primary Health Care shall provide general health services of preventive, curative, promotive and rehabilitative nature to the population as the entry point of the health care system. The provision of care at this level is largely the responsibility of Local Governments with the support of State Ministries of Health and within the overall national health policy. ii. Noting that traditional medicine is widely used and that there is no uniform system of traditional medicine in the country but that there are wide variations with each variant being strongly bound to the local culture and beliefs, the local health authorities shall, where applicable, seek the collaboration of the traditional practitioners in promoting their health programmes such as nutrition, environmental sanitation, personal hygiene, family planning and immunizations. Traditional health practitioners shall be trained to improve their skills and to ensure their cooperation in making use of the referral system in dealing with high risk patients.

Secondary Health Care

The Secondary health care level shall provide specialized services to patients referred from the primary health care level through out-patient and in-patient services of hospitals for general medical, surgical, paediatrics, obstetrics and gynaecology patients and community health services. It shall also serve as administrative headquarters supervising health care activities of the peripheral units. Secondary health care shall be available at the district, division and zonal levels as defined by the authorities of the State. Adequate specialized supportive services such as laboratory, diagnostic, blood bank, rehabilitation, and physiotherapy shall be provided.

Tertiary Health Care

Tertiary health care, which consists of highly specialized services, shall be provided by teaching hospitals and other special hospitals which provide care for specific disease conditions or specific group of patients. Care should be taken to ensure that these are evenly distributed geographically. Appropriate supporting services shall be incorporated into the development of these tertiary facilities to provide effective referral services. Selected centres shall be encouraged to develop special expertise in the advanced modern technology thereby serving as a resource for evaluating and adapting these new developments in the context of local needs and opportunities.

National Health System Management

It is generally recognized that a more effective and efficient delivery of health care can be achieved in this country by a more efficient management of the health resources. Experience has shown repeatedly that many well-conceived health schemes fail to meet expectations because of failures in implementation. It is essential to establish permanent, and systematic managerial processes for health development at all levels of care. These shall include appropriate control to ensure the continuity of the managerial process from design to application.

The National Health Managerial Process

A national managerial process shall be established to include the following elements.

(a) The national health policy - comprising the goals, priorities, main directions towards priority goals, that are suited to the social needs and economic conditions in the different States and form part of national, social and economic development policies;
(b) Programming - the translation of these policies through various stages of planning at the local, state and national levels into strategies to achieve clearly stated objectives.
(c) Programmed budgeting - the allocation of health resources by Governments of the Federation for the implementation of these strategies;
(d) Plan of Action - describing strategies to be followed and the main lines of action to be taken in the health and other sectors to implement these strategies.
(e) Detailed programming - the conversion of strategies and plans of action into detailed programmes that specify objectives and targets and the technology, manpower, infrastructure, financial resources, and time required for their implementation through the health system;
(f) Implementation - the translation of detailed programmes into action so that they come into operation as integral parts of the health system; the day-to-day management of programmes and the services and institutions for delivering them, and the continuing follow-up of activities to ensure that they are proceeding as planned and scheduled;
(g) Evaluation - of health development strategies and operational programmes in order to progressively improve the effectiveness and efficiency of their implementation;
(h) Reprogramming - with a view to improving the master plan of action or some of its components, or preparing new ones as part of a continuous managerial process for national health development.
(i) Relevant health information - to support all these components at all stages to ensure regular and wide dissemination of needed information.

> NATIONAL HEALTH CARE RESOURCES

Background

Resources for health development are important, albeit, indispensable component for an effective and efficient health care delivery. The appropriate and targeted applications of these resources, (material and non-material) in the right mix (quality and quantity), at the right places and in time shall be central for achieving the goals and objectives of the National Health Policy.

National Health Manpower Development

Planning human resources for health shall include:

a. Revitalizing and providing appropriate and quality human resources for health care delivery at all levels
b. Ensuring equitable distribution of human resources for health care delivery between urban and rural areas including difficult terrain such as mountainous, riverine and inaccessible area in the country.
c. Promoting collaboration among human resources for health care delivery at all levels, at the tertiary and secondary levels with and among those in cognate private and public health institutions.
d. Ensuring adequate staff at all levels in line with health sector development plans.
The policy shall ensure that:

(a) Institutions for the training of traditional health practitioners are accredited by a regulatory board.
(b) The regulatory board, from time to time, reviews curricula for training of traditional health practitioners and provides appropriate guideline towards their integration into the mainstream of Health care delivery.
(c) Traditional health practitioners are to be retrained and certificated in order to increase their skills and effectiveness in line with the regulatory guidelines.
(d) Traditional health practitioners are instructed on how to make effective use of the referral system of orthodox medical care.

Monitoring and Evaluation

Monitoring and evaluation are fundamental activities aimed at ensuring the satisfactory performance of the health care delivery system. The Human Resources for Health Development unit at all levels shall be strengthened to perform their statutory functions.

The policy shall ensure:

a. that the Human Resources for Health Development unit at federal, state and local government authorities, in collaboration with other agencies, monitor and evaluate all health care institutions within their area of jurisdiction annually to ensure their compliance with human resources for health development norms, and sanctions imposed where appropriate.
b. monitoring and evaluation reports contribute significantly to personnel training, placement and reward at all levels

Financing For Human Resources for Health

In order to achieve the aims and objectives of human resources development the policy shall prescribe the following:

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