HEALTHCARE SERVICES AND THE AFTERMATH OF BOKO HARAM INSURGENCY (A CASE STUDY OF JERE LOCAL GOVERNMENT AREA)

ABSTRACT

This study sets out to document “how does health services cope with the aftermath of Boko Haram insurgency in Jere L.G.A”. The study investigated the strategies devised by the various successive Nigeria governments in the organization and management of health services.  The purpose of the study was to explore the question, how does health services in within Jere LGA cope with the aftermath of an insurgency era. The study was conducted within the health services sectors in Jere L.G.A. a sample of 120 respondents from the healthcare services sectors and its parastatals in Jere responded to a questionnaire on the organization and management of health services and the performance of the health sectors. Content analysis of official reports and related literature, questionnaire, individual interviews and group discussions were employed to complement the survey data. Frequency distribution was used for data analysis. In order words, efficient management services is capable of bringing about the achievement of Jere L.G.A health goals’. It is established that the introduction of management services in the health sector is an achievable goal and will bring about the desired health outcomes. The findings revealed that international donors plays a big role to the health services sectors within Jere aftermath the insurgency era, also it’s likely that to enhance increase allocation to the health sectors, harmonization of schemes of service and the activities of the various professionals in the health sector, provision of equal opportunity to all cadres, the increase in working hours, safety, rehabilitation of infrastructure and safely conducting of door to door immunization, institutionalization of health care planning for effective health care delivery management where all seen as strategies that would enhanced the general improvements of the health services. The aggregate findings revealed that fearlessness among health workers and patients, increase in working hours and safety, rehabilitation of infrastructure, safely conducting of door to door immunization are seen as the achievement to the health services aftermath the insurgency era within the L.G.A. The study concluded that, weak and failure to mount an effective re-organization and management regime will lead to more challenges than is currently being experienced with grave consequences. It was therefore recommended that steps should be taken by the government to use the appropriate faith-based organizations to constantly readdress the ideological and religious perversions which Boko Haram has created, to redirect the perverted back to the genuine religious teachings. This will reduce the surge of radicalization in the society. 

TABLE OF CONTENTS

Fly Leaf      -        -        -        -        -        -        -        -        -        -        i

Title Page    -        -        -        -        -        -        -        -        -        ii

Certification          -        -        -        -        -        -        -        -        iii

Declaration -        -        -        -        -        -        -        -        -        iv

Acknowledgement -        -        -        -        -        -        -        -        v

Table of Contents -        -        -        -        -        -        -        -        vii

List of Tables-      -        -        -        -        -        -        -        -        -        ix

List of Figures-     -        -        -        -        -        -        -        -        ix

Abstract      -        -        -        -        -        -        -        -        -        -        x

CHAPTER ONE

INTRODUCTION

1.1     Background of the Study -        -        -        -        -        -        -        1

1.2     Statement of the problem -        -        -        -        -        -        -        5

1.3     Significance of the study -        -        -        -        -        -        -        6

1.4     Objectives of the study   -        -        -        -        -        -        -        7

1.5     Research Questions        -        -        -        -        -        -        -        8

1.6     Scope and Delimitations of the Study -        -        -        -        -        8

1.7     Limitation of the Study   -        -        -        -        -        -        -        8

1.8     Definition of Term -        -        -        -        -        -        -        -        9

CHAPTER TWO

LITERATURE REVIEW

2.1     Theoretical Framework   -        -        -        -        -        -        -        11

2.2     Conceptual Framework   -        -        -        -        -        -        -        17

2.2.1 Emergence of Global Health Systems -        -        -        -        -        24

2.2.2 The Nigerian health Services -  -        -        -        -        -        -        25

2.2.3 Problems of Nigerians Health Services Sectors and Possible Solutions -        -        27

2.3     Historical Background and Evolution of Boko Haram in Nigeria    -     -        44

2.3.1 The Boko Haram insurgency in Borno State -        -        -        -        47

2.4     How Boko Haram is devastating health services in north-east Nigeria   -        -        51

2.5     Activities of Boko Haram and the Responses     -    -        -        -        55

2.6     Impact of External Donor and NGOs on Health Services -        -        58

2.7     Summary of Literature Review    -      -        -        -        -        -        65

CHAPTER THREE

3.1     Research Design   -        -        -        -        -        -        -        -        66

3.2     Area of the Study -        -        -        -        -        -        -        -        67

3.3     Population of the Study   -        -        -        -        -        -        -        68

3.4     Sample Size and Sampling Technique -        -        -        -                  68

3.5     Instruments for Data Collection -        -        -        -        -        -        71

3.6     Validity of the Instrument         -        -        -        -        -        -        71

3.7     Reliability of the Instrument     -        -        -        -        -        -        72

3.8     Procedure or Methods of Data Collection     -        -        -        -        72

3.9     Procedure or Method of Data Analysis Technique  -        -        -        73

CHAPTER FOUR

RESULTS AND DISCUSSION

4.1     Demographic Variable of Respondent’s -     -        -        -        -        74

4.2     Data Presentation and Analysis -        -        -        -        -        -        77

4.3     Research Findings -        -        -        -        -        -        -        -        83

CHAPTER FIVE

5.1     Summary.    -        -        -        -        -        -        -        -        -        88

5.2     Conclusion  -        -        -        -        -        -        -        -        -        89

5.3     Recommendations -        -        -        -        -        -        -                  91

References  -        -        -        -        -        -        -        -        -        -        92

