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CHAPTER ONE

INTRODUCTION

1.1 Background of Study

A health policy is an organizational framework for the distribution of health care

needs of a given community. It is a complex system of inter-related elements that contribute

to the health of the people in their homes, educational institutions, in work places, the public

(social or recreational) and the psychological environments as well as the directly health and

health-related sectors. Health is wealth and to create wealth at the individual, family,

community or national level, people must be healthy; to enjoy wealth that is created, an

individual, family, community or nation must be healthy. Health is good entry point for

breaking the vicious cycle of ill-health, poverty and under-development and for converting it

to the vicious circle of improved health status, prosperity and sustainable development

(WHO, 2020).

Health Policy development and implementation is one of the catalyst that aids in

sustainability of the health sector. Policy can be defined as the laws, ordinances, and rules, as

well as the government (or other) support to implement projects on the ground (Neera,

Yufang, Yao, Liyum and Yongpin, 2017). A heath sector policy therefore is a conscious plan

of action and the action itself, initiated to solve a specific social problem in the health sector

(Bolaji, 2020). Yusuf et.al, (2017) propose that a health sector policy is a definite course or

method of action selected from and in the light of given conditions to guide and usually

determine present and future decisions in the health sector. National Health Policy (2016)

noted that health policy can be defined as the decisions, plans, and actions that are undertaken

to achieve specific healthcare goals within a society.

Health policy makers play a fundamental role in every country’s health sector. Policy

makers on health issues are mainly saddled with the responsibility of translating policy
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documents into programmes and interventions to promote public health and primary care. In

countries where health policy makers have been unable to implement useful policies and

health legislations, the health systems tend to under-perform. Therefore, the role of health

policy makers remains crucial to the development of any health system. When Nigerian

health policy makers fail in their duties such as ensuring that policies for health, health

legislations, declarations, frameworks and programmes interventions are the properly

implemented at all levels, then the health systems under-performs.

Health policy formulation and implementation involves a well-planned patterns or

course of activity. It requires a thorough close-knit relation and interaction between the

governmental agencies via the executive, legislature, bureaucracy, and judiciary. The

objective of health policy is always and for all times the betterment of the entire society.

Implementation is required to ensure that those policies have their desired effect (Vedanthan

and Kamruddin, 2018). Ajulor (2018) states that policy implementation is the process of

changing a formulated policy into reality. It provides the operational area of function in

carrying out public policy declared by competent authority. In the execution of public policy,

the combination of human, material, machine, and money is highly necessary

The success of any health system in Akwa Ibom State lies in the nature and manner of

health policy making and execution process employed. Health policy as an instrument of

government affects the lives of each person in a state, as it occupies a key position in the

success of every administration, whether public, private or not-for-profit making

organization. Health policy formulation and execution in Akwa Ibom State is central to

sustainable health delivery. Implementation of formulated health policies helps to address

recognized problems in the health sector. Based on the afore stated back ground, it therefore

becomes expedient to assess public policy implementation and development in Akwa Ibom

State (2015- 2021).

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1.2 Statement of the Problem

The problem of health policy or health policy implementation in Akwa Ibom State has

not been the non-conceptualization or formulation of good policies. Rather, the translation of

good policies into good outputs and eventual outcomes has been the bane of public policy

process in the state at large. Many policy objectives in Akwa Ibom State have not been

actualized as result of what transpires between policy makers, implementers and recipients in

the policy process because many of the times, the policy implementers do not implement in

accordance or exactly what was made by policy makers thereby making the policy recipients

not to be satisfied with the policy that was made.

Both at the State and local government levels, several health policies have over the

years been developed, but have failed to achieve the desired outcome due to poor

implementation. Critics argued that the lack of enforcement is the graveyard of the previous

health policies developed in the country (Ahmed, 2016). The application of most of the

national health policies is often bedeviled with challenges and abandoned unimplemented.

It is hardly debatable that implementation is the bane of public policies and programmes in

Akwa Ibom State. A well formulated policy or programme is useless if not properly

implemented as its stated objectives will not be realized. Indeed, there is a usually wide gap

between formulated policy goals and the achievement of those goals as a result of ineffective

implementation in almost all facets of public administration in Akwa Ibom State.

The results of health policy failures in Nigeria in general and Akwa Ibom State in

particular have been devastating leading to several problems which such failures has brought

untold hardship on the citizens. Health policy failures in Akwa Ibom State willed to

widespread problems but if the policies in Akwa Ibom State are well implemented, it will

lower incidences such as high maternal mortality, increased incidence of life threatening

diseases, reduced assess to quality medical attention by citizens, obsolete infrastructure,

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inadequate medical facilities, underfunding of the hospitals and numerous other problems.

Having observed that poor implementation of health polices has been a recurrent feature in

Nigeria and its negative impacts are colossal; It then becomes imperative to assess the public

policy implementation and development in Akwa Ibom State.

1.3 Objective of the Study

1.3.1 Main Objective

The main objective of the study is to assess health policy implementation and

development in Akwa Ibom State between 2015 and 2021.

1.3.2 Specific Objectives

The specific objectives of this study were;

i. to examine the effects of health policy implementation on Primary health care services.

ii. to examine the effects of health policy implementation on Child Health Care Services.

iii. to examine if the polices on health has reduce the incidence of fake or unapproved

drugs in the State.

1.4 Research Questions

This study was guided by the following research questions;

i. What are the effects of health policy implementation on Primary Health Care

Services?

ii. What are the effects of health policy implementation on Child Health Care Services?

iii. Has government policies on health reduce the incidence of fake or unapproved drugs

in the State?
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1.5 Research Hypotheses

In order of the researcher to arrive at a reliable conclusion as regard this study, it is

important to formulate the hypotheses (i.e. null and alternative) so that at the end, one could

be accepted and the other rejected to facilitate the dependability of this research work thus.

1. Ho: Implemented health policies has significant effect on Primary Health Care

Services in Akwa Ibom State

Hi: Implemented health policy does not have significant effect on Primary Health

Care Services in Akwa Ibom State

2. Ho: Implemented health policies has significant effect on Child Health Care Services

in Akwa Ibom State

Hi: Implemented health policies does not have significant effect on Child Health Care

Services in Akwa Ibom State

3. Ho: Health Policies in Akwa Ibom State has reduced the incidence of Fake or

Unapproved Drugs?

Hi: Health Policies in Akwa Ibom State has not reduced the incidence of Fake or

Unapproved Drugs?

1.6 Significance of the Study

This study has both theoretical and empirical significance. Empirically, policy

experts, politicians, legislators and health workers will find the findings of the study useful as

major issues discovered will serve as a guide to the federal government in their choice of

policy implementation.

Theoretically, the study will be of great importance to the students, teachers, lecturers

and future researchers will add to the pool of existing literature in the subject matter.
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1.7 Scope of the Study

This study focuses on the health policy implementation and development of Akwa

Ibom State. This study is limited to Akwa Ibom State and especially the government on

policy implementation and how it affects the development of health sector in the state. The

scope of this study is to examine the process of policy implementation and development in

the state and drawing up a comparative analysis with a reasonable conclusion.

The study centered on health policy implementation and development in Akwa Ibom

State. The content scope of the study is delimited to health policy formulated and

implemented between 2015 to 2021.

1.8 Limitation of the Study

Limitations of the study are those constraints the researcher faced in the course of

carrying out this study. In carrying out this research, some basic problems were encountered

which to an extent inflexed the debt nesses of the research primary among this problem

include:

Finance: Work of this nature requires finance for assembling of materials used for study, but

due to limited resources that are easily accessible and affordable, it hindered an in-depth

investigation demanded and made it difficult to compare fact

Lack of Statistical Data: Information sought for are either totally unavailable or cannot be

released to the public, despite all these short comings, much afford was indeed does not out

weight the desire ability or need to carry out a sound research Therefore. Limitations of this

study bordered on finance, getting data from relevant government agencies, feedback from

respondents and time constraint, among others. These limitations notwithstanding, the

findings of the study would reflect the nature of policy implementation of industrialization in

Akwa Ibom State.

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1.9 Definition of Terms

Policy: A policy is a conscious plan of action and the action itself, initiated to solve a specific

social problem.

Health policy: Health policy can be defined as the "decisions, plans, and actions that are

undertaken to achieve specific healthcare goals within a society".

Policy Implementation: Policy implementation is the process of assembling resources

(including people), allocating resources and utilizing resources (operations), in order to

achieve policy objectives.

1.10 Organization of the Study

The study will be composed of five chapters which include;

Chapter One: This shall provide background of the study, the research problem, study

objectives, study research questions, significance of the study, scope of the study and

definition of terms

Chapter Two: This chapter shall be dedicated to reviewing relevant literature with respect to

the current topic and also looking at relevant theories that will guide the study

Chapter Three: This chapter will concentrate on the methodology for the study and will

specify the design adopted for the study, the population of the study, the sample and sampling

frame, instrumentation, validation of the instrument, method of data collection and method of

data analysis

Chapter Four: Data collected during the study will be presented, analysed and discussed in

this chapter

Chapter Five: This shall be the last chapter of the study. It shall concentrate on the

summary, conclusion and recommendations made after the study.

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CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.0. Introduction

In brief, past studies on public policy have been mainly dominated by scholars of

political science and public administration and have tended to concentrate more on the

contents of policy, the process of its formulation and its implementation. The study of public

policy has evolved into what is virtually a new branch of the social sciences- the so called

policy sciences. This concept of policy sciences was first formulated (Harold Lasswell 1951).

Today, the policy sciences have gone far beyond new and naïve aspirations for societal

relevant knowledge. The policy science movement grew out of a quest for a science of

policy. Policy science is a new supra-discipline, oriented towards the improvement of policy-

making and characterized by a series of paradigms different in important respects from

contemporary normal sciences.

Public policy is best described as the broad area of government laws, regulations,

court decisions, and local ordinances. Today, government affects all aspects of our lives.

Everyone has a stake in the public policies enacted by federal, state, and local governments:

Many citizens and groups try to influence public policy through the political process by

supporting candidates and political parties. That's a good way to make a positive impact, but

not the best way. Politicians and political parties come and go. Their positions on issues can

change due to circumstances. They can be voted out of power as easily as they are voted in.

The best way to make a lasting impact on public policy is to change public opinion. When

you change the beliefs of the people, politicians and political parties change with them.
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2.1.1 Policy Making Process

Policy making is the process by which the government or enterprise develops of

formulates and implements an effective strategy to meet desired objectives. Strategy in this

context is the unified comprehensive plan that is developed to reach these objectives. Public

policy process can be classified into five stages.

2.1.2 Policy Implementation

Policy implementation is the process of assembling resources (including people),

allocating resources and utilizing resources (operations), in order to achieve policy

objectives. The administrative agencies are the primary implementers of public policy, but

the judiciary and legislature a are also involved. The legislature may over-rule the decision of

the executive by two-third majority, while the Courts interpret statutes and administrative

rules and regulations. Agencies also make "administrative laws" through delegated legislative

authority by the legislature when implementing statutes passed by the congress or National

Assembly. The application of a public policy passed by the Legislature can change the nature

of the policy itself, as implementation often affects policy content (Anderson et al, 1978).

2.1.3 Policy Monitoring and Evaluation Stage

This is the last stage of the policy process. It involves an attempt to determine whether

a policy has actually worked or not. It is essential to monitor formulated policies during the

implementation stage. Monitoring involves the assessment of progress on public policies.

programmes and projects in comparison with what was initially planned and budgeted. Its

object is the detection of deviations, so that corrective measures could be applied. Evaluation,

on the other hand, is concerned more with results of a policy or programme. It tries to

determine the relevance, effectiveness and impact of policy and programme activities in the
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light of their objectives. It is also concerned with the efficiency with which programmes are

deficiencies. (Anderson, Brady and Bullock, 1978) categorized evaluation in two ways;

i. Political evaluation to assess the political feasibility of the policy;

ii. Systematic evaluation, which seeks to objectively measure the impact of the policies

and determine how well objectives are actually accomplished. Such an evaluation

focuses on the effects which a policy has on the problem to which it is directed to

solve.

2.1.4 Conceptual Framework

Meaning of Public Policy

The concept of public policy presupposes that there is a domain of life which is not

private or purely individual, but held in common. It is important to understand the concept of

"public" for a discussion of public policy. We often use such terms as "public interest" public

sector", "public servant" and so on. The starting point is that "public policy" has to do with

those spheres which are so labelled as "public" as opposed to spheres involving the idea of

"private". The concept of public policy presupposes that there is an area or domain of life

which is not private or purely individual, but held in common. The public comprises that

domain of human activity which is regarded as requiring governmental intervention or

common action.

Public policy has been variably defined. In majority of cases, differences in

definitions are semantic than substantive. Dye (1995) defines public policy as whatever

governments choose to do or not to do. According to Dye (1995:2), public policy is

conceived as whatever governments choose to do or not to do. To him, however,

governments do many things in the state. Thus, governments regulate conflict within the

society, they organize society to carry on conflict with other societies, they distribute a great
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variety of symbolic rewards and material services to members of the society among others. A

critical look at Dye's definition indicates that governments can as well refuse to participate in

the contemporary globalization process hitherto championed by the capitalist states of US,

France and Britain. Hence, the argument by some scholars that the Third World countries like

Nigeria, are coerced and further integrated into the orbit of global capitalism is baseless and

unfounded implicit in the above assertion. This is clearly because ax Dye posits, public policy

which is the mechanism through which the nation states are expected to remove trade barriers

and open their borders for the world to be globalized is purely a matter of choice by the state

and not by coercion.

