Challenges of implementing sustainable health care delivery in Nigeria under environmental uncertainty

Abstract

Introduction: The increasing cost of health care in developed and developing economies has called for a change in the way health activities are implemented. Nigeria is faced with fundamental health care related challenges coupled with recent security issues. Uncertainty prevails as health system dynamics unfolds.Objectives: To explore the relationship between environmental uncertainty and health care delivery system in Nigeria. The study aims at reviewing the dynamics of health care delivery in some developed economies and Nigeria with regard to methods of adaptation of health care under uncertainty, and developing a framework for sustainable health care delivery. Methods:Databases were searched for relevant literatures using the following keywords: environmental and health uncertainty, Nigerian health care system, Nigerian primary health care, health care financing and sustainability. Other keywords used include: US, Europe and China health care dynamics, among others. Scientific databases obtained from the Internet were used including online journals, which were sourced mainly from the Google. Relationships if any were established and a framework for sustainability developed. Results:Environmental uncertainty has a multiplicity of interactions with different aspects of health care system, resulting in poor infrastructural development, inadequate government funding, absence of integrated system for disease prevention and surveillance, policy reversals, security challenges, and unimpressive health indicators in Nigeria. A framework for implementing sustainable health care delivery under uncertainty is proposed. Discussion and conclusion: Uncertainty abounds in the Nigerian health care delivery system; causing further distortion in development of the health sector. Effective mobilization of health care professionals, use of sustainable care plans by government, use of integrated medical intelligence and surveillance systems, accountability, commitment, and above all quality leadership -will minimize uncertainty factors and enhance health care performance and sustainability in Nigeria.

Implications of Outbound Medical Tourism on Public Health Care Development in Nigeria

“…The health sector of a country constitutes the spine for its economic growth and development (Anyika, 2014). Several countries across the world view health care development as having to do with their citizens, institutions and the legal framework created to integrate resources for effective and efficient health management for the prevention and care of diseases, injuries and illnesses.…”

“…The key factors affecting the aggregate Nigeria health care system development and responsible for Nigerians to become medical tourists include inadequate health facilities and equipment, poor human resources management, lack of motivation and remuneration, corruption, poor health care financing, decreased expenditure on health by the government, political instability, shortage of essential drugs and supplies, inadequate access to health care, absence of integrated system for disease response, prevention, surveillance and treatment; high user fees and inadequate health care providers, and lack of confidence in the nation's health sector (Obansa & Orimisan, 2013). The crisis has led to the timely response of external agencies, including multilateral and bilateral donors (Onyibocha et al, 2014); however, they have still not translated into improved health status and overall quality of life of the Nigerian masses (Anyika, 2014). Nigeria is faced with the challenge of ineffective and inefficient use of past opportunities to develop a sustainable health care system.…”

Dispensing errors and uncertainty: Perspectives of pharmacists in a tertiary health facility in Lagos, Nigeria

“…[5] Power outages, and dilapidated infrastructure in some public health institutions in Nigeria, do affect the storage conditions of medicines and vaccines, and could generate dispensing errors and uncertainty in the quality of drugs that get to the patient. [28,32] 1.2.5 Uncertainty and therapeutic outcomes One of the domains of uncertainty in health care is treatment, which involves risks and benefits of therapeutic interventions. [5] Sommers and Launer [29] posit that when uncertainty is high in a health setting, quality emerges through adaptive relationships, collective sense-making and on-the-job learning from one another.…”

“…Uncertainty associated with dispensing error falls into three categories, according to its fundamental sources, issues and locus, [5] and include: a probability (clinical uncertainty), ambiguity (imprecision of estimates), and complexity (multifactorial and multi-disciplinary). [5,28] It could also result from living within complex adaptive systems where varying mixes of natural and man-made (mechanical/structural) systems interact and resist control. [29] In health care, judgment and decision tasks are uncertain -characterized by uncertainty of information or outcome or by a concern for a person's preferences.…”

Code red: Towards authentic transformational leadership of emergency management

“…[38,39] A systems perspective of emergency management is informed by the theory of open complex adaptive systems, whereby systems are organize themselves in response to external environmental stimuli in the form of small to catastrophic emergency events, all requiring systems intervention to safeguard lives and mitigate injuries. [40][41][42][43][44][45][46][47] Emergency management systems are composed of five complex subsystems, each with unique and specific internal self-organizing processes. These are summarized in Table 1.…”