HEALTH INSTITUTION

ADMINISTRATION
Historical Development of Hospitals
in Nigeria
Colonial administration limited coverage and
scope
Supervised under Department of Health
Later became Regional Responsibility
Some became federal at Independence
Others taken over gradually with creation of states to
ensure federal presence and promote equity
Tertiary health care emerged with establishment of
University medical schools
Tertiary special hospitals developed by Federal
Government to cover special areas such as
psychiatry, orthopaedics, Eye care, Ear Care
Types of Hospitals in Nigeria
The health system is organised along the
following tiers:

Primary Health Posts, Health Centres,

Secondary Cottage hospitals, General
hospitals, State Specialist hospitals,

Tertiary- University affiliated Teaching Hospitals,
Federal Medical Centres, Special hospitals
Tertiary Hospitals
Institution Ownership Number Available
University Teaching
Hospital
Federal

15
University Teaching
Hospital
State 12
Federal Medical Centre Federal 23
Federal Psychiatric
Hospital
Federal 8
National Orthopaedic
Hospital
Federal 3
National Eye hospital Federal 1
National Ear Care
Hospital
Federal 1
National Hospital Federal 1
Private Private
Management Structures for
Hospitals in Nigeria - Federal
Minister of Health in Supervisory Ministry

Management Board of Hospitals
The Chief Executives of Hospitals
Hospital Departments and Units Clinical,
Support Services, Training Institutions


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
Functions of Organs
Board: Appointment , promotion, discipline,
development of institution, responsibility for its
assets

Chief Medical Director chief executive for day
to day running of the hospital
Chairman MAC for clinical responsibilities
Director of Administration secretary to the
Board, performance of duties as directed by the
CMD

Challenges of Administration
Basically administration implies management function in
the hospital setting
Centralised supervision despite Boards
Funding dependent on Government budgetary allocation
Expenditure dependent on public service regulations
Promotion of Efficiency
Managing Autonomy
Meeting staff demands
Generating Revenue from out of pocket payments no
health insurance
Managing the Policy environment
Surviving the hassles

Nature of Autonomy
Legislation provides for Management Board with
specified functions
Funding comes from Central body
Expenditure determined by regulation
Fund can be generated
Board can employ and fire but emolument is
based on a unified grading and disciplinary
process is complex
Loans from external sources require ministerial
approval

Improving Efficiency
Controversial but necessary
Contracting out specific services and functions
Improving procurement of drugs, equipment and
supplies
Clinical Audits
Changing staff levels and mix
Reducing patient stays
Reducing avoidable wastes
Performance measurement
Monitoring and Evaluation of services and cost regularly
through research
Pitfalls
Awareness of extant Government
Regulations
Resisting pressures for over employment
Resisting pressures of unrealistic
commitment to unions
Undue optimism about release of
budgetary allocations

Functions of Teaching Hospitals
Not clearly defined in documents and policies
Practice varies with locality and need to
generate revenue:
Health care curative, preventive, emergency
services, referrals, training, research
Controversial issues:
Extra mural and intramural services
Provision of primary and secondary services
Social functions
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
What do we administer
The three (Ms):
Men
Material
Money
Human Resources Management
Recruitment/Appointment/Employment
Not letter of appointment
Deployment
Discipline
Junior
Senior
Development
Disengagement
Retirement
Relieve from duty
Dismissal
Death
Material Management
Sourcing
Efficient and effective use
Maintenance
Replacement
Monitoring
Financial Management
Most scarce
Sourcing
Effective and efficient utilisation
Budgeting




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