**3. Results and discussion**

#### **3.1 OM health infrastructure inequality in Ekiti State**

The Federal Republic of Nigeria placed health in the concurrent legislative list and thus all three tiers of government share the responsibility for the health sector. Ekiti State Government has the responsibility for Secondary Healthcare Services and the newly established University of Ado-Ekiti Teaching Hospital in Ado-Ekiti while the Local Governments have the responsibility of Primary Health Centres and the Health Posts in their wards.

The State Ministry of Health plans and develops health programmes. It also supervises the implementation procedures in line with the National Health Policy Guidelines. The Ministry, through the Hospital Management Board (HMB), provides Secondary Healthcare Services through seventeen (17) General and Three (3) Specialist Hospitals.

An overview of the available health infrastructure in Ekiti State is provided in Table 1. The table shows that there were 458 health facilities in the state. A total of 315 or 68.78% belongs to the public sector while private sector accounted for 31. 22%.


Source: Computed based on data obtained from Planning, Research and Statistics Department, Ekiti State Ministry of Health, Ado-Ekiti

Table 1. Distribution of Healthcare Facilities in Ekiti State (January 2011)

202 Health Management – Different Approaches and Solutions

hunger, is also indirectly related to health given the effect of poverty and hunger on the health status of individuals. This is an indication that the health sector requires significant public policy attention and commitment of resources. The governments of most states in South-west Nigeria, including Ekiti State, have laid emphasis over the years on free medical treatment, at least, for the vulnerable segment of the population (Ekiti State Planning

The National Health Accounts revealed that the bulk of health spending by Nigerians is on curative care, which utilizes 74% of the total healthcare. Preventive care is a distant second; this consumes only 1% of total healthcare in 2002. In some African countries, including Nigeria, government expenditure on health may have increased over the years but, it is still below the statutory recommendation (WHO 2001). WHO estimates that a minimum government expenditure of USD34 per person per year will be required to provide an essential package of public health interventions in order to achieve health related MDGs

Nigeria's health policy which has identified primary healthcare as its fulcrum, defined a three tiered referral system for the management of patients. A network of primary healthcare centres in proximity to where people live, offering care of relatively low technology, is the first level of care from which patients gain entry into the healthcare system. Seriously ill patients beyond the management competence of primary healthcare workers are referred to secondary level general hospitals from where referrals are made to tertiary health facilities. The division of labour between the three complementary and easily recognizable levels seemed a rational, equitable and cost-effective way of dealing with the

Health service management is decentralized at the three tier levels. In addition, some states have Health Management Board (HMB), which is responsible for direct service delivery while the Ministry of Health focuses on policy formulation, standard setting and; monitoring and evaluation. The private sector provides 65.7% of healthcare delivery in Nigeria. Efforts are on for increased public-private participation in healthcare delivery but there is yet to be a framework for collaboration (WHO, 2011). The underlying principles and values for the National Health Policy include: the principle of social justice and equity and the ideals of freedom and opportunity; health and access to quality and affordable healthcare is a human right; equity in healthcare and in health for all Nigerians is a goal to be pursued; and primary healthcare shall remain the basic philosophy and strategy for

The Federal Republic of Nigeria placed health in the concurrent legislative list and thus all three tiers of government share the responsibility for the health sector. Ekiti State Government has the responsibility for Secondary Healthcare Services and the newly established University of Ado-Ekiti Teaching Hospital in Ado-Ekiti while the Local Governments have the

The State Ministry of Health plans and develops health programmes. It also supervises the implementation procedures in line with the National Health Policy Guidelines. The Ministry, through the Hospital Management Board (HMB), provides Secondary Healthcare

Commission, 2004)) thus implying an alignment of public policy with the MGDs.

(WHO 2001). Nigeria is just striving to meet this target (NPC, 2004).

healthcare problems of the rural poor (Musa & Ejembi, 2004).

national health development (Federal Republic of Nigeria, 2004)

responsibility of Primary Health Centres and the Health Posts in their wards.

