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Why Privatization is not the answer in the Nigerian's Government (Hospitals should not be privatized in Nigeria)

 Why privatization is not the answer in the Nigerian’s Government

Privatization is the transfer of ownership, property or business from the government to the private sector. It is regarded to bring more efficiency and objectivity to the organizations that government companies have no concern with (The Economic times , 2016). That is to say that it gives the private sectors an opportunity to make decisions about what, where and how to produce goods and services (Andrew Berg; and Elliot Berg, 1997). Privatization aims at:

Fiscal relief by cutting government subsidies to money-losing State-owned Enterprises (SOEs) and/or by establishing new revenues from their sale

 Increase the efficiency of the enterprise

 Increase the efficiency of the entire economy through more competitive markets and better allocation of revenues/resources across firms and sectors

 Increase the political support and broadened institutional underpinnings for market-based economy or further liberalization

 Establish stronger financial markets
 Investment and stimulate entrepreneurship (Andrew Berg; and Elliot Berg, 1997).

Privatization in Nigeria:
In Nigeria, in the unitary system of government such as indstries or assets owned by lower levels of government example: municipalities, being transferred to the central government to be operaed and owned at the national level (Prof. Taiwo Asaolu, 2015). Industries that are usually operated by nationalization include transportation, communication, energy, bank and natural resources and they become state owned enterprises; they aim to achieve social, political and economic objectives ( Ademola Ariyo and Afeikhena Jerome, 2004).
In the 1960s and 70s, many of the nationalized corporations went through a process of denationalization in other words privatization. The reason is because some state owned enterprises ran out at a loss by the government. They are characterized by low productivity, inefficiency, corruption and nepotism. Therefore, privatization is a strategy adopted by the government to improve the delivery of services by state owned enterprises as a means of economic re-engineering embarked upon to solve the problems related with state owned enterprises by the government (Ladipo Adamolekun , 2005).
1   
     No! National corporations should not be privatized.

    Why?
     In Nigeria, privatization over some time has not been a popular reform. It has received so much
     criticism from labor, academia and individuals. As it is seen as a means of instrument for an efficient
      resource management for rapid economic development and poverty reduction, privatization inflicts damage on the poor through loss of employment, reduction in income and reduced access to basic social services or leads an increase in prices (Chudi-Oji Chukwuk, 2013). That is to say that it abuses the public interest”. For example; if the National Emergency Management Agency whose aim is to manage natural disasters in Nigeria is being privatized, then the public will have to pay their services (Nigerian Association, n.d.).

      Government loses out on potential dividends: A lot of issues arise from ownership, management and control of public enterprises operated in the public interest. These includes the political interference, miss-allocation of resources, loss of revenue, corporation, lack of management autonomy; scarcity of foreign exchange leading to rampant in both private and public sectors due to economic deterioration (The impact of Privatization in Nigeria, 2015).

The problem of externalities: The utilities create negative externalities (i.e. pollution, damaging the environment). The public sector companies, the government can regulate the output and make sure that it is at the socially optimal level. In the private sector, the maximization of profit is the only concern, therefore leading to the occurrence of socially damaging externalities.

Job losses:Privatization increases enforcement among private companies to be efficient or at least find some way of reducing their costs in order to make a profit given by the regulators (Economics on Privatization , 2013).


Conclusion:              
Intergovernmental relations are to play a “bridge building” role to establish a degree of coordination and cooperation to divided powers (Okafor, J,C, 2007). In developing countries, such as Nigeria, it is necessary for the state to take active roles in matters associating with the economic development considering the absence of strong private sector. The available resources to the private sector are inadequate to provide certain goods and services. For instance, the investment in establishing a hydroelectricity-generating plan or water scheme for a large urban center is huge for a private sector to handle. Since the development is related to social services, post-independent African governments need to acknowledge the need to be involved in providing certain social and economic services (Prof. Taiwo Asaolu, 2015).
Ngadiuba Alina
Cluj School of Public Health
2nd Year student
(The Economic times , 2016)


REFERENCES:

