BUDGET AND BUDGETARY CONTROL AS A TOOL FOR EFFECTIVE DECISION AND PLANNING IN PRIVATE SECTORS IN AKWA IBOM STATE.

BUDGET AND BUDGETARY CONTROL AS A TOOL FOR EFFECTIVE DECISION AND PLANNING IN PRIVATE SECTORS IN AKWA IBOM STATE.

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ABSTRACT

The aim of this study is to access the distribution pattern of healthcare facilities in Abak Local Government Area of Akwa Ibom State at present is witnessing a tremendous increase in population with grossly inadequate healthcare facilities to carter for the basic medical needs of these teeming population. Therefore, to say the least, this apparent inadequacy of healthcare facilities negates the principal of social justice for equitable distribution pattern of healthcare facilities in the area. Accordingly, this social malady is laid out systematically in the study using research methodology that include among other things; data collection from primary and secondary sources. Whereas, primary data was basically derived from administration of questionnaire, personal interview and direct observation while on the other hand, secondary data source emanate from textbook, published and unpublished, thesis and dissertation, journal, internet/materials, administrative maps of the study area, conference and seminar papers, The hypothesis was scientifically tested using Nearest Neighbour  Statistical Analysis Index (Rn) and a simple descriptive method revealed skewed and grossly uneven distribution pattern of healthcare facilities in the area. In view of this, it is advanced among other things; that urgent and deliberate Government policies should be tailored towards revamping existing healthcare facilities and provision of new ones with minimum threshold requirements in order to provide robust and efficient healthcare facilities manned with trained personnel to meet the medical needs of the teeming population of Abak Local Government Area of Akwa Ibom State.


CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

            Health is a crucial component of human well-being. It is defined by Bircher (2005) as a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture and personal responsibility. Health is among the most important services provided by the government of both developed and developing nations in the world, as the productivity level of any one is dependent on its state of health. According to the Nigerian Federal Ministry of Health (1998), the health of the people does not only contributes to better quality of life but also essential for sustained economic and social development of the country. Thus, health is known to be an important resource in the process of economic development, thereby making expenditure on health a productive investment.

            Health is a universal human right and focus of social and political concern worldwide. Thus, adequate and effective distribution of health care facilities contributes immensely to health care service provision and needs of the people (Ujoh,and Kwagbsende,2014).Access to medical services is one of the basic necessities of any modern human community. It is a major complement to strong, dynamic and progressive society (Marcus, and Makanjuola, 2011).

            It has been observed that the Chinese economy has been growing at a spectacular rate and people’s living standards have improved significantly since the reform and opening up. At the same time, Chinese healthcare resources have developed significantly to cater for rising demand. Average bed numbers per 1000 people grew from 0.15 in 1949 to 4.55 in 2013 (China Health Statistics Yearbook, 2013). However, imbalanced distribution of health resources has led to severe inequality between cities and rural areas, which largely influences social stability and harmony in China. According to the Chinese government, about 80 percent of health resources (e.g., hospitals, bed numbers, and practitioners) are allocated in Chinese cities (Lee, 2004). In addition, the size of large hospitals has been expanding excessively and the majority of health resources are concentrated in large city hospitals [Health and Family Planning Statistics,2016].

            In Nigeria, much concern has been focused on providing the basic needs of the people as a strategy to reduce the level of poverty in the society. Hence, the concern for the spatial patterns of distribution of the basic development needs that affect the wellbeing of the people (Atser, and Akpan, 2009). Health care provision in Nigeria is the responsibility of the three tiers of government in the country, these are the Local Government, State Government and the Federal Government who handles the primary, secondary and tertiary facilities respectively. However, because Nigeria operates a mixed economy, private providers of health care also have a visible role to play in health care delivery. The Federal Government's role is mostly limited to coordinating the affairs of the University Teaching Hospitals and the Federal Medical Centres (tertiary health care) while the state government manages the various general hospitals (secondary health care) and the local governments focus on dispensaries (primary health care) which are regulated by the Federal Government through the National Primary Health Care Development Authority (NPHCDA).