In spite of the above argument, we must not lose sight on the clandestine techniques

usually adopted by the imperial countries to achieve their agenda in the third world. Thus,

evidence has shown that the imperial states usually advise the third world, Nigeria inclusive

to adopt certain economic prescriptions such as liberalization, deregulation, monitization etc

as conditions to receive assistance or aids from the Bretton Word Institutions (IMF and

World Bank). Since the third world countries do not often have any other alternative, they

comply with these exploitative directives through the adjustment of their public policy

decision making apparatus. Consequently, Nigeria is a victim of the above ugly political and

economic situation. In Nigeria, the government has adopted several economic policies that

adversely affected the economy of the country. For instance, the Babangida's regime adopted

Structural Adjustment Programme (SAP) in 1986 which rather than revamping the Nigeria's

economy as articulated and professed by the IMF and World Bank, only succeeded in

distorting and worsening the country's economy. It is equally imperative to note that before

the adoption of SAP in 1986, the Shagari's administration had earlier adopted what was

referred to as Austerity Measure a policy that only succeeded in compelling Nigerians to

"tighten their trouser belts. This particular policy also subjected Nigerians to abject poverty,
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malnutrition, hunger, diseases, untimely deaths, among others.

The failure of policy makers to put the above critical issues into consideration before

adopting these policies, which they usually referred to as "meeting the minimum acceptable

global practice, has resulted in the collapse and failures of most government policies like

privatization and its kindred terms ultimately designed to achieve desired policy goals in

Nigeria. This is supported by Adamolekun (1983:142) who avers that "public policy is a

course-setting involving decision of the widest ramifications and longest time perspective in

the life of an organization" However, this therefore suggests that the adoption, formulation

and implementation of economic policies like privatization, commercialization, deregulation

particularly in Nigerian, ought not to have been done in a hurry. The implication of these

policies to the economy and the interests of the Masses must have been considered first by

the policy makers in Nigeria. Therefore, public policies in Nigeria, particularly those that

have far-reaching implications on the citizens should not be implemented simply because the

issues in contention are global. Rather, Government should adopt and implement policies that

have the highest advantage to the state and less disadvantages and negative effects on both

the citizens and the economy (Anifowose et al, 2010),

Dimock, et al (1983:40) sees public policy as "deciding at any time or place what

objectives and substantive measures should be chosen in order to deal with a particular

problem" Here Dimock, et al (1983) agrees that public policy as what is decided by the

government, it objective and what substantive measures should be choose Government tends

to put substantive measures in order to deal with a particular problem because without the

government making policy there will be no implementation.

Chandler and Plano (1988:40) defined public policy as "the strategic use of resources

to alleviate national problems or governmental concerns" According to Chandler and Plano

here they opines that public policy resources to alleviate national problem, it is focus on the
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use of available resources to solve national problem Government uses resources that are

available to solve national problem.

Freeman and Sherwoods (1968) posit that it is the public response to the interest in

improving the human conditions. In these definitions, there is divergence between what

governments decide to do and what they actually do Public policy is a guide which

government has designed for direction and practice in certain problem areas. There are

several implications of this concept of public policy as a relatively stable, purposive course of

action followed by government in dealing with some problem or matter of concern. First, the

definition links policy to purposive or goal-oriented action rather than to random behaviour

or chance occurrences. Public policies in modern political systems do not, by and large, just

happen. They are instead design to accomplish specified goals or produce definite results.

although these are not always achieved. Second, policies consist of courses or patterns of

action taken over time by governmental officials rather than their separate, discrete decisions

Third, public policies emerge in response to policy demands, or those claims for action or

inaction on some public issue made by other actors - private citizens, group representatives,

or legislators and other public officials-upon government officials and agencies. In response

to policy demands, public officials make decisions that give content and direction to public

policy. These decisions may enact statutes, issue executive orders or edicts, promulgate

administrative rules, or make judicial interpretations of laws.

Policy is seen as a way of doing things or decision rule; while the second considers it

as substantive programmes referring specifically to the context of what is being done and not

necessarily how it is being done (Pola, 2021). In like manner, Ross (2019) suggested that

policy should be seen as a long series of more or less related activities and their consequences

for those concerned rather than as a discrete decision. Policy is a projected programme of

goal, values and practices; policy process is the formulation, promulgation and application of
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identifications, demand and expectations concerning the future interpersonal relations of the

self.

Sharkansky (2019) defined policy as a proposal, an on-going programme, or the goals

of a programme, major decisions or the refusal to take certain decisions. Egonmwan (2018)

sees public policy as a government programme of action. Continuing, public policy stands for

various degrees of goal articulation and normative regulation of government activities. This

means what government intends to do or achieve (goals) and how it intends to do it

(implements)

Ugoo E. Abba, et. al. (2018) defined policy as a principle or group of related

principles, with their consequent rules of actions, that condition and govern the successful

achievement of the business objectives to which they are directed. They maintained that a

policy should contain both a principle and a rule of action. A principle is an expression that is

accepted as a significant truth with respect to the relationships between cause and effect in a

particular problem. A rule of action is a restrictive statement of the application of the

principle in a particular business situation. Both should be stated together for maximum

effectiveness, although one or the other is occasionally omitted when it is clearly implied.

The operative words in the above definitions are “behavioural consistency and receptiveness”

associated with government efforts to resolve public problems.

Public policy refers to important activities of government. It is whatever government

chooses to do or not to do. To attain economic and social development, government pursues

diverse versions of economic programmes and reforms to bequeath a prosperous socio-

economic future. The transformation Agenda of the federal government of Nigeria is one of

such policies. Achieving the core objectives of this policy will put Nigeria on the path of

recovery and growth, and ensure increase access to basic amenities of life for the citizenry.

The formally articulated aims of public policies are the consolidation or furtherance of the
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public interest as usually justified by the authorities, although analysis may reveal self

seeking or sectional motives behind many policies (Egonmwan, 2020). Inasmuch as public

policies are developed by governmental bodies and officials, non-governmental actors may of

course influence public policy development. According to Rein (1971) they are the people

who engage in the daily affairs of a political system. `These people are recognized by most

members of the system as having responsibility for these matters, and take actions that are

accepted as being binding most of the time by most of the mentors as long as they act within

the limit of their roles (Ekpo, 2020).

2.1.5 Health Policy

Health policy can be defined as the "decisions, plans, and actions that are undertaken

to achieve specific healthcare goals within a society". (National Health Policy, 2021).

According to the World Health Organization (2020) an explicit health policy can achieve

several things: it defines a vision for the future; it outlines priorities and the expected roles of

different groups; and it builds consensus and informs people.

Health policy often refers to the health-related content of a policy. Understood in this

sense, there are many categories of health policies, including global health policy, public

health policy, mental health policy, health care services policy, insurance policy, personal

healthcare policy, pharmaceutical policy, and policies related to public health such as

vaccination policy, tobacco control policy or breastfeeding promotion policy. Health policy

may also cover topics related to healthcare delivery, for example of financing and provision,

access to care, quality of care, and health equity (National Health Policy, 2021).

Health policy also includes the governance and implementation of health-related policy,

sometimes referred to as health governance, health systems governance or healthcare

governance. Conceptual models can help show the flow from health-related policy
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development to health-related policy and program implementation and to health systems and

health outcomes. Policy should be understood as more than a national law or health policy

that supports a program or intervention. Operational policies are the rules, regulations,

guidelines, and administrative norms that governments use to translate national laws and

policies into programs and services (Ahmed, 2021).

The policy process encompasses decisions made at a national or decentralized level

(including funding decisions) that affect whether and how services are delivered. Thus,

attention must be paid to policies at multiple levels of the health system and over time to

ensure sustainable scale-up. A supportive policy environment will facilitate the scale-up of

health interventions.

There are many aspects of politics and evidence that can influence the decision of a

government, private sector business or other group to adopt a specific policy. Evidence-based

policy relies on the use of science and rigorous studies such as randomized controlled trials to

identify programs and practices capable of improving policy relevant outcomes. Most

political debates surround personal health care policies, especially those that seek to reform

healthcare delivery, and can typically be categorized as either philosophical or economic.

Philosophical debates center around questions about individual rights, ethics and government

authority, while economic topics include how to maximize the efficiency of health care

delivery and minimize costs.

The modern concept of healthcare involves access to medical professionals from

various fields as well as medical technology, such as medications and surgical equipment. It

also involves access to the latest information and evidence from research, including medical

research and health services research (National Health Policy, 2021). In many countries it is

left to the individual to gain access to healthcare goods and services by paying for them

directly as out-of-pocket expenses, and to private sector players in the medical and
 17

pharmaceutical industries to develop research. Planning and production of health human

resources is distributed among labour market participants.

Other countries have an explicit policy to ensure and support access for all of its

citizens, to fund health research, and to plan for adequate numbers, distribution and quality of

health workers to meet healthcare goals. Many governments around the world have

established universal health care, which takes the burden of healthcare expenses off of private

businesses or individuals through pooling of financial risk. There are a variety of arguments

for and against universal healthcare and related health policies. Healthcare is an important

part of health systems and therefore it often accounts for one of the largest areas of spending

for both governments and individuals all over the world (Ahmed, 2021).

2.1.6 National Health Policy in Nigeria

The National Health Policy and Strategy to Achieve Health for All Nigerians,

promulgated in 1988, was the first comprehensive national health policy and it was acclaimed

to be a good policy document. But this was 16 years ago. Between then and now, many

things have changed and it is, therefore, necessary to review the policy to reflect the new

realities and trends in our national health situation (National Health Policy, 2021).

A National Health Summit was organized in 1995. Participants which included health

experts, leaders, policy makers, health providers, health planners and administrators and

representatives of health-related sectors examined the factors that had militated against

improvement in our national health status and tried to chart a course of remedial action that

would take Nigerians into the 21st Century and beyond in good health. The recommendations

that emerged from the Summit and other subsequent activities called for the need to take a

critical look at the National Health Policy with a view to effecting those changes that would

accelerate health development in Nigeria. The Federal Ministry of Health organized the
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review of the policy during 1996 and 1997 but the revised policy was not formally endorsed.

The Health Sector Reform Change Agents, products of the Change Agent Programme (CAP)

which was developed jointly with the Federal Government of Nigeria by the Department for

International Development (DFID) and funded by the latter, decided to bring their

experiences from the developing countries they visited to bear on the health sector reform

process in Nigeria by, among other things, working further on the revised policy document.

In addition, they organized some consultations on their new draft and submitted their output

as part of their contribution to the development of a comprehensive health sector reform

programme that was embarked upon since the second half of last year (Obodo, 2018;

Makinde, 2018).

Many professional organizations and other stakeholders made some written

submissions to the new Health Minister as part of their contributions to the development of

the health sector reform programme, the revision of the National Health Policy, and the

drafting of a National Health Bill. Relevant parts of their contributions were therefore used to

further refine the draft revised National health Policy submitted by the Health Sector Reform

Change Agents.

A National Consultative meeting involving States’ Health Commissioners and

representatives of various other stakeholders was organized to review the final version of the

revised policy document. The useful comments and suggestions that were made at the

Consultative meeting that also reviewed the draft National Health Bill were used to develop

this current version of the National Health Policy (National Health Policy, 2021). From the

foregoing, one can see that the revised policy document has gone through many iterations of

the earlier version by incorporating the views and comments of a wide range of stakeholders.

It is expected that this revised health 2 policy will have a greater chance of successful

implementation especially given the fact that the National Health Bill, when passed, will
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provide the necessary legal backing to the policy (Obodo, 2018; Makinde, 2018).

2.1.7 The historical context of health policy development in Nigeria

First, a discussion of the historical development of health policies in Nigeria is

appropriate here. The period between 1472 and 1880 witnessed the arrival of the country's

western-style health care delivery system. Between 1880 and 1945 saw the building and

staffing of hospitals by Christian missionary health care workers. From 1945 till today

witnessed the development of several national health plans starting with the First Colonial

Development Plan in 1945-1955 (Decade of Development). The other ideas that evolved are

the following

i. 1956-1962: The Second Colonial Development plan

ii. 1962-1968: The First National Development Plan

iii. 1970-1975: The Second National Development Plan

iv. 1975-1980: The Third National Development

v. 1981-1985: The Fourth National Development Plan

vi. 2020-2018: Five Year Strategic Plan (Scott Emuakpor, 2019).

The new national health policy adopted in 2021 launched the National health

insurance scheme that protects citizens against high costs of treatment, and fair financing of

health care. The National Health Act of 2020 and the National Health Policy of 2021 were

established to provide the framework for the development, regulation, and management of

national health systems and set standards for delivering services. The new policy was a

response to several unfinished agenda of the Millennium Development Goals (MDGs); the

new Sustainable Development Goals (SDGs); emerging health issues (especially epidemics);

the provision of the National Health Act 2020; and the new Primary Health Care (PHC)

governance reform of bringing Primary Health Care under one Roof and Nigerians’ renewed
 20

commitment to Universal Health Coverage (UHC). Other considerations were globalization;

climate change; challenges of insurgency, and its impact on the Nigerian health system.

Furthermore, the countries' experience in implementing the Revised National Health Policy

2020 and the National Strategic Health Development plan (2019-2020) provided the basis for

the development of the new policy. The 2021 National Health Policy acknowledged the

transition of disease burden in the country from communicable infectious diseases to non-

communicable lifestyle diseases; thus, the strong rationale for the active involvement of

physiotherapists in policy development and implementation.