Services through seventeen (17) General and Three (3) Specialist Hospitals.

**3.1 OM health infrastructure inequality in Ekiti State** 

**3. Results and discussion** 

The distribution of the healthcare facilities by types across the LGAs is presented in Table 2. The table shows that Ado, an urban LGA, had the highest number of facilities with 75 while Irepodun/Ifelodun, a rural LGA, had 30.


Source: Computed based on data obtained from Planning, Research and Statistics Department, Ekiti State Ministry of Health, Ado-Ekiti

Table 2. Distribution of Healthcare Facilities in Ekiti State by Types

Table 3 presents the results of the assessment of the distribution of health infrastructure in Ekiti State using the Index of Dissimilarity and Gini Coefficient. This is with a view to

Health Infrastructure Inequality and Rural-Urban Utilization of

Oguntade & Yusuf (2007).

facilities in Ado LGA.

Source: Authors' computation

Land Area per Private Hospital (Square Km) Land Area per Public Hospital (Square Km)

Table 5. Land Area and Persons per Healthcare Facility in Ekiti State

relatively cheaper (Mafimisebi & Oguntade, 2010).

Irepodun/

**services** 

Orthodox and Traditional Medicines in Farming Households: A Case Study of Ekiti State, Nigeria 205

Table 5 shows that the land area per private, public and; public and private (combined) healthcare facilities were larger for Irepodun/Ifelodun LGA compared to Ado LGA. This implies that, on the average, residents of Irepodun/Ifelodun LGA had to cover longer distances to access a healthcare facility than the residents of Ado LGA. There were more persons per private healthcare facility in Irepodun/Ifelodun LGA compared to Ado LGA in spite of the higher population of Ado LGA. This is because of the tendency of the private healthcare facility operators to concentrate their facilities in urban centres, where incomes are higher and the residents can afford to pay for services in line with the findings of

There were more persons per public healthcare facility in Ado LGA compared to Irepodun/Ifelodun LGA in spite of the fact that government had established 33 healthcare facilities in Ado LGA compared to 19 healthcare facilities in Irepodun/Ifelodun LGA. This is because the population is much higher in Ado LGA than in Irepodun/Ifelodun LGA. When the number of both public and private healthcare facilities is taken into consideration, there were 4,305 persons per healthcare facility in Irepodun/Ifelodun LGA compared to 4,115 in Ado LGA. It thus appears that public healthcare facilities have moderated the effects of the concentration of private healthcare

> Land Area per Public and Private Hospital (Square Km)

Ado LGA 7.09 9.03 3.97 7,348 9,352 4,115

Ifelodun LGA 32.89 19.04 12.06 11,741 6,797 4,305 All LGAs 41.18 18.69 12.86 16,673 7,569 5,206

**3.2 Implications of health infrastructure inequality in Ekiti State for access to OM** 

Analysis of the distribution of healthcare facilities in Ekiti State revealed the presence of inequality. A further analysis of the distribution focusing at Ado, the most urbanized LGA, and Irepodun/Ifelodun LGA, a rural and largely agricultural LGA, gave an indication of the implication of the inequality in the distribution. While there was not much difference in the number of persons per healthcare facility in the urban and rural LGA studied, the land area per healthcare facility was three times larger in the rural LGA than in the urban LGA. This implies that residents of the rural LGA have to travel longer distances to access a healthcare facility compared with the residents of the urban LGA. The rural LGAs in Nigeria generally have poorer road networks and fewer commercial transportation facilities (Mafimisebi, 2010). Thus the residents of the rural LGAs are disadvantaged in terms of access to OM services. This may discourage the use of OM services in the rural LGAs and encourage the use of TM which is easily available and

