2.0 INTRODUCTION

A study of innovation in health management would require an in-depth analysis of the scope and nature of primary health care (PHC) delivery as perceived by scholars—and that is the purpose of this section on literature review. Basically, the chapter starts with discussions on concepts such as “innovation,” “service,” “human and material resource management” and “health care.” By starting with the evolution of concepts and definitions relating to innovative management and health care delivery in their current forms and future expectations, this study on “Innovative Health Management Strategies for Enhancing the Primary Health Care Delivery in Nigeria” will examine the fundamental elements of population health management.

Rabeh (2014) notes that strategic management is dependent on the effectiveness of analysis conducted by organizations, and how results—as well as expectations—are aligned with opportunities and challenges in a business environment. Thus, business administrators are saddled with the responsibility of identifying the most effective strategic management models and best service delivery frameworks. The manufacturing sector therefore presents an ideal setting for understanding the role of innovation in service because, in this study, health care is considered as an intangible commodity delivered to care users who are also required to pay for service received.

The main objective of business research is to identify the strengths, weaknesses, opportunities and threats (SWOT) within a complex system. This explains why organizations conduct business research while choosing organizational strategies that fit both internal and external processes. In the context of health care, it is also necessary to discuss the most efficient ways of integrating people, process and technology. This activity is accomplished by evaluating the idea of "fit" while selecting innovative management strategies. For example, the integration of customer relationship management (CRM) technology is considered by reviewing literatures connected with the ideas of “best fit” and “best practice.” With the acquired understanding, any existing model influencing the formulation and implementation of organisational management strategy is then examined using both internal and external factors, including other characteristics of innovation.

Moving towards the core theme of the research, this section on literature review will analyse key strategies for achieving population health management outcomes. An overview of Nigeria PHC system provides insight into the underlying reason for this academic research. Discussions on global health issues will include an analysis of challenges facing health organisations—such as change management, wrongful application of strategies, poor funding etc. This section will also present a review of the current situation and prospects of health care delivery in Nigeria—with a comparative study of health systems in selected developing countries. Since the core of this research is on the benefits of formulating and implementing innovative management strategies connected with human capital development, process improvement and technology adoption, the review of literature moves to connect these basics with business strategy.

This study aims mainly at understanding the performance of primary health care providers and the variables driving performance. It also investigates the role of innovation in healthcare delivery, especially in Nigeria, where mismanagement of human, material and intellectual resources is perhaps the bane of primary health care (PHC). Although the study uses quantitative surveys at the level of primary health care facilities, health workers and care users in their vicinities, the main objective is to explore the health management strategies currently utilised in the Nigerian PHC system—as well as to recommend an innovative way of enhancing service delivery to individuals and households in rural communities.

2.1 AN OVERVIEW OF THE PHC SYSTEM IN NIGERIA

Nigeria operates one of the world’s most complex health care systems (Grol & Wensing., 2001). Public health in the country functions within a three-tiered administrative structure. The Federal Government (FG) controls affairs in University Teaching Hospitals and Federal Medical Centres. In the lower cadres, the state government coordinates affairs in general hospitals whereas the local government is responsible for dispensaries (Worlu et al., 2016). As a major stakeholder in Nigeria’s health care system, the private sector provides medical services to a large number of citizens, too (Adelowokan et al., 2019). But more importantly, successive Nigerian leaderships have—through various acts of parliament—formulated and implemented myriad of health policies to accommodate fast-evolving concerns in public healthcare. Only few health programmes such as the National Health Insurance Scheme (NHIS) is widely adjudged to be effective, reliable and suitable for the wide-growing health needs of Nigerians (Wensing et al., 1998; Aiyegbusi & Adegbite., 2008). Health care services under the NHIS are categorized as follows:
(a) Preventive care—which includes health education, family planning, and immunization
(b) Maternity Care—which covers up to 4 live births
(c) Outpatient Care
(d) Specialists Consultation
(e) Inpatient Care—which guarantees access to a standard ward for about 15 days per year
(f) Preventive Dental Care

Studies in health management show the growth and long-term survival of Nigeria’s healthcare system relies on the successes of NHIS (Adefolaju., 2014), whose major milestone is the continuous quality care rendered to children less than 5 years old and the disabled. Generally, the financial cost of PHC services in Nigeria is cheap and affordable although stakeholders in the system have not properly exploited developmental options offered by the application of innovative health management strategies (Bartholomew et al., 2001; Abayomi., 2012; Biege et al., 2013). The identified challenges of Nigeria’s PHC system include: (a) inadequate infrastructure, especially at the local government level (b) unreliable data storage systems (c) dysfunctional surveillance mechanisms to assess performance of PHC service (d) low morale of doctors due to unavailability of modern health equipment, politicization of service, corrupt practices among local government area (LGA) leaders, and poor remuneration for health workers etc.