Community Participation and the Politics of Primary Healthcare Delivery in Lagos State.
A Thesis Submitted to the School of Postgraduate Studies, University of Lagos.
This thesis is an investigation of the forms and extent of community participation in health care delivery and the extent to which their participation affects the performance of the health care system. Developments in the health sector in Nigeria three decades after the Declaration of Alma-Ata Conference in Kazakhstan (former Soviet Union), where primary health care was declared a strategy of delivering healthcare services, show that the health care system has deteriorated considerably, resulting in inefficient and ineffective service delivery. It is possible to explain the failure of the health system to respond to the various efforts of governments directed towards its renewal within the context of the inter-related nature of public health governance and the effectiveness of public health policies. Since major health problems in the country demand attention from the government health care delivery therefore becomes a political issue with the state assuming a central position in its determination. Given the complex nature of health care policy formulation and implementation, the question is, how does the interaction amongst actors in the process affects the effectiveness of primary health care? Further inquiries revolve around the question on the relative strength of the community to participate in the process of health care delivery and how this determines the population’s health outcome. The study adopts both quantitative and qualitative methods in its enquiry and utilizes three data sets (questionnaire administration, focus group surveys and key informant interview) in examining the forms of community participation in selected communities in Lagos State. The thesis provides empirical evidences of the decline of community participation in the forms and the process of health care delivery. Contrary to the approach of primary health care which emphasizes the participation of community members in the planning of their health care development, findings revealed that, most of what has been described as community participation is rather symbolic, and largely takes a form of incorporation of the community into implementation of health programmes. Rather than be a partner, the community is turned a subject of health care delivery. The reason adduced is that, politics of health legislation, health programmes development and implementation disempowered the communities by making health care an issue of ‘who gets what, when, and how’ in the country. The study suggests a system of health governance that incorporates the complex nature of health care delivery in the country. Government should devise ways of reintegrating the notion of community participation into the strategy of health care delivery in the country and ensure that its implementation as much as possible is bereft of politics. The study recommends making ‘participatory development’ ideology of health care delivery in the country. This is with the view to changing the social order as it affects health care delivery and its implications for citizens’ health outcomes. This can be achieved within the context of an enduring ideology.