Abstract:
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
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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.