Appendix -  -        -        -        -        -        -        -        -        -        -        97

LIST OF TABLES

Table 3.1: Jere Loca Government Area Health Facilities -        -        -        69

Table 4.1: Martial status of respondents-     -        -        -        -        -        74

Table 4.2: Age Range of Respondents         -        -        -        -        -        75

Table 4.3: Educational qualification - -        -        -        -        -        -        75

Table 4.4: Marital status of Respondents     -        -        -        -        -        76

Table 4.5: Years of Service/Experience       -        -        -        -        -        77

Table 4.6: Does the objectives of Health sectors within Jere LGA -     -        -

being achieved?     -        -        -        -        -        -        -        -        -        77

Table 4.7: What are the Major setback caused by the Boko Haram

insurgency to health services within Jere LGA?      -        -        -        78

Table 4.8: Constrains hampered health management service in Jere?   -         79

Table 4.9: Respondents Opinion on the Major actors in providing

donor funds development assistance in Health Services within Jere LGA?  -    80

Table 4.10: What Health facilitators of the health services sector must

do in order to improve provision of health services in Jere?        -        -        81

Table 4.11: What are the achievement to the health services sectors

in Jere LGA aftermath of the Boko Haram insurgency? -  -        -        82

LIST OF FIGURE

Figure 3.1: Map of Borno State Showing Jere Local Government Areas   -    69

                                                 CHAPTER ONE

INTRODUCTION

1.1     Background of the Study

Over the years, health and healthy well-being of humans has been conceptualized in diverse ways.  Health or healthy well-being of humans does not merely connote the absence of ailments and disease. Its sum total also encompasses the proper physical, mental and social functioning of humans. Health is also influenced by socio-economic, cultural, environmental as well as hereditary factors (Wilson: 2017, WHO: 2016, Deliege: 2016). The attainment of healthy well-being by individuals, and the community at large, is therefore, a social concern because a society can function properly only when majority of its members are healthy enough to perform the tasks that sustains human society. In all historical epochs, human societies have evolved institutions, which provide health and medical services, prevent diseases, treat diseases whenever sickness occurs and promote overall health well-being of citizens (Calhoun: 2016). The philosophy and organizational structure that govern health care delivery systems and institutions vary from historical epoch to the other and from one society to another. While several factors may be responsible for the variation, but one factor can easily be identified. The whole process depends on the individual or group’s definition of what constitutes a disease and the cause(s) of illness. In most societies of the world, the definition of what constitutes a disease, the perception of the cause(s) of illness, the course of treatment and preventive measures required, all influence the allocation and management of resources to solve health related problems.

The conception of the causes of disease can be categorised into two broad views. While the first category can refer to as the naturalist view, the second is simply the supernatural conception. The naturalistic view of disease causation emphasizes objective identifiable causal agents. The dominant explanation of this view is the germ theory of disease causation. It attributes sickness to pathogenic micro organisms of which diagnosis largely, consists of identifying the disease agent or the abnormal organ, surgical remedy and, or a combination of both. (Field: 1960, Twumasi: 2014).  The supernatural view regards diseases as being caused by agents and factors such as gods, spirits, retribution for sins and taboos, witchcraft and sorcery by fellow human beings.

While the foregoing two broad views, are not mutually exclusive to any given socio-cultural setting, the naturalistic perspective appears to be the most dominant in the modern globalize world. In the quest for effective global health system management, the naturalistic perspective has given rise to bio-engineering medicine. This approach continues to permeate the world’s peoples and cultures in varying degrees (Turner: 2007). Nigeria is not an exception. The foregoing not withstanding, there are variations among nations with respect to nature of government public health policies, structural organization and the management of institutions responsible for the health care delivery. The variations are a function of the level of economic, social and political development of nations. Existing variations can be grouped into two main perspectives thus: the egalitarian and the utilitarian perspectives. 