1.       Ademola Ariyo and Afeikhena Jerome. (2004, July 04). Utility privatization and the poor: in Nigeria. Global Issues Paper. Retrieved from https://www.boell.de/sites/default/files/assets/boell.de/images/download_de/internationalepolitik/GIP12.pdf
2.       Andrew Berg; and Elliot Berg. (1997). Methods of privatization. Journal of International Affair. Retrieved from http://fspac.ubbcluj.ro/moodle/pluginfile.php/20769/mod_resource/content/0/Berg1-Methods%20of%20Privatization.pdf
3.       Chudi-Oji Chukwuk. (2013). Nigerian Economy – Effects Of Privatization And Commercialization Policies. Nigeria. Retrieved from http://www.doublegist.com/nigerian-economy-effects-privatization-commercialization-policies/
4.       Economics on Privatization . (2013). S-cool. Retrieved from Disadvantages of Privatization : http://www.s-cool.co.uk/a-level/economics/privatisation/revise-it/the-disadvantages-of-privatisation
5.       Ladipo Adamolekun . (2005, November). Re-Orienting Public Management in Africa: Selected Issues and Some Country Experiences. Economic Research Working Paper. Retrieved from http://www.afdb.org/fileadmin/uploads/afdb/Documents/Publications/00457497-FR-ERWP-81.PDF
6.       Nigerian Association. (n.d.). Dept for Nigerian Related Website . Retrieved from Nigeria Info net: http://www.nigeriainfonet.com/Directory/associations__organizations5.htm
7.       Okafor, J,C. (2007). Comparative Models and Patterns of Intergovernmental Relations. In J. a. Onuoha, Theory and Practice of Intergovernmental Relations. Enugu, Enugu state , Nigeria : Quintagon Publishers. .
8.       Prof. Taiwo Asaolu. (2015, November 08). The Nation. Privatization in Nigeria: Regulation, deregulation, corruption and the way forward. Retrieved from http://thenationonlineng.net/privatization-in-nigeria-regulation-deregulation-corruption-and-the-way-forward/
9.       The Economic times . (2016, November 18). Retrieved from Privatization : http://economictimes.indiatimes.com/definition/privatization?from=mdr
10.    The impact of Privatization in Nigeria. (2015, March 23). UK essays. Retrieved from https://www.ukessays.com/essays/economics/the-impact-of-privatization-in-nigeria-economics-essay.php


Vulnerable Children in Nigeria


 
With high priority of The National Government and International Stakeholders across the Globe, there are negative outcomes of the growing of orphans and vulnerable children (OVC) population worldwide. It is recognized that such negative outcome is of a result of the issue with the social, economic and human rights dimensions (Boston University Center for Global Health and Development: Initiative for Integrated Community Welfare Nigeria, 2009).
With evidence based data, there is a huge proportion of orphans and vulnerable children. With the population of 187, 430, 718; the number of adults and children living with HIV is one of the highest in the world (Boston University Center for Global Health and Development: Initiative for Integrated Community Welfare Nigeria, 2009).
In Nigeria there has been a response to crisis of orphans and vulnerable children due to HIV/AIDS in largely community driven with the extended family providing the safety net for protection; care and support (HIV/AIDS: Problems Of Orphans; Vulnerable Children in Nigeria, 2013).
In 2003, 7 million of the population were orphans with an approximate of 1.8million which were affected with HIV/AIDS. The increasing level of poverty; as result of low resources, lack of basic credits and employment facilities, has jeopardized the realization of the wellbeing of orphans and vulnerable children in Nigeria (HIV/AIDS: Problems Of Orphans; Vulnerable Children in Nigeria, 2013).
In Nigeria, 10.7% of the 69 million children are vulnerable (UNICEF, 2007), 10% of children are orphans, (7% in North-West to 17% in South-East), 10% in Rural, 11% in Urban, Benue state has the highest prevalence of orphans (25%), followed by Akwa Ibom (22%); while Niger state has the lowest (2.7%). Benue state has the highest prevalence of Orphans and Vulnerable Children (OVC) aged 6-17yrs (49%), followed by Imo (45%), and Rivers (41%); with Kwara having the lowest (9%) (NSAA, 2008). One of the important challenges in countries like Nigeria that have increased number of children infected or affected with the HIV/AIDS epidemic, is the need to assist families and communities to care for these children ((NDHS), 2008).
In some of the world’s poorest countries in Sub-Sharan Africa, the adverse effects of the AIDS Epidemic are felt more severely, where its consequences have been as upsurge in the sum of children orphaned as a result of death of both parent because of its complication. Orphans are not only affected by HIV/AIDS, but also makes children more vulnerable in a number of ways (The Impact of HIV/AIDS on children in Nigeria, 2015).
HIV/AIDS significantly affects children’s life and families of children’s caregivers. Parents of HIV positive children go through trauma of sickness and eventually death. Certain children carry the burden of caring for a sick parent and this may result to drop-out of school, and carry on the responsibilities of an adult (NSAA, 2008).  Due to parental HIV-related illness costs, and eventually death, this substantially reduces household resources, causes unemployment, or renders a caregiver jobless; which may lead to poor health care of a child, lack of education, and the nutritional status of child significantly declines.
Recent studies show that 17.5 million children are orphans or vulnerable children: 2.5million of these orphans are HIV/AIDS positive in Nigeria. The capacity and resources of the individuals and households have been overextended by the growing number of OVC and the complexity of their needs (Onoh, 2014)
Also, gender-related stereotypes; gender profiling and inequalities between men and women contribute to the public health problems in Nigeria (Effanga, 2014).

