Why fund Community-based private Healthcare Establishments?

Nigeria , like many developing countries, has an underdeveloped healthcare delivery system. The World Health Organisation (WHO), in its world health rating system, ranked Nigeria 187 th out of 191 in overall health system performance. Listing the failings of many health systems, the WHO pointed to the fact that many health systems in majority of the poorly-performing countries focus on the public sector and often disregard the frequently much larger private sector community-based providers of healthcare ( World Health Report 2000 )

Over the last decade or so, about 60% of health service expenditure in Nigeria occurs outside of the public sector on a range of non-profit, traditional and modern practitioners (World Bank 1994). The treatment seeking behaviour of the majority of the population is geared towards seeking self remedy first and when all else has failed, do the clients present to a physician. ( Brieger et al. 2002 . Urban malaria treatment behaviour in the context of low levels of malaria transmission in Lagos - African Journal of Medical Sciences) .

The beneficiaries of this trend are the patent medicine vendors and pharmacy shops, which has continued to proliferate at an alarming rate. (DFID Country Health Briefing Paper) .

Because of the harsh economic climate prevalent in Nigeria , most of these health services are priced out of the reach of most. Hence, healthcare development in the country is largely limited to curative services with prevention, promotion, rehabilitation and other aspects of total health development receiving little attention. ( Erinosho O. 1982. Health Planning in Nigeria - Nigerian Journal of Sociology and Anthropology 8:34-49). As expected, there is the problem of accessibility and affordability where private healthcare services are provided.

Consequently, the health seeking behaviour of the average Nigerian does not go beyond efforts to respond to acute conditions ( Alubo O. 2001 . The promise and limits of private medicine: health policy dilemmas in Nigeria . Health Policy and Planning: 16(3): 313-321) . In this process, common remedies are tried first, and professional help sought only when these fail, hence patients typically present to a physician when the condition is already critical, if not too late ( Igun U. 1979 . Stages of health seeking: a descriptive model. Social science and Medicine 13A: 445, Ityavyar D. 1987. Background to the development of health services in Nigeria . Social Science and Medicine 24: 487-99).

All these factors have contributed to the dismal healthcare statistics of Nigeria and other sub-Saharan African countries.