DR. OLAWEPO, OLATAYO, A.
DEPARTMENT OF COMMUNITY MEDICINE
FACULTY OF MEDICINE
AHMADU BELLO UNIVERSITY,
C.E.A Winslow, one of the leading figures in the history of public health, in 1920, defined public health as “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts”1.
THE CORE FUNCTIONS OF PUBLIC HEALTH
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.
The challenges of these public health functions and performance in Nigeria are now hereby considered vis-à-vis the stated functions above.
(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...