Policy and practice : The case of medical facilities in Nigeria

Elaborate health programmes have always been an important feature of national development plans in Nigeria, especially since independence in 1960. The aspect of the programmes that is examined in this paper is the geographical distribution of medical facilities. The policy objectives in this regard have been to improve access to facilities and personnel by distributing them equatably according to population, and to correct the rural-urban imbalance in the system. But how far have these objectives been realized? In an attempt to answer this question, the situation in Bendel State is examined in some detail and the results show that the rural-urban imbalance is still evident. Correlation analyses showed that areas that have a comparatively large urban population have more facilities and personnel than areas that are predominantly rural. Also, three step-wise multiple regression analyses revealed that Urban population is a far more important factor than total population in explaining the distribution of hospitals, hospital beds and doctors. The doctor/population ratios are exceedingly high for the predominantly rural areas, over 1:70,000 in some cases. These ratios are far in excess of 1:14,000 which was the national target for 1980. All these show that some important policy objectives of the health programmes have not been realized.