            The pattern of distribution of heath care facilities and level of utilization has since been a thing of interest considering the effect it possess on the developmental level of any region. According to Inyang 1994, the level of access to health care facilities is a function of the degree of fairness in spatial distribution of the health care facilities. It was also observed that the problem that exist in the health care sector is not totally on the service quality but on the adequacy of health facilities provided and according to Ujoh and Kwaghsende (2014), the quality of services rendered is related to the level of manpower available, this explains that it is not only for the facilities to be equally distributed but to have health personnels who can deliver the services to people for which the facilities are created to serve. However, because Healthcare facility distribution in Nigeria has been characterized by significant disparity which is evident in their locational pattern of distribution where some of these healthcare facilities are concentrated in one area at the expense of other areas, the maximum benefits of total of its provision have not been enjoyed by all. This is observed to have awakened the need for researches on the pattern and utilization of Health Care Facilities in different part of the country and has made governments to show serious commitment towards addressing the inequalities.

            In Akwa Ibom State as it is in most parts of the country, there is the dual problem of inadequate facilities and high level of poverty which with resultant low personal mobility, constrained access to health care facilities. It is therefore imperative to examine the spatial distribution pattern of health care facilities in Abak Local Government Area of Akwa Ibom State. Against this background, this research will examine the spatial distribution pattern of health facilities in Abak Local Government Area with a view to ascertain whether there is any imbalance in the pattern of the healthcare facilities distribution when compare with population distribution of the area.

1.2       Statement of the Problem

            The Nigerian population according to the National Population Commission (2006), is estimated to be over 140million, this increasing trend shows a need for increased and improved health services which could be said to be one of the reasons for the involvement of Nigeria in the Sustainable Development Goals (SDG). The Sustainable Development Goals (SDG) is made up of eight point agenda, out of which three are accrued to health issues, these include; Reduction of child mortality, improvement of maternal health, combat HIV/AIDS, malaria, and other diseases (USAID, 2005). This has made the health sector to be greatly engrossed in the establishment of more health care facilities for the people and it has also inspired several researches to examine the distribution, accessibility and utilization of health care facilities in the different part of the nation. Health facilities of different types and magnitude are located in all the nooks and crannies of the country to cater for the ever increasing population.

Abak Local Government Area has for some time now witnessed tremendous increase in population which calls for the provision of health care facilities to meet the needs of the teeming population.

            To this end, the federal, state, local governments, the private concerns as well as the International organizations have indicated interest in transforming the area or improve the health condition of the citizenry by providing health facilities in the area. In line with this developmental drive, and the resolve of the government to improve upon the health condition of the people, health facilities have been sited in different locations in the area. These health facilities are crucial to the locality as they are development catalyst for improved health conditions. Thus, According to Olawuni, (2007) cited in Adetunji and Aloba (2013), every successive Nigerian governments in collaboration with other Non-governmental agencies devoted substantial part of their annual budgets to health care provision and delivery.

            In-spite of these advantages, the distribution pattern of health care facilities in Abak Local Government Area, and accessibility to some of these facilities are worrisome regarding the rationale behind their location. While some areas are favoured, others are disadvantaged, thus resulting in a skewed spatial location in the area. This disparity in health care facilities distribution has implication in the health condition of the people. Also, knowledge on the nature of distribution pattern of health care facilities is expedient in understanding the level of success or otherwise of health care delivery system in Abak Local Government Area. It is on this premise that a careful analysis of special location of health care facilities in Abak Local Government Area and its implication becomes imperative.

1.3       Aim and Objectives

            The aim of this research is to assess the distribution pattern of health care facilities in Abak Local Government Area. To achieve this aim, the following objectives were pursued, to:

i.                                to identify all Public Healthcare Facilities in Abak Local Government Area

ii.                  to analyse   the  distribution pattern of Healthcare Facilities in the study area;

iii.                to categorize the Healthcare Facilities into primary, secondary and tertiary,

iv.                to assess the relationship between spatial of healthcare facilities on population distribution in the study area.

v.                  to recommend suitable location for health care facilities in the area.

1.4        Research Questions

(i)                             What type of health care facilities are in Abak Local Government Area?

(ii)        What pattern of health care facilities distribution is in the study area?

(iii)             What categories of Healthcare Facilities are in the study area?

(iv)                What is the relationship between the distribution of primary healthcare facilities and   population distribution of the area

(v)            Where should future health facilities be located in the study area? 