The OVC situation in the context of HIV/AIDS in Nigeria:
Orphans and children in very difficult circumstances have been of major concern in most child-enrolled programs before the HIV/AIDS epidemic. The OVC issue existed long before due to the fact that there are other causes of orphanage and vulnerability; which has significantly worsened by the impact of the AIDS Epidemic ((UMN), 2007).
Recent estimates show that there are about 1,800 new HIV infections every day, and 1,400 deaths from AIDS-related illness among children below the age of 15 (UNAIDS, 2007).  Children between this age are victimized for one in six AIDS-related deaths worldwide, and one in seven new HIV infections mostly through mother-to-child transmission of HIV. Many children are further infected with HIV through parental illness, or death from infection((UMN), 2007).
2006 Global AIDS epidemic shows that Nigeria had 930,000 children orphaned by AIDS at the end of 2005. New estimates show that 1.8-2million children are orphaned by AIDS in Nigeria, and  1 in every 10 households provides care for an orphan((UMN), 2007).

Socio-economic Ramifications to the OVC Issue:
Children suffer from psychological because of the experience of poverty resulting from loss of family income. Social dislocation, stigma, and discrimination, loss of childhood: children having the responsibilities of a caregiver towards a sick parent; siblings or other family members with HIV or anyother poor health conditions((UMN), 2007).

OVC Problem in Nigeria:
Globally, the position of youths echoes a deeping and widening neglect and invincibility of children in Nigeria. There has been a high steady prevalence of HIV/AIDS in 2005 as it declined from 5.8% to 4.45 in 2001,  since the HIV/AIDS incidence of a 13 years old child in 1986; which it has been estimated that a million chidren orphaned by AIDS were living in Nigeria (Onyebuchi, HI/AIDS: Problems of Orphans and Vulnerable Children in Nigeria, 2003).
The impact of HIV/AIDS has had an increasing rate on a number of orphans: those who lost their parents to AIDS as a result; leaving them vulnerable. Although there is an insufficient available data, there has been a call of desperation for those who are social excluded, exploitation, and abuse facing a large percentage of orphaned children in Nigeria  (Onyebuchi, HI/AIDS: Problems of Orphans and Vulnerable Children in Nigeria, 2003).
1.       39% of children are involved in sexualactivities
2.      43% of women aged 20-24 were married before the age of 18;
3.      High rate of infant, child and adolescent mortality
4.      Unavailabilty of healthcare services
5.      Lack of education, poor school performance, the education enrollment is low
6.      Rejection of intra household: maltreatment, and abuse/harassment from other peers

With the estimation of previous studies, 40% children may have been involved in child trafficiking, drug trafficking, or engaged themselves in prostitution to earn money. An estimated population of 50million Nigerians below the age of 18 are from low income population, and 40% of them do not acquire primary education due to discrimination due to the result of HIV/AIDS  (Onyebuchi, HI/AIDS: Problems of Orphans and Vulnerable Children in Nigeria, 2003)

Help improve the health of other


Improving Access to Emergency Healtcare



Improving people’s access to emergency medical services by strengthening Integrated emergency system and its further development 

The reality and practice of improving health care service is complex, and as different programs and sectors are varying approaches towards the same objectives of improving access, quality and efficiency. But before we get to the objectives of the improvement of people’s access to health care services, let us understand the concept and purpose of such task.
Improving access to health services is a priority case in Romania. This case study helps in accessing the primary and specialty care suggestions at a great opportunity of improvement. And with this, it is entitled that public health officials should develop a strategy plan for the improvement of health care accessibility.
As Romania has a high prevalence of both communicable and non communicable diseases, polices should be implemented for the occurrence of diseases such as cancer and tuberculosis (TB).  These policies need to be conceptualized to give it a means of achievement.