Persons per Private Hospital Persons per Public Hospital Persons per Public and Private Hospital

assessing the extent of inequality in the distribution across the LGAs. The distribution was assessed with respect to populations and the land areas of the LGAs with a view to determining if there was inequality in the distribution of the facilities. For the two indices used, the closer they are to 1, the more inequality exists in the distribution of the health facilities. The table indicates there was some inequality in the distribution of the health facilities whether considered from the point of view of the population or the land area since the values of the indices are all different from zero. The table reveals that all the indices for private hospitals were higher than the corresponding indices for public hospitals. This implies that inequality in the distribution of the private health facilities was higher than that of public facilities. The table also reveals that all the indices considered from the point of view of land areas were higher than the corresponding indices considered from the point of view of populations of the LGAs. This implies that inequality is higher when the distribution is assessed on the basis of land area than on the basis of population. Finally, the indices for both public and private hospitals combined were lower than the corresponding indices for private health facilities. This shows the moderating effect of the distribution of the public health facilities on inequality in the distribution of private health facilities.


Source: Authors' computation

Table 3. Concentration Indices for Health Facilities in Ekiti State

Table 4 presents information on the land area and healthcare facilities in Ado and Irepodun/Ifelodun LGAs and Ekiti State as a whole (All LGAs). Table 5 contains the estimated land area and number of persons per healthcare facility in Ado and Irepodun/Ifelodun LGAs and Ekiti State as a whole. The total land area of the state is 5,888.1 square kilometers out of which the land areas for Ado and Irepodun/Ifelodun LGAs are 297.9 square kilometers and 361.8 square kilometers, respectively. Ekiti State has a population of 2,384,212 while the populations of Ado and Irepodun/Ifelodun LGAs were 308,621 and 129,149, respectively. There were 458 healthcare facilities in Ekiti State out which 75 and 30 were in Ado and Irepodun/Ifelodun LGAs, respectively.


Sources: Land Area- Surveyor-General's Office, Ekiti State, Population – National Bureau of Statistics, Abuja, Healthcare Facilities, Ekiti State Ministry of Health

Table 4. Land Area, Population and Healthcare Facilities in Ekiti State

Table 5 shows that the land area per private, public and; public and private (combined) healthcare facilities were larger for Irepodun/Ifelodun LGA compared to Ado LGA. This implies that, on the average, residents of Irepodun/Ifelodun LGA had to cover longer distances to access a healthcare facility than the residents of Ado LGA. There were more persons per private healthcare facility in Irepodun/Ifelodun LGA compared to Ado LGA in spite of the higher population of Ado LGA. This is because of the tendency of the private healthcare facility operators to concentrate their facilities in urban centres, where incomes are higher and the residents can afford to pay for services in line with the findings of Oguntade & Yusuf (2007).

There were more persons per public healthcare facility in Ado LGA compared to Irepodun/Ifelodun LGA in spite of the fact that government had established 33 healthcare facilities in Ado LGA compared to 19 healthcare facilities in Irepodun/Ifelodun LGA. This is because the population is much higher in Ado LGA than in Irepodun/Ifelodun LGA. When the number of both public and private healthcare facilities is taken into consideration, there were 4,305 persons per healthcare facility in Irepodun/Ifelodun LGA compared to 4,115 in Ado LGA. It thus appears that public healthcare facilities have moderated the effects of the concentration of private healthcare facilities in Ado LGA.


Source: Authors' computation

204 Health Management – Different Approaches and Solutions

assessing the extent of inequality in the distribution across the LGAs. The distribution was assessed with respect to populations and the land areas of the LGAs with a view to determining if there was inequality in the distribution of the facilities. For the two indices used, the closer they are to 1, the more inequality exists in the distribution of the health facilities. The table indicates there was some inequality in the distribution of the health facilities whether considered from the point of view of the population or the land area since the values of the indices are all different from zero. The table reveals that all the indices for private hospitals were higher than the corresponding indices for public hospitals. This implies that inequality in the distribution of the private health facilities was higher than that of public facilities. The table also reveals that all the indices considered from the point of view of land areas were higher than the corresponding indices considered from the point of view of populations of the LGAs. This implies that inequality is higher when the distribution is assessed on the basis of land area than on the basis of population. Finally, the indices for both public and private hospitals combined were lower than the corresponding indices for private health facilities. This shows the moderating effect of the distribution of

the public health facilities on inequality in the distribution of private health facilities.