Hypothesis

Ho:       There is no significant relationship between the spatial distribution pattern of health care facilities and population distribution in Abak Local Government Area.

H­1:       There is a significant relationship between the spatial distribution pattern of health care facilities and population distribution in Abak Local Government Area.

1.5       Significance of the Study

            There have been concerted efforts by the government and non-governmental organizations as well as the private concern to foster improved health condition by ensuring a rational decision making in the location of health care facilities within a region. As a step towards improving the standard of health care facilities in the study area, the study on assessment of spatial distribution and accessibilities of health care facilities in Abak Local Government Area is relevant in that it will provide the public and decision makers with information such as location, personnel strength, available facilities, status of health care facilities, to enhance proper planning and decision making. The information provided will enable the government and health professionals in policy and decision making such as planning for the future expansion, distribution of materials or facilities among these health care facilities in the study area.

            Apart from being beneficial to the government agencies (Ministry of Health, House of Assembly, National Population Commission, Ministry of Environment, National Bureau of Statistics, etc.) in terms of throwing more light on the evenness or disparity in health care facilities location, the recommendations when implemented will help transform the people by enhancing their well-being, even facility distribution as a result of rational location of subsequent health care facilities in the area.

1.6       Justification for the Study

            In the past, few attempts and initiatives involving spatial analysis of health care facilities have been created in urban area with only limited achievement in

 rural areas. However, though the lists of all the public facilities are available, but lack of precise knowledge of how they are spatially distributed, this makes planning and decision making very difficult in the study area. The need to look into how healthcare facilities are distributed within the study area so as to give suggestion on location for future health care facilities.

1.7       Scope of the Study

            The scope of this research is limited to the distribution of health care facilities in Abak Local Government Area, Akwa Ibom State. It does not takes into consideration the distribution of  others level of health care  facilities owned by individuals, but only those provided by government in the study area.

1.8       Structure of Research

            This research is composed of two major parts: Part A is introductory and contains chapters 1 to 4 while Part B is made up of chapters 5 and 6 and it focuses on the findings, analysis and discussions as well as the study’s implications and recommendations for further research.

The contents in the chapters are outlined as follows: Chapter one: this provides an overview of the research issue, the inception of the study, its objectives and significance.

Chapter two presents detailed information about the study area – Abak Local Government Area, vis-a-viz her location, topography, drainage, climatic conditions, socio- economic attributes of people in the area. 

Chapter three presents a detailed description of the context of the research, review of related literatures and outlines concepts and theories which will underpin the study. This includes central place theory, and concepts derived from researches done in the developing world.

Chapter four presents the methodological approach used in the research. It provides how the sample frame was obtained. It also explains the data collection techniques and the procedures used for the analysis of data.

Chapter five describes the findings of the research. It gives socio-economic and demographic characteristics of the respondents. Findings of the research are analyzed, compared and discussed in this chapter.

Chapter six presents the study’s summary of the study, theoretical and urban planning implications. Recommendations made based on the findings are also presented in this chapter.

1.9       Healthcare Facilities In Europe

Outpatient Care

Outpatient Care is provided in a medical treatment facility (hospital, clinic, etc.) for a condition or course of treatment, which does not require admission to a hospital (in other words, for a treatment which would require an overnight stay). Outpatient care can be provided by primary care physicians and various types of medical specialists.

A person seeking medical care (a patient or sick person) usually first sees what is often referred to as a “primary care physician” – this person is also often referred to as a “general practitioner”, “family doctor”, “pediatrician”, etc. and he/she could be a dentist, gynecologist, etc.  For care from a primary care physician, it is usually necessary for the person seeking care to have previously registered (been enrolled) with that physician.

A doctor may refuse to accept a patient for treatment in any of the following situations:

·         If the doctor already has a full roster of registered persons – such that the doctor would not have the ability to properly care for their existing registered persons if additional persons were registered.

·         If the doctor’s office is located too far away from the to-be-registered person’s place of residence – i.e. the doctor would be too far away from the person’s home should a home visit be necessary.

·         If the patient is not insured by a health insurance company with which the provider of medical services has a contract; this does not apply to persons with insurance who are insured in another Member State of the European Union, a state that is part of the European Economic Area or the Swiss Confederation, or persons from a country with which the Czech Republic has entered into a social security agreement, which includes within its scope a substantive right to healthcare.