The underlying philosophy and central focus of the National Health Policy are based

on the primary health care (PHC) concept that the services provided can reach the rural

communities, where the majority of Nigerians reside. The goal of the PHC is to prevent and

treat the disease, which is responsible for much morbidity, disability, and mortality (National

Health Policy, 2021). Included in the National Health Policy objective is the involvement of

diverse health care workers in PHC. Unfortunately, the participation of physiotherapy in

primary healthcare is yet to be appreciated and given prominence. There has been a strong

focus on PHC as the cornerstone of the Nigerian health system since 1975(Federal Ministry

of Health, 1988). WHO initiated the community-based rehabilitation (CBR) program

following the Alma-Ata Declaration in 1978 to enhance the quality of life for people with

disabilities and their families, meet their basic needs, and ensure their inclusion and

participation (World Health Organization, 2019. The CBR was initially a strategy to increase

access to rehabilitation services in resource-constrained settings. However, CBR is now a

multi-sectorial approach working to improve the equalization of opportunities and social

inclusion of people with disabilities while combating the perpetual cycle of poverty and

disability (World Health Organization, 2020). One of the components of CBR is the

provision of functional rehabilitation services in rural areas. Though captured in the 2021
 21

National Health Policy, this program is yet to succeed in its implementation.

2.1.8 Features of the New National Health Policy

The new National Health Policy has been formulated within the context of: the Health

Strategy of the New Partnership for Africa’s Development (NEPAD), a pledge by African

leaders based on a common vision and a firm conviction that they have a pressing duty to

eradicate poverty and place their countries individually and collectively on a path of

sustainable growth and development.

The Millennium Development Goals (MDGs) to which Nigeria, like other countries,

has committed to achieve. The New Economic Empowerment and Development Strategy

(NEEDS) which is aimed at re-orienting the values of Nigerians, reforming government and

institutions, growing the role of the private sector, and enshrining a social charter on human

development with the people of Nigeria. The development of a comprehensive health sector

reform programme as an integral part of the NEEDS. (Obodo, 2018; Makinde, 2018).

2.1.9 Underlying Principles and Values of the New National Health Policy

The principles of social justice and equity and the ideals of freedom and opportunity

that have been affirmed in the 1999 Constitution of the Federal Republic of Nigeria. Health

and access to quality and affordable health care is a human right. Equity in health care and in

health for all Nigerians is an ideal goal to be pursued. Primary health care (HC) shall remain

the basic philosophy and strategy for national health development. Good quality health care

shall be assured through cost-effective interventions that are targeted at priority health

problems. A high level of efficiency and accountability shall be maintained in the

development and management of the national health system. Effective partnership and

collaboration between various health actors shall be pursued while safeguarding the identity

of each.
 22

Since health is an integral part of overall development, inter-sectoral cooperation and

collaboration between the different health-related Ministries, 6 development agencies and

other relevant institutions shall be strengthened; and a gender sensitive and responsive

national health system shall be achieved by mainstreaming gender considerations and

implementation of all health programmes (World Health Organisation, 2020).

2.1.10 Overall National Health Policy Objective

To strengthen the national health system such that it will able to provide effective,

efficient quality, accessible and affordable health services that will improve the health status

of Nigerians through the achievement of the health-related Millennium Development Goals

(MDGs).

2.1.11 Targets of the National Health Policy

The main health policy targets are the same as the health targets of the Millennium

Development Goals, namely:

Article I. Reduce by two-thirds, between 1990 and 2020, the under-5 mortality rate.

Article II. Reduce by three-quarters, between 1990 and 2020, the maternal mortality rate.

Article III. To have halted by 2020 and begun to reverse the spread of, HIV/AIDS.

Article IV. To have halted by 2020 and begun to reverse the incidence of malaria and

other major diseases.

 23

2.1.12 National Health Policy Declaration and Commitments

The federal, state, local governments and private health sector of Nigeria hereby

commit themselves and all the people to intensive action to attain the goal of health for all

citizens, that is, a level of health that will permit them to lead socially and economically

productive lives at the highest possible level.

All Governments of the Federation are convinced that the health of the people not

only contributes to better quality of lives but is also essential for the sustained economic and

social development of the country as a whole. The people of this nation have the right to

participate individually and collectively in the planning and implementation of their health

care. However, this is not only their right, but also their solemn duty.

Primary health care is the key to attaining the goal of health for all people of this

country. Primary health care is essential health care based on practical, scientifically sound

and socially acceptable methods and technology made universally accessible to individuals

and families in the community through their full involvement and at a cost that the

community and state can afford to maintain at every stage of their development in the spirit

of self-reliance. It 7 shall form an integral part both of the national health system, of which its

central function and main focus is the overall social and economic development of the

community. All Governments and the people are determined to formulate strategies and plans

of action, particularly action to be taken by governments, to re-launch and sustain primary

health care in accordance with this national health policy.

All Governments agree to co-operate among themselves in a spirit of partnership and

service to ensure primary health care for all citizens, since the attainment of health by people

in any area directly concerns and benefits others in the Federation (World Health

Organisation, 2020).
 24

2.1.13 The Federal Government undertakes the following health policy programs

i. To provide policy guidance and strategic support to States, local governments and the

private sector in their efforts at establishing health systems that are primary health

care oriented and are accessible to all their people.

ii. To coordinate efforts in order to ensure a coherent, nationwide health system

iii. To provide incentives in selected health fields to the best of its economic ability to

promote this endeavour.

iv. In collaboration with the State and Local Governments and the organized private

sector as well as Non-Governmental Organizations (NGOs), to undertake the overall

responsibility for monitoring and evaluation of the implementation of the health

strategy. Governments accept to exercise political will to mobilize and use all

available health resources rationally.

2.1.14 Major Thrusts of National Health Policy

The major thrusts of the National Health Policy are relate to;

i. National Health System and Management.

ii. National Health Care Resources.

iii. National Health Interventions.

iv. National Health Information System.

v. Partnerships for Health Development.

vi. Health Research.

vii. National Health Care Laws (National Health Policy, 2021).

 25

2.1.15 National Health Policy Implementation, Monitoring and Evaluation

Health policy development and its implementation in any nation are a complex and

dynamic assignment that involves several stakeholders' active participation in a well-

coordinated, strategic, and synergetic manner. There is no single blueprint for conducting

policy process because it varies based on the political, historical, and socio-economic

situation prevailing in each country (World Health Organisation, 2020). In Nigeria, the

stakeholders in health policy development and implementation include but not limited to the

Federal Ministry of Health as initiator, its agencies, representatives of developing partners,

the private health sector, professional Regulatory bodies, civil society organizations,

Ministries of health from States/FCT and the academia (National Health Policy, 2021). Inputs

are also garnered from the health care professional associations and individual healthcare

providers. The implementation of health policy involves transforming the policy statements

into a plan of action by the agencies.

To achieve the policy objectives, the Federal Ministry of Health shall develop and/or

implement the following with all the relevant stakeholders;

i. The new National Health Act

ii. Health Sector Reform Programme, 2020 – 2018

iii. Strategic Plan for Accelerating the Attainment of the Millennium Development Goals,

2020 – 2018

iv. Recommendations on Repositioning the Federal Ministry of Health, 2020

v. Recommendations on Strengthening the Coordination and Management of the

Tertiary Health Institutions, 2020

vi. Blueprint on Revitalization of Primary Health Care in Nigeria, 2020

vii. Blueprint on Accelerating the Implementation of the National Health Insurance

Scheme
 26

viii. Strategic Plans for the Priority Health Problems e.g., Roll Back Malaria, HIV/AIDS,

Reproductive Health, Polio Eradication and Routine Immunization, tuberculosis and

Leprosy, etc. States shall be expected to develop and implement similar plans and

programmes within the context of national guidelines

2.1.16 Monitoring, Evaluation and Feedback Tools

Relevant indicators shall be developed for monitoring and evaluating progress made

in the implementation of the revised health policy. Most of the indicators 59 cover input,

process and impact indicators and they are already spelt out clearly in the documents on

Health Sector Reform Programme, Strategic Plan for Accelerating the Attainment of the

MDGs, the Blueprint for the Revitalization of PHC and the various Strategic Plans for

Priority Health Problems. The following indicators of health related MDGs shall receive the

major focus;

i. Prevalence of underweight children under 5 years of age

ii. Under-5 mortality rate

iii. Infant mortality rate

iv. Proportion of 1-year-old children immunized against measles

v. Maternal mortality ratio

vi. Proportion of births attended by skilled health personnel

vii. HIV prevalence among young people aged 15 to 24 years

viii. Number of children orphaned by HIV/AIDS

ix. Prevalence and death rates associated with malaria

x. Proportion of population in malaria-risk areas using effective malaria prevention and

treatment measures

xi. Prevalence and death rates associated with tuberculosis

 27

xii. Proportion of tuberculosis cases detected and cured under Directly Observed

Treatment Short-course (DOTS)

xiii. Proportion of population with access to affordable essential commodities on a

sustainable basis.

2.1.17 Policy implementation

The revised National Health Promotion Policy (NHPP 2019) clarifies policy direction

and sets standards. Translating the policy and standards into actionable interventions requires

strengthening existing health promotion systems and setting up new ones such as planning

and periodic implementation review systems where they do not exist. Additionally,

implementation will be driven by ancillary documents including a variety of Plans,

Guidelines, Standard Operating Procedures (SOPs) and Algorithms.

After another round of difficult decision-making, finally the policy comes to the stage

of implementation. Here, the decision makers should be aware (and maybe made aware by

the policy analysts) of the necessary infrastructure for proper implementation, or the actions

that should be taken to strengthen or enlarge it. Those actions become priority and take

immediate execution. This is the test for both the political willingness and the potentials for

success of the selected policy alternative. Implementation involves three activities directed

towards putting a policy into effect. The three activities required for implementation are as

follows;

i. Interpretation,

ii. Organization and,

iii. Application.

Interpretation means the translation of the programmatic language into acceptable and

feasible administrative directives. These can be laws, regulations, decisions and resource
 28

allocation. Organization requires the establishment of administrative units and methods

necessary to put a programme into effect. Resources like money, building, staff, equipment

are important for implementation of the formulated policy issues. Application requires the

services to be routinely administered.

The process of interpreting and organization to implement policy goals it is often

termed strategic planning, that must be followed by operational planning and management as

part of the application phase of the implementation. Yet, putting certain policy in the daylight

should go hand in hand with its monitoring and evaluation - for the simple reason of knowing

its effects, but also gaps and challenges, as well as possibilities for improvement, once they

are identified. The policy analyst, again, plays crucial role in walking hand-in-hand with the

decision makers, using its forecasting and policy adaptation skills.

2.1.18 Monitoring and evaluation

Authorities should consider monitoring and evaluation as an integral part of the policy

making, both in terms of resource availability as well as its effectiveness. This is often not the

case in the newer democracies, where even good policies sometimes have poor

implementation, as a result of a lack of proper alert or corrective mechanisms aimed at

identifying the faults in the system. Essential part of the monitoring is setting realistic

performance indicators, measuring and evaluating each one of them against the expected

outcomes of the policy, set during the issue identification and policy analysis stages. The

results obtained should be shaped to serve as a feed into the next step, which could be fairly

easy to perform, once the necessary decision-making data is in place.

 29

2.1.19 Deciding the Policy fate: maintenance, succession or termination

Under the condition that the monitoring and evaluation stages have been properly

performed (and this is not to be considered a one-time action), the decision on whether the

chosen policy alternative is to be continued, modified or completely ceased is relatively easy

to adopt - if, of course, other political interests are not interfering with the decision. As the

later is often the case, the role of monitoring and evaluation is thus more important, as it can

strengthen the position against the decision made solely on the bases of unilateral political (or

even partisan!) interests.

2.1.20 Concept of Development

According to Thomas (2004) he opined that development is a concept which is

contested both theoretically and politically, and is inherently both complex and ambiguous,

recently it has taken on the limited meaning of the practice of development agencies,

especially in aiming at reducing poverty and the Millennium Development Goals.

According to Shah (2017) Development means improvement in country’s economic

and social conditions. More specially, it refers to improvements in way of managing an area’s

natural and human resources in order to create wealth and improve people’s lives. Shah while

elaborating on the meaning of development suggests that while there can be value judgments

on what is development and what is not, it should be a universally acceptable aim of

development to make for conditions that lead to a realization of the potentials of human

personality. Shah outlines several conditions that can make for achievement of this aim;

i. The capacity to obtain physical necessities, particularly food;

ii. A job (not necessarily paid employment) but including studying, working on a family

farm or keeping house;

iii. Equality, which should be considered an objective in its own right;

 30

iv. Participation in government;

v. Belonging to a nation that is truly independent, both economically and politically,

and;

vi. Adequate educational levels (especially literacy).

The people are held to be the principal actors in human scale development.

Respecting the diversity of the people as well as the autonomy of the spaces in which they

must act converts the present day object person to a subject person in the human scale

development. Development of the variety that we have experienced has largely been a top-

down approach where there is little possibility of popular participation and decision making.

According to Shah (2017) Human scale development calls for a direct and

participatory democracy where the state gives up its traditional paternalistic and welfare role

in favour of a facilitator in enacting and consolidating people’s solutions flowing from below.

“Empowerment” of people takes development much ahead of simply combating or

ameliorating poverty. In this sense development seeks to restore or enhance basic human

capabilities and freedoms and enables people to be the agents of their own development.

According Todaro (1985:87) sees development as a multi-dimensional process

involving the reorganization of the entire economic and social system. This involves, in

addition to improvement of income and output, radical changes in institutional, social and

administrative structure as well as in popular attitudes, customs and belief. In his contribution

on the meaning of development, Seers (1969:3) argued that: the question to ask about a

country's development is therefore what has been happening to poverty. What has been

happening to unemployment? What has been happening to inequality. If all three of these

central problems have been declined from higher level, then beyond doubt this has been a

period of development for the country concerned. If one or two of these central problems

have been growing worse, especially if all three have, it would be strange to call the result
 31

development, even if per capita income doubled. Development in human society today is not

a one-sided process but rather a multi-sided issue. Some individuals perceive development as

increase in their skill and ability; others view it as maximum freedom, the ability to create

responsibility and so on (Schumpeter, 2000:75).

