Decentralisation of Health Care Delivery in Nigeria: Issues in Governance and Citizens’ Participation in Local Health Care

Abstract

Issues of citizens participation in democracy continue to be a recurring decimal in governance discourse. This is more so as it is widely believed that promoting the main tenets of democracy and increasing peoples participation will engender development. The inference from this is that, since development is about people, when people are part of the decisions that affect their lives, then, they would be able to make meaningful contributions to issues that concern their own development. It is therefore argued that popular participation is in essence the empowerment of the people to involve themselves in creating structures and in designing policies and programmes that serve the interests of all and contribute optimally to the development process. Decentralisation emerged as a result of global trend to local autonomy and self-determination, and as a result of a trend to reduce reliance on centralised planning and be more responsive to market forces as well as local needs. In relation to the health sector, decentralisation is concerned with changing the way health systems are organised to produce effective service delivery. The point has been made that decentralisation could be useful in supporting and developing health services and bring it closer to people. This paper therefore examines the process of decentralisation and how it impacts on primary health care (PHC) service delivery in Nigeria.