Accessibility of medical care services: -

Medical care services should be available for not just the high income population but also for the low income population. It is the public health officials’ responsibilities to ensure that there are adequate supplies of medical care services such as clinical services and hospitals. Under this strategy we have the following:

Care is available:

As initially stated, it is important that the availability of health care services is assured to both low income and high income populations. Sufficient supply of clinics and hospitals at both urban and rural communities where people can be diagnosed and treated promptly, and can obtain quality preventive care early enough to avoid illness or complications. Services should be offered within a reasonable distance from where people live.              
Volunteers should enroll their patients in public programs, ensure transportation to health care appointments, provide translation and interpretation services and/or case study manage those with chronic and costly illness. Low income population should be privileged for they do not understand their medical conditions or are able to afford the health care services.  
                                   
Care is appropriate:

The right mix of health care professionals exists to attend to people’s most frequent needs. Cultural and linguistic barriers are addressed in such a way that patients get proper diagnoses and can communicate effectively with their providers. For this to be achieved there should be an organized “training” among both the health care professionals and public health officials. This educates them more on how to communicate with their patients and approach a problem effectively. Also, the health care professionals such as doctors, chemists, nurses and so on can prescribe or educate their patients more about their prescribed medications.

Sufficient supply of ambulances; Emergency Medical Services (EMS): -
This is defined as a comprehensive system which provides the arrangements of personnel facilities and equipments for the effective, coordinated, and time delivery of health and safety services to victims of sudden illness or injury.
The purpose of EMS focuses on providing timely care to victims of sudden and life-threatening injuries and/or emergencies in order to prevent needless mortality or long-term morbidity. They function as the following: -                                                                                         Accessing emergency
Care in community
Care in route
Care upon arrival to receiving care at the health care facility
As Romanian medical care is not up to the Western standards due to the fact that basic medical supplies are limited, especially outside major cities, it is significant that the public health officials meet up to such criteria of sufficient of EMS. Collaboration with private medical hospitals or investors can contribute in the improvement of EMS.

Reducing the cost of medical services: -
One major problem of the health care system in Romania is financial stability. As the cost of health care services increases, the chances of accessibility declines by half, leaving the low income population defenseless (that is to say, their medical conditions increases for they cannot afford the services provided by the health care).  If the government emphasizes on the high price of the health care services, it is at least expected for the health care professionals to take matters into their own hands. It is easier for them to organize fund raising because they have contacts who can invest in such campaigns. With fund raising as well as  the collaboration with public health officials, projects can arise. Such projects can align with non-governmental organizations whose responsibilities are to ensure that the low income populations are enrolled in programs, and provided free medical privileges.

Conclusion: -
With such strategy, health accessibility will be improved. The prevalence of diseases will decline.

REFERENCES
  1.     Embassy of the United States; Bucharest Romania. http://romania.usembassy.gov/acs/health4.html
  2.    Arora N (2003). Interacting with cancer patients: The significance of physicians’ communication behavior. Social Science & Medicine; 57:791-806.
  3.  Audit Commission (2002). Integrated services for older people: Building a whole system approach in England, London. http://www.audit-commission.gov.uk/reports/AC-/ REPORT. asp?ProdID=0CDFF060-E76E-11d6-B1E3-0060085F8572
  4.     Avendano M, Aro A and Mackenbach J (2005). Socio-Economic Disparities in Physical Health in 10 European Countries. In: Börsch Supan et al. (eds.), Health, Ageing and Retirement in Europe: First results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Mannheim.
  5. John A. Kitzhaber, M.D Governor of Oregon, 1995–2002 Co-Chair, Board of Directors National Policy Consensus Center; improving health care access. Finding solutions in a time of crisis.  http://www.policyconsensus.org/publications/reports/docs/Healthcare.pdf/
  6.  Derogatis, L.R. (1993). Brief Symptom Inventory (BSI) Administration, Scoring, and Procedures Manual, 3rd edition. Minneapolis, MN: National Computer Systems.
  7.  Derogatis, L.R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13: 596-605.
  8. Dunst, C.J. & Leet, H.E. (1987). Measuring the adequacy of resources in households with young children. Child: Care, Health, and Development, 13: 111-125.
  9.       Eiken, S., & Glantowicz, S. (2004). Improving Medicaid access for people experiencing chronic homelessness: State examples. Baltimore, MD: Centers for Medicare and Medicaid Services.
  10.  Improving healthcare access for people with visual impairment and blindness. http://www.bmj.com/content/344/bmj.e542/
  11.   National Association of Country and City Health Officials. Developing a local health department strategic plan. A how-to-guide. http://www.naccho.org/topics/infrastructure/accreditation/upload/strategicplanningguidefinal.pdf/
  12.   People 2010, Conference Edition. Washington, DC: U.S. Department of Health and Human Services, 2000.
  13.  National Committee for Quality Assurance. The State of Managed Care Quality, 2000. Washington, DC: National Committee for Quality Assurance, 2000.
  14. Strobino, D.M., Koenig, M., and Grason, H.A. Approaches and Indicators for Measuring Quality in Region VIII Family Planning Programming. Baltimore, MD: Women’s and Children’s Health Policy Center, Johns Hopkins School of Public Health, 2000
  15.   WHO, Policy recommendations for smoking cessation and treatment of tobacco dependence. http://www.who.int/tobacco/resources/publications/tobacco_dependence/en/HHS Gov. U.S department of health and human services.  