Public Hospitals Only 0.036 0.026 0.143 0.042 Private Hospitals Only 0.208 0.343 0.254 0.474

Hospitals 0.064 0.017 0.164 0.099

Table 4 presents information on the land area and healthcare facilities in Ado and Irepodun/Ifelodun LGAs and Ekiti State as a whole (All LGAs). Table 5 contains the estimated land area and number of persons per healthcare facility in Ado and Irepodun/Ifelodun LGAs and Ekiti State as a whole. The total land area of the state is 5,888.1 square kilometers out of which the land areas for Ado and Irepodun/Ifelodun LGAs are 297.9 square kilometers and 361.8 square kilometers, respectively. Ekiti State has a population of 2,384,212 while the populations of Ado and Irepodun/Ifelodun LGAs were 308,621 and 129,149, respectively. There were 458 healthcare facilities in Ekiti State out

> Private Healthcare Facilities

Sources: Land Area- Surveyor-General's Office, Ekiti State, Population – National Bureau of Statistics,

Public Healthcare Facilities

Gini Coefficient

Dissimilarity Index

Table 3. Concentration Indices for Health Facilities in Ekiti State

which 75 and 30 were in Ado and Irepodun/Ifelodun LGAs, respectively.

Ado 297.9 308,621 42 33 75

Ifelodun 361.8 129,149 11 19 30 All 5,888.1 2,384,212 143 315 458

Table 4. Land Area, Population and Healthcare Facilities in Ekiti State

(Square Km) Population

Abuja, Healthcare Facilities, Ekiti State Ministry of Health

Population Land Area

Dissimilarity Index

Gini Coefficient

Public and Private Healthcare Facilities

Ownership Status

Both Public and Private

Source: Authors' computation

LGA Land Area

Irepodun/

Table 5. Land Area and Persons per Healthcare Facility in Ekiti State

#### **3.2 Implications of health infrastructure inequality in Ekiti State for access to OM services**

Analysis of the distribution of healthcare facilities in Ekiti State revealed the presence of inequality. A further analysis of the distribution focusing at Ado, the most urbanized LGA, and Irepodun/Ifelodun LGA, a rural and largely agricultural LGA, gave an indication of the implication of the inequality in the distribution. While there was not much difference in the number of persons per healthcare facility in the urban and rural LGA studied, the land area per healthcare facility was three times larger in the rural LGA than in the urban LGA. This implies that residents of the rural LGA have to travel longer distances to access a healthcare facility compared with the residents of the urban LGA. The rural LGAs in Nigeria generally have poorer road networks and fewer commercial transportation facilities (Mafimisebi, 2010). Thus the residents of the rural LGAs are disadvantaged in terms of access to OM services. This may discourage the use of OM services in the rural LGAs and encourage the use of TM which is easily available and relatively cheaper (Mafimisebi & Oguntade, 2010).

Health Infrastructure Inequality and Rural-Urban Utilization of

Ministry of Agriculture with its headquarters in Ado-Ekiti.

compared with Irepodun/Ifelodun farmers.

**4.2 Income from farming activities** 

the state capital.

farmers.

