CHAPTER ONE
INTRODUCTION
1.1   Background to the Study
The importance of public sector reform to health and the grand economy cannot be overstressed. The current drive to improve management in governments through public service reform programs to increase efficiency, effectiveness, and the delivery of quality service to the public is common to many African countries, including Nigeria. The public sector has, for long, enjoyed a pride of place, particularly since the post-industrial revolution era. Public administration moved away from being mere watchmen, to being the engine of the society and become the major provider of various services, including health service delivery. Generally, all societies have some forms of public service provisions for reasons of economics, risk, and moral responsibility (Omoyefa, 2008).
Governments, in many parts of the world, are structurally and constitutionally tied to the civil service, irrespective of the system of government (Olagboye, 2005). This according to Agagu (2008) explains why the relationship between the government and the public service in Nigeria endured in spite of the various forms of governments the country has been experimenting with since independence.
Almost all African countries are caught in the web of public sector reform. Good governance and efficient public administration are regarded as a wishful thought without public sector reform. Also, accountability, transparency, and merit-driven public service are thought to be unachievable except programs of public sector reform are drawn up. Efficiency, effectiveness, and responsiveness of government to the yearning of its citizens could only be gauged through the lenses of the public sector reform (Omoyefa, 2008).
African governments are, therefore, churning out policies on a daily basis. Not minding their relevance and positive impact on their people provided, these policies are part of the new public sector management in the name of public sector reform, not minding the fact that the public sector reform was suggested and imposed on the African countries by external interests. Public service reforms, which have taken place in Africa during the last two decades, are part of a global phenomenon that has touched all parts of the world – developed, developing, and countries in transition (Mutahaba & Kiragu, 2002).
While the African leaders innocently and ignorantly accepted the externally induced programs of reforming their public sector institutions as a way of bettering health service delivery, the developed countries that are propellers of donor agencies are interested in re-colonizing African countries through the back donors. It is a subtle way of neo-colonialism and consequent perpetual slavery without realizing it.
In Nigeria, for instance, the Public Sector Reform (PSR) has been on the agenda for a number of years. As noted by Obasanjo (2005) the context of health is rapidly changing. In advanced economies, health care systems are deemed financially unstable, while in emerging economies, they are still being shaped. These systemic changes result from the government pressure to contain the cost of health care. These costs have increased due to the growing number of ageing population and sophisticated technological advancement in medicine (in developed countries) and high unemployment rate, population explosion and poor accountability in developing countries. Concerns for affordability of health care are rife and there is a need to operate the health system in a more efficient manner. However, Nigeria is faced with the challenge of non-implementation public policies to develop a vibrant and sustainable health care delivery; so the future of health care seems uncertain.