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HEALTH INSTITUTION

ADMINISTRATION

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Historical Development of Hospitals

in NigeriaColonial administration limited coverage andscope

Supervised under Department of Health

Later became Regional Responsibility

Some became federal at Independence

Others taken over gradually with creation of states toensure federal presence and promote equity

Tertiary health care emerged with establishment of

University medical schoolsTertiary special hospitals developed by FederalGovernment to cover special areas such aspsychiatry, orthopaedics, Eye care, Ear Care

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Types of Hospitals in Nigeria

The health system is organised along thefollowing tiers:

Primary Health Posts, Health Centres,

Secondary Cottage hospitals, General

hospitals, State Specialist hospitals,

Tertiary- University affiliated Teaching Hospitals,

Federal Medical Centres, Special hospitals

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Administrative Structure

Administrative structure specified in law:

University Teaching Hospitals Act Decree 10 creates the following:

Management Board

Committees of the Board

Posts of Chief Medical Director

Chairman Medical Advisory Committee

Director of Administration

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Functions of Organs

Board: Appointment , promotion, discipline,development of institution, responsibility for itsassets

Chief Medical Director chief executive for dayto day running of the hospital

Chairman MAC for clinical responsibilities

Director of Administration

secretary to theBoard, performance of duties as directed by theCMD

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Challenges of Administration

Basically administration implies management function inthe hospital setting

Centralised supervision despite Boards

Funding dependent on Government budgetary allocation

Expenditure dependent on public service regulationsPromotion of Efficiency

Managing Autonomy

Meeting staff demands

Generating Revenue from out of pocket payments nohealth insuranceManaging the Policy environment

Surviving the hassles

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Nature of Autonomy

Legislation provides for Management Board withspecified functions

Funding comes from Central body

Expenditure determined by regulationFund can be generated

Board can employ and fire but emolument isbased on a unified grading and disciplinary

process is complexLoans from external sources require ministerialapproval

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Improving Efficiency

Controversial but necessary

Contracting out specific services and functions

Improving procurement of drugs, equipment andsupplies

Clinical Audits

Changing staff levels and mix

Reducing patient stays

Reducing avoidable wastes

Performance measurement

Monitoring and Evaluation of services and cost regularlythrough research

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Pitfalls

Awareness of extant Government

Regulations

Resisting pressures for over employment

Resisting pressures of unrealistic

commitment to unions

Undue optimism about release ofbudgetary allocations

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Need to satisfy the Public

Institutions set up as political programmes

to bring effect of government to the public

Public has right to ask questions about its

staffing and services

The interest is sometimes loud and

aggressive

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What do we administer

The three (Ms):

Men

Material

Money

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Material Management

Sourcing

Efficient and effective use

MaintenanceReplacement

Monitoring

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Financial Management

Most scarce

Sourcing

Effective and efficient utilisationBudgeting

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Thank you