Orthodox and Traditional Medicines in Farming Households: A Case Study of Ekiti State, Nigeria 207

The average household size in Ado LGA was 5.9, while that of Irepodun/Ifelodun LGA was 6.7 and there was no significant difference between these two values. The average farm size per household in Ado LGA was 1.49 hectares, while in Irepodun/Ifelodun LGA, it was 2.26 hectares. There was significant difference between the two average farm sizes at the 5% level. This may be as a result of the fact that land is more expensive per unit area in Ado LGA; a phenomenon which started about 15 years ago when Ado-Ekiti became the capital of Ekiti State. The influence of rapid urbanization of Ado-Ekiti has probably also spread to other towns in the LGA causing rising land prices. The phenomenon of rural urban migration has also contributed significantly to the rising population in Ado LGA leading to a relatively higher population density compared to other LGAs. Thus, farms are larger in Irepodun/Ifelodun LGA in spite of greater access by farmers in Ado LGA to extension services; due to the proximity of the Agricultural Development Programme Unit of the State

Primary data analysis also revealed that average years of respondents' farming experience in Ado and Irepodun/Ifelodun LGAs were 28 years and 35 years, respectively. There was a significant difference in these mean values at the 1% level. This shows that farmers in Irepodun/Ifelodun LGA were more experienced in farming activities than their Ado LGA counterparts. This might be as a result of the fact that farmers in Irepodun/Ifelodun are exposed earlier in life to farming and allied activities being the major economic activities in most rural areas in Nigeria (NBS, 2006). In Ado LGA however, there are more opportunities to be engaged in the non-farm sector. This is because Ado LGA is host to

Table 7 shows that the average years of formal education was 8.6 in Irepodun/Ifelodun and 11.3 in Ado LGA and there was a significant difference in these mean values at the 5% level. Thus, the tendency exists for a higher influence of the western education on Ado farmers

The mean income from farming activities per household per annum was N76,748.56 for Irepodun/Ifelodun LGA and N124,822.94 for Ado LGA. There was statistically significant difference between the average incomes at the 1% level (Table 7). This is understandable because the rural areas are usually at a disadvantage compared with the urban areas in market prices (World Bank, 1993; Mafimisebi, 2010). Most rural dwellers are into farming as their main economic activity. The rural areas lack storage facilities and most farm products become perishable within few days of harvesting (Lancaster & Coursey, 1984). Thus, there is a glut of agricultural products in the rural markets where farmers witness low patronage and have to dispose of their products at lower prices. They can only sell at better and more remunerative prices obtainable in the urban markets if they own or can afford payment for transport facilities to convey their products to the urban centres. This easier, cheaper and timely access to urban markets in Ado and surrounding towns by farmers in Ado LGA may have been responsible for the significant difference in farm incomes between the two sets of

**4.3 Expenditure on TM and OM by urban and rural farming households** 

The empirical results in Table 7 show that the average amounts of money expended per annum on OM for treatment of common ailments by farmers in urban and rural areas were N10,160 (\$67.7) and N4,530 (\$30.2), respectively. The corresponding amounts of

The findings of this study corroborate the results of the Core Welfare Indicator Survey (NBS, 2006). The indicators of health access for Ekiti State obtained from the Core Welfare Indicator Survey (NBS, 2006) are presented in Table 6. The table shows that access to health facility in the State was 68.9%. Access to health facility in the urban areas was 72.8%, while in the rural areas, it was 64.6%. Access to prenatal care in Ekiti State was 99.9%. Delivery by health professionals was 92.1% while fully vaccinated children was 86.4%. In the urban areas, the percentage for fully vaccinated was 88.6, while the percentage for the rural areas was 84.3. The need for medical services was defined for those who were sick or injured in the four weeks preceding the survey. About 6.1% of households in the state indicated need for medical services. In the urban areas the percentage was 6.0, while in the rural areas it was 6.1. About 8.0% of households in Ekiti State used medical services within the four weeks preceding the survey. Lower number of households (7.5%) used medical services in the urban areas than in the rural areas (8.6%) within the four weeks preceding the survey. It appears there were more health challenges in the rural areas of the state. The results of this survey clearly indicate that access to health facility was higher in the urban areas than in the rural areas. However, the need for and the use of medical services were higher in the rural areas than in the urban areas.


N.A. – Not Available Source: NBS (2006)

Table 6. Health Access Indicators for Ekiti State