Should a primary care physician refuse to register (or accept) an individual as a patient, the refused person is entitled to have the refusal provided to them in writing. In the case of an emergency (i.e. an accident or sudden acute illness), no doctor can refuse to see a patient; however, once the emergency has been dealt with, the attending doctor can transfer the patient into the care of a primary care physician with whom the person is (or should otherwise have been) registered.

Individuals always have the right to visit a specialist without first seeing their primary care physician. They do not need what is often referred to as a “referral”.

The following types of outpatient care are provided:

a)    Primary Outpatient Care. This includes visits (usually to a doctor’s office) for the following types of care: preventive, diagnostic, therapeutic and assessment. It also includes the coordination of the continuity of healthcare services being provided by other providers (specialists, medical facilities). Primary outpatient care also includes any necessary home visits to a patient.

b)    Specialized Outpatient Care. This is care that requires the services of a medical specialist (for example, an internist, surgeon, cardiologist, etc.).

c)    Stationary Care. This care is provided to patients whose medical condition requires repeated daily outpatient type treatments.

Inpatient Care

If, and as required by the nature of an illness, a primary care doctor or outpatient specialist can ‘recommend’ that a patient receive treatment in a hospital (a medical facility of the inpatient care provider), or the doctor can ‘directly arrange’ for the patient’s admission to a hospital. There are the following types of inpatient health care facilities: acute standard, acute intensive, follow-up and long-term

1.10     Healthcare Facilities In Canada North

1. Ambulatory surgical centers

Ambulatory surgical centers, also called outpatient surgical facilities, allow patients to receive certain surgical procedures outside a hospital environment. These environments often offer surgeries at a lower cost than hospitals while also reducing the risk of exposure to infection—since patients are there for surgery, not to recover from sickness and disease.

Ambulatory surgical centers don’t provide diagnostic services or clinic hours. Instead, they take patients who have been referred for surgery by a hospital or physician—they’re designed to be “all business” when it comes to surgical care.

2. Birth centers

A birth center is a healthcare facility for childbirth that focuses on the midwifery model, according to the American Association of Birth Centers. They aim to create a birth environment that feels more comfortable to the mother and allows for a cost-effective, family-inclusive birth.

Birth centers are not typically equipped with the same contingency equipment and staff as a hospital, such as surgeons in case of a C-section or a neonatal intensive care unit. As a result, birth centers accommodate only healthy pregnancies without any known risk or complication factors.

These facilities are guided by principles of prevention, sensitivity, safety, cost-effectiveness and appropriate medical intervention when needed.

3. Blood banks

Blood banks allow donors to donate blood and platelets while also storing and sorting blood into components that can be used most effectively by patients.

“Red blood cells carry oxygen, platelets help the blood clot and plasma has specific proteins that allows proper regulation of coagulation and healing,” writes the American Society of Hematology. Sometimes patients need these particular components specifically, and sometimes they just need lots of blood. For example, a single car accident victim Blood is essential for human life, and it can’t be manufactured—only donated. So these facilities work to build the supply for patients who need it.

4. Clinics and medical offices

There are many healthcare facilities that fit that definition across a wide variety of treatment specialties.

Many people go to a clinic for routine doctor’s appointments and checkups. These healthcare facilities can be a physician’s private practice, a group practice setting or a corporately owned clinic that may be connected to a larger healthcare system or hospital.

Clinics cover a lot of ground in  healthcare. For example, you could visit a dental clinic to have a toothache investigated, a physical therapy clinic to recover from an athletic injury or a pediatric speech therapy clinic to help your child overcome an articulation disorder.

If there is a specialized health area you need to see an expert for, then odds are that there’s a clinic somewhere to accommodate you. The goal of these clinics is to give people preventative care and important diagnoses with as much convenience as possible.

That goal has also led to “walk-in” clinics becoming situated in grocery and convenience stores, malls and even airports. These clinics allow patients to get a flu shot or receive a prescription without making an appointment at their physician’s office. While many medical providers believe that a continued relationship with a provider is better for patients’ long-term health, the speed, convenience and sometimes lower cost of a walk-in clinic can be ideal for a quick need.