According to Dudley (1977:67) defined development on the basis of human well-

being. For him, development does not mean only capital accumulation and economic growth

but also the condition in which people in a country have adequate food and job and income

inequality among them is greatly reduced. It is a process of bringing about fundamental and

sustainable changes in society through bureaucracy. It encompasses growth, embraces such

aspects of the quality of life as social justice, equality of all citizens, equitable distribution of

income and the demonstration of the development process (Lawal, 2007:3; Egharevba,

2007:56).

According to Rodney (2008:36) conceived development whether economic, political

or social to imply both increase in output and changes in the technical and institutional

arrangement by which it is produced. In other words, development as a multi-dimensional

concept is basically about the process of changes which lies around the spheres of societal

life. From the foregoing, it becomes obvious that development involves the capacity of a

society, government or social system to manage resources efficiently to improve the well-

being of the citizens. This fact, therefore, demand the institutionalization of good governance

element such as adherence to rule of law, accountability and growth with equity, in which the

poor and the rich both benefit as well.

2.1.21 Health policy development in Nigeria

In the health sector, the ultimate goal of the policy and decision makers is expected to

be the wellbeing of the population, universal access to health services and/or providing
 32

better healthcare at optimal budget spending. As this is a very broad definition of a

mission of health authorities, it includes infinite number of issues that need to be solved,

addressed or improved. So, it is of quite an importance the order by which they are addressed,

or the timing at which they are put onto the table. For example, the issue of propagating

breastfeeding is not an unimportant one, but it has lower priority over providing health

access to the whole population (including the rural areas); not that the healthy diet and

nutrition programs are less important, but the vaccination preventive program will certainly

be given a higher priority on the government policy agenda; etc. Yet, one should be

aware that sometimes some apparently “less important” issues are put on the agenda

for different reasons (among which e.g. the political rating improvement), and those policy

windows should be used to push forward particular policy alternative(s), ideally optimal

for the general public or the vast majority of population. Major role in setting the health

policy agenda is played by the international community, especially in the developing

countries. This very noble intention, can sometimes be motivated by the objectives of

solving the macroeconomic situation in the country, rather than by the goals of establishing a

good system that would provide high quality healthcare; other times, it is related to a trend in

the world, that would not necessarily be of high value if applied to an unprepared national

context. Thus, it is very important to judge the source of the policy agenda setting, in order to

be able to react upon it according to the national priorities and needs in this very sensitive

social service sector.

 33

2.1.22. Challenges Facing Health Policy Implementation and Development

Both at the national and state levels, several health policies have over the year been

developed, but have failed to achieve the desired outcome due to poor implementation.

Critics argued that the lack of enforcement is the graveyard of the previous health policies

developed in the country (Ahmed, 2021). The application of most of the national health

policies is often bedeviled with challenges and abandoned unimplemented. This schism is

due, in part, to the failure to harness the expertise of all relevant stakeholders such as

physiotherapists. Other problems include inadequate funding, poor planning, corruption, and

insufficient human and material resources (Obodo, 2018; Makinde, 2018) these challenges

are:

i. Intolerance and Conflict: As a result of the heterogeneous nature of the country

which is fully represented in its multiethnic nationalities; aggregating the interest of

all groups seems difficult as what is favourable to one ethnic group might not be

favourable to another; of which the latter will not tolerate if it is made into a policy

and the aftermath of this is conflict. An instance is the unification policy that was

passed as a decree in 1966 which was not tolerated by the northerners and thus

resulted into the July 29, 1966 coup and consequently civil war, serving as a sword

struck in the Achilles heels of majority of the public policies in existence as at that

time.

ii. Corruption: This is an anguis in herba a snake conveniently hidden in the grassland

of Nigeria social scene. It is a moth that has eaten deep into the fabrics of Nigerian

public policy practice. Observable from the analysis is that corruption manifests itself

in different shades in Nigerian public policy practice ranging from (a) most Nigerian

policies are formulated based on the interest of the public office holders and political

leaders alone, the interest of the strong individuals of the society (economic and
 34

political elites) and political Godfathers, or the interest of the maker (be it the leader

or public bureaucrats) and not citizenry-beneficially oriented; therefore the policy

goals becomes subordinate to these interests (b) most policies in Nigeria are made to

attract public attention and used as political tool to sustain power rather than the real

developmental gain (c) most Nigerian policies are corruptly formulated without the

contribution of the citizenry (d) most Nigerian policies are made and implemented as

a Machiavellian tool to subdue perceived oppositions be it in persons, parties or ethnic

groups (e) most Nigerian policies perceived as threat to the strong individuals of the

society are corruptly killed. The consequence of this is that most policies in Nigeria

are either inappropriately formulated or lack well defined objectives and programmes

for their effective implementation. Little wonder, Okoli and Onah (2020) state that

implementation of policies in Nigeria take the form of “learning process” or “trial and

error”. In this context, policies or programmes are haphazardly implemented and even

sometimes abandoned or dismantled midway because the basis for formulating the

policy was not, in the first instance, predicated on existing data, realities or need.

Hence as note by Makinde (2020), Nigeria has no comprehensive policy standards

and objectives to guide the bureaucracy in its policy formulation and implementation

activities and procedures.

iii. Strong Individual Factor: This is undoubtedly one of the highest challenges of the

Nigerian public policy practice. Ocholi (2019) quoted Ekpu as saying that the

government institutions were strategic to the country’s pursuit of democratic ideas but

instead of serving as the bulwark of democracy, they have become weakened by

inefficiency, corruption lack of commitment, incompetence, tribalism, hooliganisms

and other sundry handicaps”. The implicit of a weakened government institution is the

emergence of corruption-bred strong individuals who forms circles of elite cabals and
 35

through their influence dictate which policy to be formulated and which to implement

in Nigeria.

iv. Citizenry Acceptance and Approval of Moral Laxity and Corruption: This is

another challenge facing the Nigerian public policy practice. The Nigerian society is

morally bedridden and nationalistically handicapped. The society celebrates

corruption at its own detriment. No one wants to question neither the policy

formulation process nor the role of the citizenry in it. No one wants to question the

ineffective implementation of formulated policies. Every individual within the society

wallows in ignorance and fear, and pretends that public policy concerns them not

whereas in actual sense, public policy is meant to reflect their welfare. This leaves me

with one question, how will their interests be incorporated into a policy when they

don’t strive to even partake in it? When this is the case, the society has not only

accepted but has also approved corrupt practices in the Nigerian public policy

practice.

v. Inadequacy of Resources: Some agencies or institutions saddled with the

responsibility of formulating and implementing given policies do not possess the

requisite manpower and financial resources to effectively implement them. It is not as

if these resources are not available in Nigeria, of course they are as Nigeria is

endowed with abundance of financial, material and human resources, but it is

inadequate budgeting, the formulation of wrong policies at the right time, corruption

in form aggrandizement of policy fund and discriminative funding of some policies

that has led to the problem of inadequate resources (Ikelegbe, 2021; Dick 2020).

There is thus politics of implementation because, the resources needed for adequate

implementation of relevant policies are not provided to realize policy objectives. This

has resulted to situations where laws could not be enforced, services were not
 36

provided and reasonable regulation not developed and applied (Makinde, 2020). The

Poverty Alleviation Policy for instance, according to Nweke (2021) is brilliantly

articulated but yet to realize its essence due largely to inadequate fund or resources.

vi. Wide Policy Scope: This is another challenge facing the Nigerian public policy

practice. Most of the Nigerian policies are over ambitious and has too many agenda.

This makes it difficult to be fully implemented thus resulting to on-paper-non-practice

syndrome. Makinde (2020) noted that most of these over ambitious and too many

agenda policies are not borne out of genuine or sincere effort to bring about rapid and

radical development but just to boast the ego of the political leaders. Instances are

those policies directed towards complete eradication of poverty which is clear to all

and sundry that not enough resources are available to achieve even in the advanced

countries.

vii. Continuity Deficiency Problem: This is a core problem bedeviling the Nigerian

public policy practice. The Nigerian public policies are usually deficient in continuity,

this is as a result of non-consultation of the citizens, ego, change of regimes, influence

of strong individuals and godfathers etc. policy sustenance is a war that Nigerian

government is not willing to win as each successive government is bent on

establishing new policies without implementing those established by the former

governments. The consequences of this are abandoned projects and policy

inefficiency.

2.1.23 National Drug Policy in Nigeria

The maiden edition of National Drug Policy (NDP) in Nigeria was launched in 1990 against the

background of inadequacies in drug availability, supply and distribution resulting from various

factors, such as: ineffective system of drug administration and control, inadequate funding of drug
 37

supply and drug control activities, high dependence on foreign sources for finished drug products,

pharmaceutical raw materials, reagents, equipment and inadequate facilities for storage,

transportation and distribution of drugs. Others limitations include: poor performance of drug

suppliers to public health care institutions, poor selection and procurement practices, involvement

of unqualified persons in procurement, distribution and sale of drugs and lack of political will to

attend to numerous drug related matters such as provision of safe, efficacious and good quality

drugs to meet the health needs of Nigerians.

The policy was formulated with laudable goals and objectives intended to address the

unsatisfactory situation at that time. Its adoption was seen as a positive development while some

modest progress were recorded with the publication of an Essential Drugs List (EDL), the National

Drug Formulary (NDF), and establishment of a statutory agency saddled with the responsibility of

drug administration and control, in addition to the introduction of drug registration procedures.

Access to essential drugs remains a key indicator in the assessment of the viability of primary health

care system in line with the Bamako Initiative. In 1975 International Labor Organization (ILO)

introduced and defined the concept of essential drug while the World Health Organisation (WHO)

prepared the first list of essential drugs in 1976. The WHO recommended the list for nations in 1979.

In 1984/85 funds were made available by donors to support drug utilization in many developing

nations. This led to the birth of Drug Policies in many countries to manage essential drugs and

improve access to them. Nigeria launched her maiden National Drug Policy (NDP) in 1990. The lapses

observed with the 1990 edition include among others: non-realization of self- sufficiency in local

production of essential drugs, absence of established and effective drug procurement system,

entrenchment of well-ordered drug distribution system, harmonization and update of drug

legislation, entrenchment and enforcement of rational use of drugs at all the levels of health care.

The 2005 revised policy was expected to serve as an opportunity for formulating new strategies, for

consolidating on the achievements in areas where progress have been recorded, and addressing

those areas that call for more positive actions. Thus, when the framework is completely laid out and
 38

fully implemented, the Nigerian people will have sustainable access to safe, efficacious and good

quality drugs

Goals and objectives of the National Drug Policy in Nigeria

The goals of the drug policy in Nigeria is to make available at all times to the Nigerian populace,

adequate supplies of drugs that are effective, affordable, safe and of good quality; to ensure the

rational use of such drugs: and to stimulate increased local production of essential drugs. The

objective of the NDP include among others: to ensure an efficient and effective drug management in

the public and private sectors, ensure access to safe, effective, affordable and good quality drugs at

all levels of health care system on the basis of health needs, promote the rational use of drugs by

prescribers, dispensers and consumers, increase local drug manufacture/production, promote

export and ensure that all drugs in the national drug distribution system are safe, efficacious,

effective and of good quality. Others include strengthening administrative, legislative, and regulatory

controls of the importation, manufacture, procurement, storage, distribution, supply, sale and use of

drugs while promoting research on herbal remedies. It seeks to integrate herbal remedies found to

be safe and efficacious into the health care systems, promote pharmaceutical research and

development of raw materials for the production, compounding and formulation of pharmaceutical

products, as well as operational research for the effective implementation of the National Drug

Policy; and enlist government commitment at all levels for the achievement of the goals and

objectives of the NDP. The target is to ensure that 60% -80% of these objectives were actualized

before the end of 2008

Strategies for implementing the National Drug Policy in Nigeria

The strategies for implementing the national drug policy are purely technical and will require

concerted efforts from pharmacists and other relevant personnel to ensure satisfactory

implementation. The strategies emphasized proper accountability and rational use of drugs by

health workers and consumers. These strategies include: selection of drugs: publication of revised

essential drugs list for use by the federal, state and local governments at all levels of health
 39

institutions in the country. Drug listing based on generics or International Non- Proprietary Names

which should be based on health need of the majority of the Population, update of EDL every four

years, use of standard treatment guidelines, national formulary and reimbursement of National

Health Insurance Scheme (NHIS). The policy introduced procurement of drugs based on EDL and

generics, open competitive tender bidding which shall be conducted in a transparent manner with

the advice of the Pharmacy Departments of the hospitals involved. Drug Revolving Fund (DRF)

scheme through the establishment of DRF committee for effective and transparent fund

management, empowering the Head of Departments (HOD‟s) of pharmacies as signatories to the

DRF account, separation of DRF accounts from other hospital accounts and training of DRF personnel

in pricing policies by putting in place mechanisms to ensure that the cost of drugs in public

institutions are minimal. Effective drug storage was captured to ensure stock security and

maintenance of drug quality throughout their shelf life and ensuring efficient and successful

operation of drug storage and distribution systems across the country.

Drug distribution, supply, sale and dispensing shall be under the control and supervision of

pharmacists at all levels as stated in the policy. Rational drug use, control of donated drugs, control

of local drug production, legislation, inspection and control of import and export of drugs should be

properly manned. The policy covers registration of drugs to ensure that the government has control

over drugs that are offered for sale and use within the country. This underscores the need to

strengthen the National Agency for Food and Drug Administration and Control (NAFDAC).

