The three core public health functions are: 1. Assessment and monitoring of health of communities and populations at risk to identify health problems and priorities. • Monitor health status to identify community health problems • Diagnose and investigate health problems and health hazards in the community • Evaluate effectiveness, accessibility and quality of personal and population-based health services.
2. Formulation of public policies designed to solve identified local and national health problems and priorities • Develop policies and plans that support individual and community health efforts.• Enforce laws and regulations that protect health and ensure safety. • Research for new insights and innovative solutions to health problems. 3.
To assure that all populations have access to appropriate and cost-effective care including health promotion services and evaluation of effectiveness of that care. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure a competent public health and personal health care workforce • Inform, educate and empower people about health issues.• Mobilize community partnerships to identify and solve health problems2. CHALLENGES The challenges of these public health functions and performance in Nigeria are now hereby considered vis-a-vis the stated functions above. 1. Assessment (a)Challenges to monitoring health status i)Poor surveillance of disease – The systematic collection, orderly consolidation and evaluation of relevant data and its prompt dissemination is inadequate.
The absence of a national biometric data system that captures all the sources of epidemiological data in the surveillance of disease has grossly affected the monitoring of health status.ii)The lack of effective tracking systems, National environmental public health tracking network which is a system of integrated health, exposure and hazard information from a variety of community sources3. Also the community Health Information Tracking System (CHITS) is not consolidated4. iii) Inequality of the health system as a result of inadequate mechanism for monitoring equity objectively by health authorities at each level of care. iv) Independent reviews of equity within the health system by observers outside the health sectors are not commissioned. v) Poor definition (assessment) of health needs.
vi) Poor quality control care systems. vii) Inadequate guidance and counseling. (b)Challenges in diagnosing and investigating health problems i)Laboratory and other diagnostic services which facilitate clinical diagnosis are limited in small peripheral institutions in remote rural areas. In such situations, health personnel have limited access to laboratory services and have to rely on their clinical skills. Under these conditions, diagnosis may be missed particularly in cases that are atypical, mild or subclinical.
ii)Standard diagnostic criteria with the use of simple algorithms are not established.iii) Concealment of cases. This results from fear of confinement and isolation hospital or of ostracism by the community in diseases that carry a social stigma e. g.
leprosy, HIV/AIDS. This can be avoided by education and proper feedback4. iv) Inadequate funding of training of health personnel to improve their clinical and laboratory skills.
v) Poor bio-emergency preparation, coordination and response. vi) Basic screening tests and intervention tools are not readily available at the primary level which accounts mostly for the burden of communicable diseases.(c)Challenges in evaluation Evaluations of health interventions in Nigeria faces measurement challenges, i.
e. defining what to measure, identifying valid indicators, testing and using the indicators in the field, and finally, validating and using the data for analysis. a. What to measure The issue of what to measure involves three key questions. i) What scope of effects should be measured (downstream, horizontal and upstream)? ii) What is the unit of observation (individual, household or community)?iii) What types of effects should be measured (biological and non-biological)? b. How to measure The most important “how to measure” issues are: i) The lack of baseline and trend data ii) The continuing tension between the need for standardized indicators and the need for measurement methods that are locally relevant and culturally sensitive. Standardization of criteria and methods is critical to being able to make comparisons across interventions, but this critical need is often in conflict with the need to customize the measures to local settings.
c. Data limitations.In developing countries like Nigeria, even if data are available at various levels, there is a big challenge to recommend policy due to some comparability issues. Currently, the main sources of data on maternal and child health indicators in developing countries can be found in the following datasets: Demographics and health survey (DHS), Reproductive Health Survey (RHS), World Development Indicators, Multiple Indicator Cluster Survey (MICS), etc.
In many developing countries, either some surveys have not been conducted or conducted for once, does not permit for trend analysis6.2. Policy formulation (a)Challenges of policy development i.
The National health Bill (NHB): The absence of a National health Act to back up the National health policy has been a fundamental weakness which means that there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions.However, since its inception, there has always been a delay in assent of the NHB by the executive arm of government. ii. Ambiguity in public design: Laws are often ambiguous because (a) Legislators and their staff lack the information or expertise to design policies with precision (b)They have contradictory provisions because the legislation is intended to serve multiple goals (c)Legislators may delegate major decisions to administrative agencies in order to keep from offending an important constituency and risking defect of the proposal.iii.
Lack of interagency coordination: One of the challenges in policy implementation lies in coordinating the different tasks, organizational cultures and varying degrees of resources when multiple agencies have responsibility for a given public health issue. iv. Inadequate funding: A fundamental problem is that administrative resources may not be commensurate with the activities required for effective policy implementation. The Federal Government has a challenge in committing fund for the development of policies, programs and guidelines.Also is the issue of donor apathy witnessed during times of economic regression7. (b)Challenges in enforcing laws and regulations i)Nuisance complaints are not properly investigated and evaluated. ii)Parties involved in nuisance investigations are not well informed and educated.
iii) No community partnerships with law enforcement agents. iv) There is no proper monitoring of contractors/providers v) No regular update of health and nuisance ordinances vi) No researches are carried out for new insights and innovative solutions to health problems2.3)Assurance (a)Challenges of linkage i)Poor collaborative referral and feedback systems within the health sector ii)Inaccessibility to simple remedies of proven efficacy or service centres iii)Public health education through the media, presentations, campaigns is not reinforced. (b)Challenges of competence (i)The lack of special population skilled personnel and advocates to meet specific health service needs. This enables under-qualified personnel to perform duties beyond their scope and training.(ii)Poor supervision of staff within institutions. iii) Lack of team effort and organization within sub-specialties within the health sector. iv) Enforcement of professional licensure and regulation is not carried out routinely.
(c)Challenges of mobilization (i)Ineffective mobilization of health resources and community partnerships to identify and solve health problems. (ii)Community representation and participation in strategic healthcare decisions and resource allocation is poor.CONCLUSIONThe challenges of the core functions of public health in Nigeria are retrogressive indicators in our health system but with the will of government, community participation and capacity building of human resources, these challenges could be surmounted. REFERENCES 1. K.
Park: Textbook of preventive and social medicine; 20th edition, pg. 8 2. Core functions of public health (internet) cited April 2012 www. idph. state. ia.
us/downloaded/core-functions. pdf. 3. Community health inter-tracking system (internet) cited April 2012.
www. healthmarket. innovations. org.
ps. 4. Environmental health tracking system (internet) cited April 2012 www. cdc. gov/eph.
tracking 5. Lucas, A. O. , Giles, H. M. Short Textbook of Public Health Medicine for the Tropics, revised edition, pg.
15. 6. Jalandhar P.
Challenges of monitoring and evaluating maternal and child health programmes in developing countries. 7. Ewedike, U. E.
, Yusuf, R. S. National health Bill: Current challenges, prospect and the way forward, MPH Seminar Series.