Inequalities to Healthcare: Implications to Survival of Children


About 7 million death among children under the age of 5 worldwide were recorded in the year 2011(UNICEF, 2012). 41% of these deaths occur in Sub Saharan Africa. Despite the fact that these deaths can be prevented through low-cost public health interventions, the death among these children remains high (Grais RF, Dubray C, Gerstl S, Guthmann JP, Djibo A, Nargaye KD,, 2007). 

Understanding the effect of difficult access to health care, inequality in healthcare outcomes, has become a central issue in public health policy (Karen Davis, 1991)
Recent studies show cultural and resource-related factors stood out as a significant limitation to healthcare services in Nigeria.

Nigeria a multi-ethnic country with diverse cultural practices, find it difficult in obtaining permission to seek medical assistant. In traditional African societies such as Nigeria, culture has a pervasive influence on the way women are being treated. In 1988, the culture policy of Nigeria proves the facts that culture represents the totality of the way of life of a given society. Therefore, discrimination against women tend to seek justification in cultural moves, beliefs, and practices. Most Nigerian women are held down from realizing their full rights as individuals (Abara Chinwe, Julie, 2012)
 For example; Hausa women of Northern Nigeria are often seen in public due to adoption of a very strict form of purdah (that is wife seclusion); as result, many Hausa women are limited to freedom of movement, hence are subject to male dominance and social control (Hugo N, 2012). It has been notified that women in purdah are expected to remain indoors at all cost, even in extreme situations such as child labor, a woman in purdah cannot seek for medical assistance until she is permitted by the husband or personally accompanies her to the hospital (Babalola S, Fatusi A, 2009)
As a result of cultural differences in Nigeria, there are ethnic variations in healthcare utilization. Antenatal and postnatal care are lower among Hausa women compared to Igbo or Yoruba tripes (Ononokpono DN, Odimegwu CO, Imasiku E, Adedini S., 2012). 

Meanwhile, higher level of maternal education has been established as a significant factor for the achievement of improved access to health care services. It has been noted that policies to increase child survival through pathways of improved healthcare access are beneficial to children of better educated mothers. This plays an important role because it shapes the cultures, opinions, customs, norms and attitudes, as well as determine exposure to a range of new ideas and values (UNICEF, 2010). 




REFERENCES

1.      ABARA, CHINWE JULIE. (2012). INEQUALITY AND DISCRIMINATION IN NIGERIA, TRADITION AND RELIGION AS NEGATIVE. DEPUTY DIRECTOR/HEAD LAGOS ZONAL OFFICE, NATIONAL COUNCIL FOR ARTS AND CULTURE. Lagos: FEDERAL MINISTRY OF CULTURE AND TOURISM NIGERIA. Retrieved from http://www.fihrm.org/conference/documents/ChinweAbara.pdf
2.       Babalola S, Fatusi A. (2009, September 15). Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754433/
3.       Grais RF, Dubray C, Gerstl S, Guthmann JP, Djibo A, Nargaye KD,. (2007, January 4). Unacceptably High Mortality Related to Measles Epidemics in Niger, Nigeria, and Chad. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761051/
4.       Hugo N. (2012). Purdah: separation of the sexes in northern Nigeria. Retrieved from http://www.consultancyafrica.com/index
5.       Karen Davis. (1991). Inequality and Access to Healthcare . Retrieved from http://www.jstor.org/stable/3350204?seq=1#page_scan_tab_contents
6.       Ononokpono DN, Odimegwu CO, Imasiku E, Adedini S. (2012, November 28). Contextual Determinants of Maternal Health Care Service Utilization in Nigeria. Women and Health, 647-688. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/03630242.2013.826319
7.       UNICEF. (2010). At a glance: Nigeria. Retrieved from www.unicef.org/infobucountry/nigeria_statistics.html
8.       UNICEF. (2012). UNICEF report on child deaths. UNICF. Retrieved from https://www.unicef.org/sowc08/docs/sowc08.pdf