Regulations for prescribing and dispensing of drugs, pharmacovigilance, drug information,

promotion, financing and affordability were other key area where the NDP is primarily responsible to

the government at all levels in addition to research and development. The policy also covers herbal

and other traditional remedies standardization and development of compendium of herbal

medicines. Human Resources Development through well trained and experienced professionals,

managers, and other personnel‟s for planning, organization and implementation of the NDP should

be encouraged. Government should, therefore: ensure constant curriculum review, expand facilities
 40

in the universities and research institutes, strengthen the capacity of trainers and develop a

comprehensive and robust in-service training programmes to address on-the-job requirements

towards the implementation of the policy. They should encourage continuing education

programmes; control of veterinary drugs and encourage international cooperation between

countries to help in combating the influx of sub-standard and counterfeit drugs. Cooperation

through the establishment of appropriate channels of communication, using WHO Certification

Scheme, use of diplomatic means for the exchange of information and liaising with appropriate

international control boards were all captured by the policy in addition to

In 1990, about 4000 varieties of drugs were in circulation in Nigeria whereas all that was needed

were approximately 200 while 50% - 60% of the drugs in circulation were either fake or substandard.

Gross deficiencies in quality control for both local and imported drug preparations have improved

markedly due to surveillance operations. Only 10% - I5% of the local drug need were manufactured

locally within the first 5years. Fake, sub-standard, adulterated and unregistered drugs were

prevalent. Erratic supplies and availability of different categories of ethical and over-the-counter

preparations and other medicinal products abound. Consumer rights and consumers‟ health

knowledge and level of awareness of their rights to quality and rational use of drugs were below

10%

2.2 Case study Literature

2.2.1 Demography

Akwa Ibom State is made up of 11 local government areas with Uyo as the capita

entry its major towns include; Uyo, Eket, Ikot Abasi, Oron, Essien Udim, Abak and Ikot

Ekpene has a population of about 4312819 million based on the 2009 projections by UNICEF

(UNICEF 2009) Citizens are predominantly Christian and the major languages spoken are
 41

Ibibio Anang and Oron Economic activities are predominantly commerce and farming with

85 percent of the population living in the rural areas

2.2.2 Historical Perspective of Akwa Ibom State

In Akwa Ibom State, over the years, Government policies have generally not

conformed to the economic development strategies adopted in the country since

independence. From the days of South Eastern State and old Cross Rover State from where it

was carved out, particularly under the administrations of Brigadier General Uduokaha Jacob

Esuene and Dr. Clement Nyong Isong, respectively, massive government investments were

made in the development of social infrastructures, human capital development as well as

industrial, commercial and financial institutions. At the time Akwa Ibom State was created in

1987, it inherited a number of industrial, commercial, financial and service institutions that

were publicly owned. But because this was a period when global thinking was in favour of

private-sector-led economic development instead of government ownership of institutions of

commercial and industrial nature, and particularly because the publicly owned enterprises in

the state had long folded up due to mismanagement and corruption, the industrial sector of

the state was virtually non-existent at the inception of the state.

What the state was rich in at its creation was the large number of public-sector

employees it inherited from the Old Cross River State estimated to be more than 60per cent

of the work force of the Old Cross River State. This situation justifies the popular description

of the state as "a civil service state" (Ekpenyong. 2001. Ekpo and Uwatt, 2005). Corporative

2.2.3 Governance

The state has continued to enjoy stable democratically elected governments

 42

inaugurated since May 29 1999, May 29 2003, and May 29, 2007 with a stated Development

Vision of transforming Akwa Ibom State into a prosperous, highly educated, technologically

driven and ethnically harmonious State in Nigeria with strategic policies programmes to

accomplish same.

2.2.4 Socio Economic Context and Status

Akwa Ibom State is strategically located on the Gulf of Guinea, which has assured

immense economic and strategic importance globally. Akwa Ibom State also provides access

to a number of land locked States in the South Eastern and Middle Belt Nigeria. The

government has strengthened healthcare delivery at the primary level by building more health

centres, rehabilitating old ones and upgrading some to the level of full hospitals. For instance,

the Primary Health Centre has been remodeled, reconstructed and equipped to join the list of

general hospitals that are located in the three senatorial districts of the state to make

secondary healthcare delivery available even where there are primary health facilities.

Other hospitals on this list are the Immanuel General Hospital, Eket; Iquita General

Hospital, Oron: St. Luke’s General Hospital, Anua, Uyo; Etinan General Hospital; General

Hospital, Ikot Okoro, Abak; General Hospital, Ikono and the Methodist General Hospital,

Ituk Mbang, in which premises the states 300-bed COVID-19 isolation and treatment centre

is located.

The capacity to deliver quality healthcare to the people of the state has been

strengthened with the setting up of the Akwa Ibom State Primary Healthcare Development

Agency (AKSPHCDA). This is in line with the practice at the federal level and some states of

the federation. The AIPHDA, which comes under a special project christened, Primary

Healthcare under One Roof, is charged, among others, with the responsibility to improve

access to quality and basic healthcare, put in place a high performance team of healthcare
 43

providers, control preventable diseases and guarantee universal health coverage of all parts of

the state.

2.2.5. Udom’s HealthCare Programme for Sustainable Development in Akwa Ibom

State

Health is wealth. This time-worn adage must be the philosophy that drives the

unprecedented transformation of the health sector in Akwa Ibom State under the leadership of

Governor Udom Emmanuel. It is a transformation, which is bringing healthcare delivery

closer to the people through increased accessibility and availability regardless their social

class or area of residence. This includes rural areas which had no health facilities, thus

forcing residents in those areas to travel long distances for medical care in hospitals that were

ill-equipped to serve that purpose ab initio.

The exercise has so far seen the revamping of health institutions that were dilapidated

in structures, which were in rundown conditions and unable to provide services to the sick,

even in the most common ailments like malaria and typhoid fever, or maternity services with

preventable deaths, including high infant and maternal mortality rates, as consequence. Those

institutions have had life breathed into them by way of remodeling, reconstruction and

rehabilitation of critical structures like emergency and accident departments, wards, theatres

and dispensaries as the case may be, as well as upgrade or replacement of equipment, to be

able to meet the challenge of providing modern healthcare delivery in a state that is being

primed to be Nigeria’s industrial hub.

The government has created an environment that is conducive for investments to

thrive a peaceful and secure state, critical infrastructure like good road network and power, as

well as incentives that investors find attractive and irresistible. This is in addition to the

traditional hospitality for which the people of Akwa Ibom are well known, which contributes
 44

to creating a welcoming environment where people can visit, live and work.

The creation of the right environment has so far yielded results in form of industrial

establishments which have been set up in the state in the last six years about 16 in all. These

industries are collectively employing thousands of people. With the oil and gas free zone the

federal government is planning to set up in the state, and the futuristic Ibom Deep Sea Port

which is going to be the biggest investment in that part of the country, Akwa Ibom indigenes

in other parts of the country are going to find it attractive to return home to seek employment

and business opportunities. The state will, no doubt, appeal Nigerians in neighbouring states

and other parts of the country in search of greener pastures.

With more people coming into the state ” local investors from other parts of the

country, foreign investors and Nigerians seeing to take up employment” there is going to be

pressure on social services, including healthcare delivery. The government has acted

proactively by investing in healthcare to build a state where health would translate to wealth a

state with a healthy population that would create individual and collective wealth for present

and future generations of Akwa Ibomites.

The government has strengthened healthcare delivery at the primary level by building

more health centres, rehabilitating old ones and upgrading some to the level of full hospitals.

For instance, the Awa Primary Health Centre has been remodeled, reconstructed and

equipped to join the list of general hospitals that are located in the three senatorial districts of

the state to make secondary healthcare delivery available even where there are primary health

facilities.

Other hospitals on this list are the Immanuel General Hospital, Eket; Iquita General

Hospital, Oron: St. Luke’s General Hospital, Anua, Uyo; Etinan General Hospital; General

Hospital, Ikot Okoro, Abak; General Hospital, Ikono and the Methodist General Hospital,

Ituk Mbang, in which premises the states 300-bed COVID-19 isolation and treatment centre
 45

is located.

The capacity to deliver quality healthcare to the people of the state has been

strengthened with the setting up of the Akwa Ibom State Primary Healthcare Development

Agency (AKSPHCDA). This is in line with the practice at the federal level and some states of

the federation. The AIPHDA, which comes under a special project christened, Primary

Healthcare under One Roof, is charged, among others, with the responsibility to improve

access to quality and basic healthcare, put in place a high performance team of healthcare

providers, control preventable diseases and guarantee universal health coverage of all parts of

the state.

The importance of an agency like the AKSPHCDA is evident at this period when the

Corona virus pandemic is still very much around, despite several measures like testing and

treatment, non-pharmaceutical safety measures and massive vaccination that are being carried

out in all the states of the federation to stem its spread. Primary healthcare development

agencies are the ones that are effectively taking charge of the vaccination campaign, as we

have seen in all parts of the country. The AKSPHCDA has therefore come at the right time.

Improvement of the quality of healthcare delivery in Akwa Ibom would, apart from

guaranteeing quick and easy access to health services at all levels and in all parts of the state,

controlling the spread of diseases and reducing the rate of preventable deaths, also create a

general state of wellbeing that would engender an enthusiastic embrace of Governor

Emmanuel’s Dakkada philosophy that challenges every Akwa Ibomite to rise to greatness.

The philosophy has already begun to yield fruits, as the people of the state have now come to

terms with the roles they can play, individually and as a people, in building the Akwa Ibom

Project a state with a solid industrial base that would guarantee sustainable socio-economic

development that outlives the present generation.

 46

2.2.6 Governor Emmanuel’s commitment to Healthcare Delivery in Akwa Ibom State

His Excellency Deacon Udom Gabriel Emmanuel recorded yet another significant

milestone when he inaugurated the pioneer Governing Board of the Akwa Ibom State

Primary Healthcare Development Agency, thus signaling the commencement and the

implementation of the ‘Primary Healthcare Under One Roof in the State.

The nature and style of the Akwa Ibom people in their response to contemporary

challenges of development, most importantly health care services is that of perseverance,

participation by all segments of the society and consistency of action. This is evidence by

past and present vision of the state which is to transform Akwa Ibom State into a prosperous,

highly educated, technology- driven, ethnically harmonious, caring and pace-setting state in

Nigeria, with strategic policies and programmes to accomplish it. One of such policies is the

development of a sound health policy to ensure a healthy living. Without good health which

is synonymous with development, the dreams and aspiration of the state cannot be achieved,

(Ibok and Daniel, 2003).

To ensure a healthy living and in line with the national policy on health as well as local

imperatives, the health care system in Akwa Ibom State is based on primary health care that

is preventive, restorative, and rehabilitative, with particular attention to high risk groups such

as children, young mothers, the handicapped and the elderly. The policy also seeks to support

healthy living for sound bodies and minds as well as combating of diseases through the

operation of an accessible, affordable, efficient, and integrated health care delivery system

that is structured around a two pronged integrated primary health care services and secondary

care strategies administered through health institution by skilled care providers, (Ekpo and

Umoh, 2007 and Udoh, 2013).

In the past few years, Akwa Ibom State government especially the present government has

given health a priority attention by investing enormous financial resources to revamp and

resuscitate the sector in order to make health care delivery not only accessible and affordable
 47

for every Akwa Ibom person, but also to ensure that nobody dies from a preventable

disease. In assertion to the 400 billion allocated to the health sector from 2015-2020 The

following represent government efforts toward that direction. 

• Provision of free medical treatment to women, children and the aged in the state

• Provision of anti-natal kits to over 1,000 pregnant widows across the state

• Provision of free medical attention to 1000 women on cervical cancer, breast cancer,

diabetes, and free talks on women

and security consciousness

• Activation and expansion of eight anti-retroviral centres, 15 prevention of mother to child

transmission (PMTCT) centres,

and 37 HIV counselling and testing centres, all rendering free services

• Construction of new Primary Health Care centres in the three Senatorial Districts of the

State.

• Renovation of old and dilapidated Primary Health Care centres across the state.

• High immunization converge to eradicate polio and all other childhood killer diseases.

• Provision of counterpart funding for all health programmes by donor organizations like

UNICEF, UNFPA, Operation Roll

Back Malaria, HIV/AIDs World Bank Assisted Programme

• Provision of mosquito nets across the state especially to pregnant women and children free

of charge.

• Training of health workers.

• Sensitization program on how to maintain a healthy living.

• Provision of ambulances to health centres across the State.

• Construction of Cottage Hospital in Essien Udim, Ibeno, Ukanafun, Eastern Obolo

and Ika Local Governments in the State etc. (Etuk and Akpan 2022). Health is wealth and the

administration of Governor Udom Emmanuel fervently believes in this epigram. This belief

has informed the massive turn around that the State has witnessed in the last four years. Thus,

the administration has provided the followings;

 48

i. Free medical services for children below 5 years, pregnant women and the aged.

ii. Procurement of state-of-the art medical equipment, 25 containers delivered.

iii. Construction and upgrading of secondary healthcare facilities across the state.

iv. Reconstruction and equipping of General Hospital, Etinan.

v. Reconstruction of General Hospital, Ikono.

vi. Ongoing reconstruction of General Hospital, Ituk Mbang.

vii. Ongoing reconstruction work at General Hospital, Ikot Okoro.

viii. Construction of Emergency Operation Centre (EOC) at Infectious Disease Hospital,

Ikot Ekpene.

ix. Relief for over 4,000 mal-nourished children.

x. Free screening & treatment of over 15,000 people for various eye diseases.

xi. Training of 20 Biomedical Engineers for maintenance of procured equipment.

xii. Provision of residential quarters for 48 House Officers in the State Hospitals and 50 in

the University of Uyo Teaching Hospital (UUTH)

xiii. Refurbishing and maintenance of house officers residential quarters at Obio Offot,

Uyo.

xiv. Accreditation for Schools of Nursing, with 272 Registered Nurses

xv. Training and Certification of 100 Doctors and Nurses in Basic Lives Support (BLS)

and Advanced Cardiac Lives Support (ACLS) with Medical Emergency Experts from

the USA.

xvi. Procurement of Automated External Defibrillators (AEDs) and Electrocardiograph

(ECG) Machines for use in Emergency Response (now fitted in ambulances).

xvii. Awareness and sensitization campaign for the control of Tuberculosis and leprosy as

well as treatment

xviii. Effective intervention and eradication of Lassa Fever and Monkey Pox in the state.
 49

xix. Restoration of services at Ibom Specialist Hospital/ Engagement of new management

CLINOTECH Group, Canada for the hospital.

xx. Reconstruction of Oxygen plant at Ikot Ekpene for supply of oxygen to other

hospitals in the state.

