The primary objective of the study was to examine the extend to which the organizational structure of ECWA Community Health Programme (ECHP) affects delivery of primary health care services (PHCS) in EDCHPS Kafanchan and Kaduna in Kaduna State, Nigeria. A case study design and survey were used in this study. The sample size of the study included two ECHP Executives, two EDCC Chairmen from both districts, two EDCHP Chairmen from both districts, two EDCHP supervisors, one Zonal Coordinator, 120 patients each from the two districts and 25 staff each from the two districts. The total sample size for the studied is 299. Both primary and secondary data were used. Data collection methods for this study included observation, interviews, administration of questionnaires and documentary reviews. Qualitative and descriptive statistics methods were used to answer the research questions. The main questions were: Why is ECWA incapable of supporting ECHP to participate in the delivery of PHCS in the two districts, to what extent have the State, and LGAs in the respective districts provided the required support for them to participate in the delivery of PHCS in the two districts, why diseases in the two districts appear to be in the increase despite concerted effort by the ECHP, what necessary resources if any does ECWA have in enabling the organization to provide PHCS to cater for the needs of the inhabitants in the two districts? The study findings show that the ECHP structure is highly centralized and that it permits collaboration at the Federal, State and ECWA Headquarters only, as a result of which it inhibits service delivery and collaboration at the district and operational levels. It was also observed that the structure is highly centralized and confusive in nature thereby nobody knows what is expected of every body to do in the organization, as a result of which the LGAs finds it difficult to collaborate nor support service delivery. The weak collaboration that exists between the ECWA and the Federal has led to weak delivery of PHCS in the two districts namely Kafanchan and Kaduna leading to increase in incidences of new diseases. Also findings xiii indicated that ECWA is severely constrained in financial and human resources in her efforts to provide improved delivery of PHCS. None of the districts studied was better than another and both were performing poorly compared to the World Health Organization Standards. Therefore, there has to be an effective and efficient structure that will facilitate strong devolution and centralization of power to enable delivery of services in the two districts. These challenges magnify the need for the management to create a governance structure that can work more collaboratively with the ECWA while adapting to the increasing pace of change. This collaborative structure must be adoptive and have the capacity to self-organization so that internal and external dynamics do not trigger yet reorganization. In addition, the key aspects attributed to effective partnerships are infact the reflection of the principles of better governance. The Local Government Partnership actors should not assume that accountability and transparency or strategic planning is pursued only for the good of the partnership. In most cases these are broader governance concerns, and PPP should link into and build on the existing efforts no matter how humble is the partner. The formulation and sustainability of Local Government partnerships with ECWA is dependent on the commitment and mobilization of councilors and political leaders. Immature political leadership will affect all municipal reform process and capacity building which is the important part of the municipality reform programme.

A Thesis Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy of Mzumbe University