5. Diabetes education centers

Diabetes is a very serious illness in the United States. Over 30 million people have diabetes and many of them don’t know it, reports the Centers for Disease Control (CDC). Additionally, over a third of the national population is highly at risk for diabetes, in a condition called prediabetes.

Patients with diabetes need to manage the disease and typically make lifestyle adjustments to keep it from becoming life-threatening. Since diabetes is so widespread, diabetes education centers rose up to help patients manage their disease and to help people at risk for diabetes to avoid it, if possible.

Diabetes education centers typically offer classes, education, support groups and a variety of resources to help patients manage their diabetes and live as complication-free as possible.

6. Dialysis Centers

Patients with kidney disease often need regular treatments of dialysis. Dialysis is a process that filters and cleans the blood artificially—the work functioning kidneys normally take on. About 14 percent of Americans have chronic kidney disease. When kidneys aren’t able to filter the blood the way they are supposed to, patients might need dialysis as often as three times a week to avoid serious complications. With such high demand, dialysis facilities rose up to meet patient needs and avoid undue strain on hospitals.

7. Hospice homes

Hospice is a designation for specific healthcare facilities that specialize in end-of-life care.

Hospice care is a model that provides not only medical support, but also emotional and even spiritual support for patients and their families. According to the National Hospice and Palliative Care organization, a patient with hospice care has a team of care providers made up of the patient's personal physician, a hospice physician, nurses, home health aides, social workers, clergy or other counselors and physical or occupational therapists, if needed.

Though patients can receive hospice care at home, if their medical needs are significant, they might live in a nursing home with hospice care, or a specified hospice home.

8. Hospitals

Hospitals are the ultimate “catch-all” healthcare facility. Their services can vary greatly depending on their size and location, but a hospital’s goal is to save lives. Hospitals typically have a wide range of units that can be loosely broken into intensive care and non-intensive care units.

Intensive care units deal with emergencies and the most serious illnesses and injuries. Patients with imminently life-threatening problems go here.

Non-intensive care units include things like childbirth, surgeries, rehabilitation, step-down units for patients who have just been treated in intensive care and many others. Typically, most hospital beds could be classified as non-intensive care.

9. Imaging and radiology centers

These facilities, much like their hospital counterparts, offer diagnostic imaging services to patients. Diagnostic imaging includes CT scans, ultrasounds, X-rays, MRIs and more. While hospitals and even clinics have imaging centers, outpatient facilities help keep costs lower and allow more convenient scheduling for patients.

Hospital facilities will likely handle imaging for urgent cases, such as an MRI for a brain injury. But any imaging that can be scheduled in advance, such as ultrasounds to monitor a pregnancy, could take place at an imaging center.

1.11     Healthcare Facilities In South America

1. Mental health and addiction treatment centers

This type of healthcare facility is a grouping for many different types of facilities. Specialty treatment centers exist all across America for specified mental health issues and addictions.

Mental health treatment facilities sometimes exist as a general institution for any mental health issue and are sometimes specialized. Examples of these kinds of facilities are suicidal thoughts (or suicidal ideation) treatment, depression treatment, trauma and post-traumatic stress disorder (PTSD) treatment, treatment for anxiety disorders, behavioral disorders and more.

You can find inpatient or outpatient versions of many mental health facilities, designed to assist patients through different stages of their healing processes. At the acute-care level, you can find mental health wards in hospitals—as well as hospitals specifically devoted to mental health and long-term care facilities.

Addiction treatment centers typically deal with drug and alcohol addictions, as well as problematic behavioral addictions like gambling, work, shopping or the internet.

2. Nursing homes

Nursing homes offer a living situation for patients whose medical needs aren’t severe enough for hospitalization, but are too serious to manage at home. Some nursing homes offer services for heavier medical needs, such as speech and occupational therapy. Other nursing homes try to create a homier atmosphere, and might operate like an apartment complex with medical staff on hand.

According to the National Care Planning Council (NCPC), nursing homes enable patients with injuries, acute illnesses or postoperative care needs to recover in an environment outside the hospital. These facilities offer long-term medical care ranging from simple to complex levels of need in an environment built for residents to live in long term instead of just staying a few weeks or months.

Many people picture elderly patients in a nursing home. For the most part that’s true—over 80 percent of patients are over the age of 65. But there are also younger patients in nursing homes who may have se


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