Ministry of Health, which is responsible for driving the state governments policies on

health, and the Ministry of Labour and Manpower Planning, which primarily plays the dual

responsibility of ensuring a smooth workforce and also developing necessary data on the

states manpower resources and capabilities. Like infrastructure and agriculture which were

the focus of the part one of this series, health and manpower development are also tightly

connected because only a healthy population can provide efficient manpower.

Since May 2015, it was evident that the health sector was a priority to Governor

Udom Emmanuel as one of his first interventions was the rehabilitation of St. Luke’s

Hospital, Anua. Established in 1937, the hospital became an eyesore after over 70 years of

existence without proper attention in terms of maintenance and rehabilitation. Like many

other healthcare facilities in the state, the hospital was dilapidated and lacking in both

facilities and manpower. “However, such illustrious history and celebrated tradition is what

was starkly compromised by systemic recession and infrastructural decay over the years, a

report on Nations Newspaper stated. “From being a major regional medical hub, St. Luke’s

Hospital, diminished in status and facility, to become a shadow of its glorious past. Its

functionality in the recent past was at best, as a primary health centre. (Inwang, 2021)

In his avowed commitment to hit the ground running from day one, Governor

Emmanuel visited the hospital for assessment just three days after his swearing-in. The

governor, who was accompanied by some key government officials, was moved to tears by

the level of rot in the hospital that he was born. He immediately ordered the rehabilitation of

the hospital. The rehabilitation exercise did not only give the hospital an aesthetic face-lift
 50

but provided the institution with state-of-the-art equipment and remodeled wards. The

Governor reconstructed the Administrative block of the hospital, constructed the male and

children wards and also constructed and equipped the gynecology ward, in honour of the

renowned Irish Missionary who worked selflessly for the hospital, Dr. Ann Ward. As part of

the activities to mark the 28th anniversary of the state creation in September 2015, the

governor commissioned the remodeled hospital within his first 100 days in office.

The intervention in St Luke’s Hospital was only a tip of the iceberg as the governor

was determined to ensure that at least one state-of-the-art health facility is reached within a

driving span of one hour in each of the ten Federal Constituencies of the State. To this end,

his administration vigorously embarked on the remodeling, upgrading, and re-equipping of

secondary heath institutions across the state for efficiency and accessibility. This was done by

upgrading, computerization and digitization of hospitals in the state towards effective

healthcare delivery and ease of tracing of medical records of patients At last count, at least

seven General Hospitals have benefitted from the rehabilitation renaissance in the health

sector namely: General Hospital, Etinan, General Hospital, Ikot Okoro, General Hospital,

Ikono, General Hospital, Ituk Mbang, General Hospital, Iquita, Oron, General Hospital, Awa

and Immanuel General Hospital, Eket.

As part of his efforts to ensure that the remodelled hospitals are well-equipped to meet

the administrations vision in the health sector, Governor Emmanuel procured 100 containers

of state-of-the-art medical equipment for health institutions across the state, with 50

containers so far delivered. Among the procured state-of-the-art medical equipment include:

electrocardiograph 3 Channels, colonoscopy (with halogen light), x-ray film processor, x-ray

film viewer, gastroscope, operating theatre light (5-Spot light), operating table and anastasia

trolley with ventilators. Others are: monitor, syringe pump, electro surgical units, monopolar-

bipolar operating instruments, suction pump, CT Scanners as well as Surgical microscope for
 51

the eyes.

In the wake of the coronavirus pandemic, the governor constructed a 300-bed

International Isolation Centre with inbuilt Molecular Virology Laboratory. The Laboratory

with a Category 3 PCR Machine was effective in testing of COVID-19 cases, a feat that was

hailed by the World Health Organization, WHO and the Nigeria Centre for Disease Control,

NCDC. Prior to that, the administration had constructed the Emergency Operations Center,

EOC, at the Infectious Disease Hospital, Ikot Ekpene as well as procured the Oxygen Plant.

“In addition to his free healthcare policy for children within the age bracket (0-5) years,

pregnant women and the aged, Governor Udom Emmanuel has put in place institutional

frameworks to coordinate and supervise effective healthcare services in the state, including:

the Primary Healthcare Development Agency, the State Hospitals Management Board, HMB

and the Ministry of Health, all with seasoned Health Professionals and Administrators at the

helm of affairs, one report reveals.

Evidently, health is of the sectors that have enjoyed the attention of the Udom

Emmanuel administration the most and this in turn, has yielded very impressive results for

the state and her people. For instance, the state government’s proactive measures during the

corona virus pandemic were pivotal to the significantly less impact of the pandemic in the

state. While responding to questions during the inter-ministerial briefing, the Commissioner

for Health, Prof Augustine Umoh said that through the state government’s massive

investment in the health sector, healthcare services in the state is very affordable. “The cost

of healthcare is very high around the world, but through the state government’s intervention

in the sector, the state has tried so much to make healthcare affordable and very accessible to

everyone, Prof Umoh said. We keep the cost of services as low as possible in Akwa Ibom

State and we will even do more this with your help”.

 52

2.2.7 Effect of Health policies on Drug Faking and Counterfeiting in Akwa Ibom State

Faking and counterfeiting of pharmaceutical products and raw materials have become a major

problem facing the international community, and Akwa Ibom state is not an exception. Recent

trends suggest an increase in counterfeit drug sales amounting to over $70 billion in 2010 and an

increase of over 90% from 2005. There has been a growing trend of all manner of counterfeiting in

Akwa Ibom State, ranging from raw materials to finished pharmaceutical products. Studies show that

drug faking and counterfeiting took alarming dimension from 1995 to 2000. This period also marked

the proliferation of illegal drugs and medicine marketers and vendors, as recorded by Erhun (2016).

Osibo (2021) suggested that there were more counterfeit drugs than genuine ones in circulation in

Akwa Ibom State and this was further compounded by weak regulations. For more than two

decades, the state battled counterfeiting without adequate political will and functional framework

to no avail. However, positive results were recorded from 1993 when the government rose up to the

challenge by promulgating and enacting the counterfeit and fake drug (miscellaneous provisions)

decree No. 21 of 1998 which prohibited the sale and distribution of counterfeit, adulterated,

banned, and fake drugs or poisons in open markets and without a license of registration. As a follow

up, the National Agency for Food Drug and Administration and Control (NAFDAC) was established in

1993 to clear the nation of fake and adulterated drugs through strict regulation and control. Positive

feats were achieved from 2001 through strict enforcement and regulations which led to marked

improvement in the fight against fake and substandard drugs and reduction of drug failure rates by

16% between 2002 and 2006. Further reduction in circulation of counterfeit drugs by over 80% was

noted by NAFDAC in 2006. In 2002, WHO reported that 70% of drugs in Akwa Ibom State were either

fake or substandard. The NAFDAC estimate of counterfeit drugs in the state, same period was put at

41%. Other scholars, who reviewed the situation in the 1990s and early 2000s, estimated the level

of counterfeiting in Akwa Ibom State to have fallen to For more than two decades, the state battled

counterfeiting without adequate between 36% and 48%. This was largely due to corruption, weak

government policies and weak monitoring and evaluation practices.

 53

2.2.8 Drug Service Administration in Akwa Ibom State

The majority of people in developing countries suffer from disease conditions common to under-

developed economies. People rely greatly on drug products due to prevailing environmental and

harsh economic climate for their daily living. This underscores the dire need for availability and

affordability of safe and effective drugs for proper health maintenance. The Nigerian government

introduced the National Drug Formulary and Essential Drugs List in 1986 and a National Drug Policy

in 1990. These, coupled with more than five decades of military rule left the nation impoverished

with very poor health

indices such as poor life expectancy of 48.8 years compared to 76 years obtainable in most

developed countries. Poor drug service administration has hindered the smooth implementation of

the essential drug list system meant to boost the National Drug Policy.

2.3 Theoretical Framework

System Theory

This theory adopted this work is anchored on David Easton's system theory whose

central theme is that all social phenomena including the political process are interrelated.

David Easton in his book, "the political system" (1953), developed a model for the study of

political life, which starts with the input-processed over different stages until the output is

obtained. A feedback process delivers reports both on the property of system and the process,

as well as the output. Both the system and it's environment exert a reciprocal influence on one

another (Easton 1953).

David Easton sees the political system in terms of those interactions through

which values are authoritatively allocated for the society. It entails inputs, outputs,

interaction, processing and system feedback that keep the entire political system functioning.
 54

The main goal of the political system is to meet the demands of the allocating resources.

According to Ludwig Von Bertanlanffy in 1920.system theory is an interrelated and

interdependent set of elements functioning as a whole. The theory suggests the functionalist

approach as the best way of examining the role of a subsystem in a larger system.

Bertanlanffy posits that it was not enough to understand the parts, that it was also important

to understand the relationship among the parts. Bertanlanffs idea behind system theory is that

nothing can be explained by isolating a component of system.

The theory attempted to view the school as unified purposeful organisation or as a

system composed of interrelated parts. This was based on the insinuation that the activity of

any part of the system has a direct bearing on every other parts of the educational system. A

system theory has open system which relatively highly permeable boundaries while the

closed system has relatively rigid impermeable boundaries thus subsystem is a system that

exist within a large system. Every system, supra system or subsystem has an environment.

System theory also rests on beliefs that in all system like the society, the school, education,

the classroom, has different parts performing different functions but in a way that each part

interacts and is interdependent with the other parts and with the system (environment) around

it. Therefore, what affect one part; affect the other parts in the system and its environments.

Bertanlanffy further points out that the history of the concept can be traced to Aristotle, who

suggested that the whole is greater than the sum of its parts. A system is an entity composed

of a number of parts, the relationship of their parts and attributes of both the parts and the

relationship. Thus, the university can be termed a system because of the number of its parts,

the relationship of these parts and the interwoven nature of their function. For instance, in the

university, there are Catering, Academic, Registry and Works Department; whatever happens

to one sub-system affects the whole system. A problem arising from the university system

may be approached by first examining the relevant subsystem of the university system.
 55

System theory thus helps administrators to be very alert bearing in mind that disruption of a

sub-system can damage the entire system. The system theory holds that an educational

organisation is a social system made up of integrated parts; a system is a unit with series of

interacted and interdependent parts, such that the interplay of any part affects the whole. A

system is therefore a structure with interdependent parts. It refers to the integration of

different components and relationships between them and their attributes, such that they form

functionally related whole. The hierarchical and lateral structure in a system and their

associated interactions and transformation are geared towards achieving the goal and purpose.

In its broadest conception, a “system” may be described as a complex of interacting

components together with the relationships among them that permit the identification of a

boundary-maintaining entity or process. In the broadest conception, the term connotes a

complex of interacting components together with the relationships among them that permit

the identification of a boundary-maintaining entity or process. A system can be defined as an

entity, which according to Mele and Polese (2010) is a coherent whole such that a boundary

is perceived around it in order to distinguish internal and external elements and to identify

input and output relating to and emerging from the entity. A systems theory is hence a

theoretical perspective that analyzes a phenomenon seen as a whole and not as simply the

sum of elementary parts. The focus is on the interactions and on the relationships between

parts in order to understand an entity’s organization, functioning and outcomes. This

perspective implies a dialogue between holism and reductionism.

Systems theory is approached when one wants to study in a complex, open ended

setting, where there are many unpredictable variables at work. According to Elujekwute

(2019) the heath sector of a state is an example of an open system with inputs filtering

through its boundaries.

This theory is important to the effective management of implementation of health

 56

policies in the sense that, the State Government will understand that various sections and

department of the Ministry of Health have inputs into the implementation of health policies

in the areas of child care, primary health services and dugs availability.

CHAPTER THREE

RESEARCH METHODOLOGY

This chapter is concerned with the research methods employed by the researcher

under the following subheadings: Area of the study, design of the study, population, sample

and sample techniques, instrumentation and validation of the Research Instruments.

Statistical Treatment of the Data

3.1 Design of the Study

The study adopts a descriptive survey research design. Descriptive survey research

design according to Ali (2016) is one in which a group of people or items are studied by

collecting and analyzing data from only a few people or items considered to be representative

of the entire group. Similarly, Osuala (2011) stated that descriptive survey research design

focuses on people, their opinions, attitudes, motivation and behaviours. Osuala further stated

that descriptive survey identifies the present conditions, prevailing needs as well as provides

information on which to base sound decision.

3.2 Population of the Study

Mugenda and Mugenda (2003) define population as a group of individuals, events, or

objectives which a researcher used to generalize the result of study, In this research work, the
 57

population for the study comprised of all the senior civil servants in Akwa Ibom State

Ministry of Health Akwa Ibom State, a total of five hundred and twenty eight (528) staff,

three hundred and thirty-six males (336) and one hundred and ninety-two females (192), from

Akwa Ibom State Ministry of Health (AKSMH, 2023).

3.3 Sample and Sampling Technique

The findings from the study will be used to generalize the population; the researcher

used stratified random sampling technique. Since the whole population cannot be studied,

hence, a sample was being drawn to represent the population of Uyo, Eket and Ikot Ekpene

senatorial district in Akwa Ibom State. The sample size was determined using Toro Yamane

formula at 0.005% level of significant.

The formula for Taro Yamane

n-

Where;

n - Sample Size

N - Total Population

1 - Constant

e - Degree of Significant

Applying the formula

n - Sample unknown

N - 528

e - 0.05

To determine the sample size

N =
 58

= 400

The study was conducted in six local government Areas, across the three senatorial

district on Akwa Ibom State

Senatorial District Local Government Respondent

Uyo Etinan 150
Ikot Ekpene Abak 120
Eket Onna 130
Total Three 400
Source: Authors field survey (2023).

3.4 Instrument for Data Collection

The research instruments used for data collection were health workers questionnaires

it has 12 items arranged according to the hypothesis. It was a five scale questionnaire ranging

from strongly agreed (SA), Agreed (A), strongly disagreed (SD), Disagreed (D), undecided

(UN). It was structured to elicit responses on health policies in the state. The questionnaire

item was scored and the mean computed .It was later classified into two groups: positive and

negative responses.

3.5 Validation of the Research Instrument

The questionnaire was face validated by the project supervisor, who read and made

necessary corrections. The corrections and suggestions where adopted.

3.6 Method of Data Collection

In the process of conducting this research, the researcher made use of both the
 59

primary and secondary sources of data. The primary source of data was face to face interview

and questionnaire. While the secondary source of data was generated from the relevant

textbooks, newspapers, journals and the internet etc.

 60

3.7 Mode of Data Analysis

The data collected at the field were presented in a tabular form and analyzed using

descriptive statistical method which involved the simple percentage and simple frequency

models .This method was chosen because of its simplicity and clarity in highlighting data .

Chi- square was used to test and analyze some selected hypothesis.

Chi-square Goodness - of - fit - test

Formula= X2⅀= (fo-fe)2

fe
Where X = chi-square
2

fo = Observed frequency

fe = Expected frequency

⅀= Summation of all the items

The Level of significance is put at 0.05 or 0.5 or 5%

Degree of freedom = n-1

Rules of Decision

Where the calculated chi-square value is less than that of the critical table value, Null

hypothesis will be rejected and alternative hypothesis will be accepted. Where the calculated

chi-square value is greater than the table value, alternative hypothesis will be accepted while

the Null hypothesis will be rejected.

 61

CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND DISCUSSION

This chapter focused on the analysis of data obtained for the purpose of this research and the

presentation and discussion of findings thereof. These were based on the research hypothesis

formulated for the study which is analysis hereunder.

4.1 Data presentation and Analysis

Table 4.1.1: Questionnaire Administered
Responses Frequency Percentage%
Returned 350 87.5
Not Returned 50 12.5
Total 400 100
Source: Authors field survey (2023).

Table 4.1.3 observed a breakdown of returned and unreturned copies of

questionnaires Four Hundred copies of questionnaires were administered to the respondents.

350 which represent 87.5% were duly returned while 50 questionnaires representing 12.5%

fifty (350) questionnaires returned were not returned. Therefore, presentation and analysis

will be based on three hundred and fifty (350) questionnaires returned.

Section A

Socio-Demographic Characteristics of the Respondents

This section contains question which deals with personal information of the respondents

1. Gender
Table 4.1.2: Distribution of Respondents based on sex
Responses Frequency of Responses Percentage%
Male 205 58.57
Female 145 41.43
Total 350 100
 62

Source: Authors field survey (2023).

Table 4.1.2 Indicated that out of 350 respondents that duly returned the questionnaire,

205 representing 58.57% were male, while 145 representing 41.43% were females. This

shows the dominance of male counterpart over their female counterpart.

2. Age Bracket
Table 4.1.3: Distribution of Respondents based on Age Bracket
Responses Frequency of Responses Percentage%
18-20 16 4.57
21-30 70 20
31-40 115 32.86
41-60 135 38.57
61 and above 14 4
Total 350 100

Source: Authors field survey (2023).

Table 4.1.3, it is adduced that the age bracket of the respondents between 18-20 years

is 16, representing 4.57% seventy respondents were between the age brackets of 21-30 years

which makes up 20% meanwhile, 115 respondent falls between the age brackets of 31-10

years representing 32.86%. The respondents that make the age bracket of 41-6 are 135

representing 38.57% lastly, 14 respondents representing 4% fall between the age bracket of

61 and above. The respondent who are between the age bracket of 21-30, 31-40 and 41-60 are

those who are matured enough to understand the issues addressed in this study.

3. Marital Status
Table 4.1.4: Distribution of Respondents based on Marital Status
Responses Frequency of Responses Percentage%
Married 223 63.71
Single 99 28.29
Divorce 28 8
Total 350 100
 63

Source: Authors field survey (2023).

From Table 4.1.4 it can be deduced that 223 respondent representing 63.71% were

married. 99 respondents representing 28.29% were single. Only 28 respondents representing

8% were divorced.

4. Educational Qualification.
Table 4.1.5: Distribution of Respondents based on Educational Qualifications.
Responses Frequency of Responses Percentage%
FSLS 19 5.43
WAEC/GCE 123 35.14
B. SC/HND 153 43.71
MA/M.SC 40 11.43
Ph. D 15 4.29
Total 350 100

Source: Authors field survey (2023).

From Table 4.1.5, it is adduced that 19 respondents representing 5.43% were those

with FSLC while 123 respondents representing 34.14% were those with WAEC GCE

Meanwhile, 153 representing 43.71% were holders of B.SC/HND 40 respondents

representing 11.43% were MA/MSC holders. Fifteen respondents representing 4.29% were

Ph. D holders.

Section B

Questions related to the subject matter

This section seeks to require from the respondents their opinion on variables

bothering on health policy implementation and development in Akwa Ibom State.

 64

Table 4.1.6: Question 1: Health policies in Akwa Ibom State has increased number of
doctors, nurses and health workers in primary health care services?
Responses Frequency of Responses Percentage%
Agree 112 32
Strongly agree 87 24.86
Disagree 99 28.29
Strongly Disagree 44 12.57
Undecided 8 2.28
Total 350 100

Source: Authors field survey (2023).

Table 4.1.6, indicates that 112 respondents representing 32% agreed and 87

representing 24.86% strongly agreed that the policy made for health in Akwa Ibom state is

effective. Whereas 99 respondents representing 28.29% disagree and 44 respondents

representing 12.37 strongly disagree with the above statement. Eight respondents

representing 2.28% were undecided.

Table 4.1.7: Question 2: Health policies in Akwa Ibom State has increased number of
primary health care centers?
Responses Frequency of Responses Percentage%
Agree 120 34.29
Strongly Agree 77 22
Disagree 80 22.85
Strongly Disagree 40 11.43
Undecided 33 9.43
Total 350 100
Source: Authors field survey (2023).

From Table 4.1.7, it is observed that 120 respondents representing 34.29% agree and

77 respondents representing 22 strongly agree that the policy implementation of health in

Akwa Ibom State has truly reduce unemployment and economic growth in Akwa Ibom State.
 65

While 80 disagree and 40 strongly disagree, whereas 33 representing 9.43% were undecided.

Table 4.1.8: Question 3: Health Policies in Akwa Ibom State has improved Maternity
Services in Primary Health Care Services?
Responses Frequency of Responses Percentage%
Agree 30 8.57
Strongly Agree 21 6
Disagree 132 37.71
Strongly Disagree 160 45.72
Undecided 7 2
Total 350 100
Source: Authors field survey (2023).
From Table 4.1.8, it shows that 30 respondents representing 8 57% agree, and 21

respondents representing 6% strongly agree that the implementation of the health policies in

Akwa Ibom State has improved maternity services in primary health care has truly been

effective. While 132 representing 37.71% disagree and 160 reprehending 45.72% strongly

disagree, 7 were undecided.

Table 4.1.9: Question 4: Health Policy in Akwa Ibom State have reduced Childhood and
under-five mortality arising from Malaria in Akwa Ibom State?
Responses Frequency of Responses Percentage%
Agree 112 32
Strongly Agree 87 24.86
Disagree 99 28.29
Strongly Disagree 44 12.57
Undecided 8 2.28
Total 350 100

Source: Authors field survey (2023).

Table 4.1.9, indicates that 112 respondents representing 32% agreed and 87

representing 24.86% strongly agreed that health policies has reduced mortality arising from

Malaria in the state. Whereas 99 respondents representing 28.29% disagree and 44

 66

respondents representing 2.28% are undecided representing 12.37 strongly disagree with the

above statement. Eight respondents representing 2.28%0 were undecided.

Table 4.1.10: Question 5: Health policies in Akwa Ibom State has improved Child
Health Care Services in Government owned Hospitals?
Responses Frequency of Responses Percentage%
Agree 120 34.29
Strongly Agree 77 22
Disagree 80 22.85
Strongly Disagree 40 11.43
Undecided 33 9.43
Total 350 100

Source: Authors field survey (2023).

From Table 4.1.10, it is observed that 45 respondents representing 34 29% agree

and 77 respondents representing 22 strongly agree that health policies has improved child

health care services in government owned hospitals in the state while 30 disagree and 40

strongly disagree, whereas 33 representing 9.43% were undecided.

Table 4.1.11: Question 6: Health policies in Akwa Ibom State has subsidized the price
of essential Drugs in Government owned Hospitals?
Responses Frequency of Responses Percentage%
Agree 30 8.57
Strongly Agree 21 6
Disagree 132 37.71
Strongly Disagree 160 45.72
Undecided 7 2
Total 350 100

Source: Authors field survey (2023).

It is shown from Table 4.1.11, those 30 respondents representing and 57% agree and

21 respondents representing 6% strongly agree that health policies in Akwa Ibom state has
 67

subsidized the price of essential drugs in government owned hospitals, While 132

representing 37.71% disagree, while 160 representing 45.72% strongly disagree. 7 were

undecided.

Table 4.1.13: Question 7: Health Policies in Akwa Ibom State has improved the
quality of Emergency services in Primary Health Care Services?
Responses Frequency of Responses Percentage%
Agree 70 20
Strongly Agree 42 12
Disagree 124 35.43
Strongly Disagree 114 32.57
Undecided 0 0
Total 350 100
Source: Authors field survey (2023).

From Table 4.1.9, it is observed that 70 respondents representing 20% agree and 42

respondents representing 12% strongly agree that Health policies in Akwa Ibom State has

improved the quality of emergency services in primary health care services, while 124

respondents representing 35.43% disagree and 114 respondents representing 32.57% strongly

disagree.

Table 4.1.14: Question 8: Health Policies in Akwa Ibom State has improved
Immunization services in Akwa Ibom State?
Responses Frequency of Responses Percentage%
Agree 124 35.43
Strongly Agree 112 32
Disagree 70 20
Strongly Disagree 42 12
Undecided 2 0.57
Total 350 100
Source: Authors field survey (2023).
Analysis from Table 4.1.14 indicates that 124 respondents representing 33.43% c and

112 representing 32% strongly agree that health policies in Akwa Ibom state has improved
 68

immunization services in Akwa Ibom state. While 70 respondents representing 20% disagree

and 42 respondents representing 12% strongly disagree, whereas only 2 respondents

representing 0.5% were undecided.

Table 4.1.15: Question 9: Health policies in Akwa Ibom State has improved Medical
test in Primary Health Care services?
Responses Frequency of Responses Percentage%
Agree 12 3.43
Strongly agree 46 13.14
Disagree 127 36.29
Strongly Disagree 140 40
Undecided 25 7.14
Total 350 100

Source: Authors field survey (2023).

Table 4.1.15 indicates that 12 respondents representing 3.43% agree and 46

respondents representing 13.14% strongly agree that health policies in Akwa Ibom state has

improved medical test in primary health care services while 127 respondents representing

36:29% disagree and respondents representing 7.14% are undecided 140 respondents

representing40% strongly disagree against the above statement. 25 respondents representing

7.14% were undecided.

Table 4.1.12: Question 10: Health Policies in Akwa Ibom State has reduced the
incidence of Fake or Unapproved Drugs?
 69

Responses Frequency of Responses Percentage%

Agree 78 22.28
Strongly agree 99 28.29
Disagree 77 22
Strongly Disagree 66 18.86
Undecided 30 8.57
Total 350 100

Source: Authors field survey (2023).

Analysis from Table 4.1.12 indicates that 78 respondents representing 22.28% agree

and 99 respondents representing 28 29% strongly agree that health policies in Akwa Ibom

state has reduced the incidence of fake or unapproved Drugs while 77 respondents

representing 22% disagree and 66 respondents representing 18.86% strongly disagree. Thirty

respondents representing 8.57% were undecided

4.2 Testing of Hypotheses

The Hypotheses were tested using data collected from questionnaire distributed. The

statistical tool used in testing the hypotheses is the chi-square test of independence. It is used

to test the probability level either to accept or reject null or alternative hypothesis so tested.

Formula = X² = ⅀(Fo-fe)
Fe
Where

X² = Chi-square

Fo = Observed frequency

Fe = Expected frequency

⅀ = Summation of all items

The level of significance is put at 0.05 or 0.5% the degree of freedom is given as (R-1) (c-1)

Rules of Decision

Where the calculated chi-square value is less than the critical table value, null
 70

hypothesis will be accepted and alternative hypothesis will be rejected. Where the calculated

chi-square value is greater than the critical table value, alternative hypothesis will be accepted

while the null hypothesis will be rejected.

Hypothesis 1

Ho: Implemented health policies has significant effect on Primary Health Care Services in

Akwa Ibom State

Hi: Implemented health policy does not have significant effect on Primary Health Care

Services in Akwa Ibom State

Hypothesis 1
Table 4.2.1: chi-square test of in dependence

Responses Agree Strongly Disagree Strongly Undecide Total

agree disagree d
Male 60 50 66 24 5 205
Female 52 37 33 20 3 145
Total 112 87 99 44 8 350

To calculate for expected frequency

Row total /column total

N
Cell A = 205 - 112 = 65.6
350
Cell B= 205 - 87 = 50.95
350
Cell C =  205 - 90 = 57.98
350

Cell D= 205 - 44 = 25.77

350

Cell E= 205 - 8 = 4.68

350
 71

Cell F= 145 x 112 = 46.4

350
Cell G= 145 x 87 = 36.04
350

Cell H= 145 x 99 = 41.01

350

Cell I= 145 x 44 = 18.22

350

Cell J= 145 x 8 = 3.31

350

Table 4.2 2: Chi-square Distribution table

Responses Fo Fe Fo-Fe (Fo-Fe)² (Fo-Fe)²

Fe
A 60 65.6 5.6 31.36 0.48
B 50 50.95 0.95 0.90 0.018
C 66 57.98 8.02 64.32 1.11
D 24 25.77 1.77 3.13 0.12
E 5 4.68 0.32 0.10 0.02
F 52 46.4 5.6 31.36 0.67
G 37 36.04 0.96 0.92 0.025
H 33 41.01 8.01 64.16 1.56
I 20 18.22 1.78 3.16 0.17
J 3 3.31 0.31 0.09 0.027
Total ∑x²=4.2

Degree of freedom = ( C-1) x (2-1)

DF = (5-1) x (2-1)
DF = 4x1
DF = 4
Level of Significance = 0.05
Calculated Value = 4.2
Critical Value = 2.78

The calculated chi-square value of 4.2 is greater than the critical table value of 2.78 at

0.05level of significance and degree of freedom of 4. Thus, the null hypothesis is rejected.
 72

From the above analysis, it can be concluded that implemented health polices has a

significant effect on primary health care services in Akwa Ibom State.

Hypothesis 2

Ho: Implemented health policies has significant effect on Child Health Care Services in

Akwa Ibom State

Hi: Implemented health policies does not have significant effect on Child Health Care

Services in Akwa Ibom State

Table 4.2.3: chi-square Test of independence

Responses Agree Strongly Disagree Strongly Undecide Total

To
Agree Disagree d
Male 80 60 36 28 1 205
Female 44 52 34 14 1 145
Total 124 112 70 42 2 350
calculate for expected frequency

Row Total/Column Total

N

Cell A= 205-124 = 72.63

350

Cell B= 205-112 = 65.6

350
X
Cell C= 205-70 = 41
350

Cell D= 205-42 = 24.6

350

Cell E= 205-2 = 1.17

350
Cell F= 145 x 124 = 51.37
350
Cell G= 145 x 112 = 46.4
 73

350
Cell H= 145 x 70 = 29
350
Cell I= 145 x 42 = 17.4
350
Cell J= 145 x 2 = 0.83
350

Table 4.2.4: Chi-square distribution Table

Responses Fo Fe Fo-Fe (Fo-Fe) (Fo-Fe)²

Fe
A 80 72.63 7.37 54.32 0.75
B 60 65.6 5.6 31.36 0.48
C 36 41 5 25 0.61
D 28 24.6 3.4 11.57 0.61
E 1 1.17 0.17 0.03 0.47
F 44 51.37 7.37 54.32 0.025
G 52 46.4 5.6 31.36 1.06
H 34 29 5 25 0.86
I 14 17.4 3.4 11.56 0.66
J 1 0.83 0.17 0.03 0.03
Total ∑x²=5.6

Degree of freedom = (C-1) x (2-1)

DF = (5-1) x (2-1)
DF = 4x1
DF = 4
Level of Significance = 0.05
Calculated Value = 5.6
Critical Value = 2.78
The calculated value of 5.6 is greater than the critical value of 2.78 at 0.05 level of

significance and degree of freedom 4. Therefore the null hypothesis is rejected. This means

that implemented health policies has significant effect on child health care service in Akwa

Ibom State.
 74

Hypothesis 3

Ho: Health Policies in Akwa Ibom State has reduced the incidence of Fake or Unapproved

Drugs?

Hi: Health Policies in Akwa Ibom State has not reduced the incidence of Fake or
Unapproved Drugs?
Table 4.2 5: Chi-Square Test of Independence
Responses Agree Strongly Disagree Strongly Disagree Undecided Total
Agree
Male 89 60 30 35 0 205
Female 58 50 22 15 0 145
Total 138 110 52 50 0 350

To Calculate for Expected Frequency

Row Total/Column Total

N

Cell A= 205-134 = 80.82

350
Cell B= 205-110 = 64.42
350
Cell C= 205-52 = 30.45
350
Cell D= 205-50 = 29.28
350
Cell E= 205-0 = 0
350

Cell F= 145 x 138 = 57.17

350
Cell G= 145 x 110 = 45.57
350

Cell H= 145 x 52 = 21.54

350
Cell I= 145 x 50 = 20.71
350
Cell J= 145 x 0 = 0
350
 75

Table 4.2.6: Chi-Square Distribution Table

Responses Fo Fe Fo-Fe (FoFe)2 (Fo-Fe)²

N
A 80 80.32 0.82 0.67 0.00083
B 60 64.42 4.42 19.53 0.30
C 30 30.45 0.45 0.20 0.0066
D 35 28.28 5.72 32.71 1.11
E 0 0 0 0 0
F 58 57.15 0.85 072 0.012
G 50 45.57 4.43 19.62 0.43
H 22 21.54 0.46 0.21 0.0098
I 15 20.71 5.71 32.60 1.57
J 0 0 0 0 0
Total ∑x² = 3.5

Degree of Freedom =(C-1) x (2-1)

DF = (5-1) x (2-1)
DF = 4x1
DF = 4
Level of Significance = 0.05
Calculated Value = 3.5
Critical Value = 2.78

The Calculated Value of 3.5 is greater than the critical value of 2.78 at 0.05 level of

significance and degree of freedom 4. Hence, the null hypothesis is rejected. This means that

health policies in Akwa Ibom State has reduced the incidence of Fake or unapproved drugs.

4.3 Discussion of Findings

This work was carried out to assess health policy implementation and development in

Akwa Ibom State. To achieve this objectives three research questions and two research

hypothesis were formulated to guide this study. A structured questionnaire was use as the
 76

major instrument to obtain data from 350 respondents. Hypothesis one (1) was tested using

question two (2), it is observed that 120 respondents representing 34.29% agree and 77

respondents representing 22 strongly agree that the policy implementation of health in Akwa

Ibom State has truly reduce unemployment and economic growth in Akwa Ibom State. While

80 disagree and 40 strongly disagree, whereas 33 representing 9.43% were undecided. This

led to accepting the null hypothesis and the alternative hypothesis.

Hypothesis two (2) was tested using question number three (3) it was observed that

112 respondents representing 32% agreed and 87 representing 24.86% strongly agreed that

health policies has reduced mortality arising from Malaria in the state. Whereas 99

respondents representing 28.29% disagree and 44 respondents representing 2.28% are

undecided representing 12.37 strongly disagree with the above statement. Eight respondents

representing 2.28%0 were undecided. This led to accepting the alternative hypothesis and

rejecting the null hypothesis.

Hypothesis three (3) was tested using question number ten (10). indicates that 78

respondents representing 22.28% agree and 99 respondents representing 28 29% strongly

agree that health policies in Akwa Ibom state has reduced the incidence of fake or

unapproved Drugs while 77 respondents representing 22% disagree and 66 respondents

representing 18.86% strongly disagree. Thirty respondents representing 8.57% were

undecided. This led to accepting the alternative hypothesis and rejecting the null hypothesis.
 77

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary

The main objective of the research work is to look at health policy implementation

and development in Akwa Ibom State this work focused on three local government in which

health policy of Governor Udom Emmanuel also cited are Onna Local Government Area,

Abak Local Government and Etinan Local Government to this end we have seen the health

policies focus of Gov. Udom, Since 2015 to 2021.

Health is wealth and the administration of Governor Udom Emmanuel fervently

believes in this epigram. This belief has informed the massive turn around that the State has

witnessed in the last four years.

Thus, health policy of the administration has provided: Free medical services for

children below 5 years, pregnant women and the aged, Reconstruction and equipping of

General Hospital, Etinan, Reconstruction of General Hospital, Ikono, Ongoing reconstruction

of General Hospital, Ituk Mbang, Ongoing reconstruction work at General Hospital, Ikot

Okoro, Construction of Emergency Operation Centre (EOC) at Infectious Disease Hospital,

Ikot Ekpene Refurbishing and maintenance of house officers residential quarters at Obio

Offot, Uyo, Training and Certification of 100 Doctors and Nurses in Basic Lives Support

(BLS) and Advanced Cardiac Lives Support (ACLS) with Medical Emergency Experts from

the USA ,Procurement of Automated External Defibrillators (AEDs) and Electrocardiograph

(ECG) Machines for use in Emergency Response (now fitted in ambulances), Awareness and

sensitization campaign for the control of Tuberculosis and leprosy as well as treatment,

Effective intervention and eradication of Lassa Fever and Monkey Pox in the state,

Reconstruction of Oxygen plant at Ikot Ekpene for supply of oxygen to other hospitals in the

state. This research work is to see how policy made for health and how it has been
 78

implemented in the state.

5.2 Conclusion

This paper analytically explored the health policies implemented in Akwa Ibom State

and health sector's performance. The health policies are implemented but not numerous

health services in the state have been given much consideration and carries no capacity to

accommodate the unemployed youth in Alwa Ibom State. Though the government has made

reasonable effort, the prerequisites for health are not completely present or have not been met

in Akwa Ibom State. In addition, certain salient ingredients needed for health development

have not been given deserves attention in Akwa Ibom State. Thus far, these policies have not

helped to actualize Akwa Ibom Sate's health sector aspiration. First, Lack of Funding to Build

and Maintain Infrastructure, inadequate allocation of financial resources to improve and

maintain the general public’s health.

Currently, the existing health care resource allocation is skewed, with a high

proportion going towards secondary and tertiary care facilities. This means that people tend

to bypass the primary health care facilities in search of better care in the secondary and

tertiary facilities.

Secondly, Healthcare is too expensive for most Akwa Ibomite State Governments;

have to invest more in basic health care.

Thirdly, the performance of health sector especially implementing polices on primary

health care by all indications, had been far below expectation.

5.3 Recommendations

Deduced from the study the following recommendations have been given to guide the

researcher for health sector to develop and perform better.

1. Government should set up accountability agency that should look into providing and
 79

maintaining a standard infrastructure for all the primary health care centers in Akwa

Ibom State.

2. To maximize the population health in the state, the major challenges in the healthcare

sector have to be overcome by increasing the national budget allocation (% per GDP)

for healthcare to match the global standard, expanding the national healthcare scheme

to reduce out-of-pocket spending.

3. Government of Akwa Ibom State in conjunction with the state ministry of health in

Prioritizing continuous medical education for healthcare staff to improve their

knowledge base, improving awareness campaigns regarding healthcare advice for the

population.

4. The state government should set up committee that comprises of state and local

communities that routinely make decisions and allocate resources for roads,

sidewalks, land use, public gathering places, housing, public transit, parks and

recreation and most especially, sign post that shows the direction of the primary

health centres.
 80

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 83

QUESTIONNAIRE

Department of Public Administration

Faculty of Management Sciences
Akwa Ibom State University

RESEARCH TOPIC: HEALTH POLICY IMPLEMENTATION AND

DEVELOPMENT IN AKWA IBOM STATE (2015- 2021)

Dear Respondent,
I am an undergraduate student of the above Department. I am carrying out a research
on the above topic. I need information from you to enable me carry out the research. It is
strictly for academic purposes and I promise that every information you provide will be
treated with optimum confidentiality. Thank you very much for your co-operation and God
bless you.

Okon, Victor Bassey

(Researcher)
 84

QUESTIONNAIRE FOR HEALTH POLICY IMPLEMENTATION AND

DEVELOPMENT IN AKWA IBOM STATE (2015- 2021)
Instruction: Please tick and fill in the space where appropriate

SECTION A: SOCIO-ECONOMIC CHARACTERISTICS

1. Name of community ……………………………..

2. Name of village: ………………………………....

3. Household head: Male Female

4. Age: 20-30 31-40 41-50 51-60 61 and above

5 Marital status: Single Married Widowed Divorced

4. Educational status

Primary education Secondary education Tertiary education

Others (specify)

5. How many people are in your household? 2-4 5-7 8-10

11and above

6. What is your basic occupation?

Farming Civil Servant Artisan Self-employed

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S/N ITEMS SA A D SD U
1. Health policies in Akwa Ibom State has increased
number of doctors, nurses and health workers in
primary health care services?
2. Health policies in Akwa Ibom State has increased
number of primary health care centers?

3. Health Policies in Akwa Ibom State has improved

Maternity Services in Primary Health Care
Services?
4. Health Policy in Akwa Ibom State have reduced
Childhood and under-five mortality arising from
Malaria in Akwa Ibom State?

5. Health policies in Akwa Ibom State has improved

Child Health Care Services in Government owned
Hospitals?

6. Health policies in Akwa Ibom State has subsidized

the price of essential Drugs in Government owned
Hospitals?
7. Health Policies in Akwa Ibom State has improved
the quality of Emergency services in Primary
Health Care Services?

8. Health Policies in Akwa Ibom State has improved

Immunization services in Akwa Ibom State?
9. Health policies in Akwa Ibom State has improved
Medical test in Primary Health Care services?
10. Health Policies in Akwa Ibom State has reduced
the incidence of Fake or Unapproved Drugs?