Since 2009 arising from the attacks of the group, Nigeria national security became threatened to the extent that over 2,000 Nigerians were killed in more than 100 attacks by Boko Haram. This act by the group also led to displacement of gender related victims such as women, girls and children who necessarily deserve some social amenities and particularly, health care services delivery. The groups to brutality increase by January 2012, it carried out its first most deadly single day attack in Kano with about 185 people killed. This attack brought about declaration of state of emergency by the Nigerian government in the states of Borno, Yobe and Adamawa in May 2013 (Blanchard, 2014).The North-Eastern region has the highest number of IDPs totaling 11,360 as a result of being the centre of the insurgent group. Most of the men are killed during the attacks; therefore the women and children end up in the IDPs without any protection (Ladan, 2013). Therefore these women and children below 18 years of age constitute the higher percentage. According to Joseph (2016). “Survey results indicate that out of 20738 IDP households included, 51.8% of the IDPs are female while 48.2% are male. The results further indicate that 55.7% of the IDPs are children below 18 years, and more than half of them are within 0 5 years age bracket”. They become vulnerable to all sorts of vices. The camps are haphazardly put together with no basic amenities to cater for the number of people living there.

The most disturbing aspect accompanied with the changes of the group brought about by its links with the international terrorist organizations as observed above was the growing sophistication and expertise of the sect since 2011 which were noticed in the areas of weaponry and the frequencies of incidences of attacks with improvised explosive devices (IEDs), car bombs, and suicide bombings used in carrying out its attacks (Walker, 2012).In view of the above trend therefore, this paper intends to investigate how the Boko Haram activities in Nigeria affects the gender related victims in the perspective of health services from the angle of the government and other institutions from within and outside the country. The paper also probe into the reality of the health service by the government and other related institutions as viewed by the aftermath of Boko Haram insurgency in Jere Local Government Area. Even before the insurgency, North-East Nigeria especially that of Borno state had some of the worst health services and socioeconomic indices in the country. This is against the backdrop of a weak health system marked by inadequate health facilities and a dearth of skilled health workers. There's also little donor support compared with other regions of Nigeria.  The insurgency has compounded these problems and also disrupted what health services there were.  Insurgents have destroyed about 788 health facilities in the region. In Borno 48 health workers have been killed and over 250 injured. The state has lost up to 40% of its facilities and only a third of those left in Borno state remain functional.  Attrition rates of health workers have also played a role. Over the past two years Borno state has lost 35% of its doctors to other states.  Insecurity in the areas occupied by the insurgents also make planning and delivering essential health interventions difficult. Resources in camps for internally displaced people have been overstretched, with humanitarian agencies providing most of the health services.  Therefore Jere is a Local Government Area of Borno State, Nigeria. Its headquarters are in the town of Khaddamari. It has an area of 868 km² and a population of 211,204 at the 2006 census > the Most of population in Jere Town (Arabic tribes Baggara).  The postal code of the area is 600.It is one of the sixteen LGAs that constitute the Borno Emirate, a traditional state located in Borno State, Nigeria.

1.2       Statement of the problem

The health services in any community forms the backbone of its growth and development. Factors affecting the overall Jere health services performance aftermath the Boko Haram  include: inadequate health facilities and structures, poor management of human resources, poor motivation and remuneration, inequitable and unsustainable health care financing, skewed economic and political relations, corruption, illiteracy, decreased government spending on health, high user fees, absence of integrated system for disease prevention, surveillance and treatment, inadequate access to health care, shortage of essential drugs and supplies and inadequate health care providers.  Borno State is the only State in Nigeria that is bordered by three countries. These include Cameroon, Niger and Chad Republic. There is a healthy trade relationship between the State and her international neighbors. Tones of grains, livestock and other consumables flow between Borno and her bordering trading partners. Despite this advantage, the State depends on monthly allocation from the Federal Government to keep it running. The scenario is further compounded by insurgency and this has hampered on the health services development in Local Government of Borno State and her immediate neighbors.  The root cause of the insurgency is yet to be unraveled as a lot has been said about the various causes of insurgency. Discovering the root cause of insurgency would solve the problem half way.

1.3   Significance of the study

The study is significant to the extent that it has documented both discrete and relative issues on the health services. It has also come up with findings, which would help government and private health care providers to develop better management capacity for running the health sector.  The study is thus significant as a contribution to the body of knowledge on how Jere Local Government Area cope with the aftermath of Boko Haram insurgency in the aspects of health services. The Boko Haram Insurgency has generated numerous scholarly debates in Social Sciences in general and also in the field of International Relations in particular. The study is significant in that it builds on existing literature on Boko Haram and also contributes to the body of knowledge. More so, while many earlier works dealt with the implications of Boko Haram insurgency on health services and security. As much of the research done with respect to the Boko Haram insurgency has treated the problem as a social issue. Considering that health services have rights that need to be protected even in situations of armed conflict, this study is undertaken with the intention of approaching how does health services in Jere Local Government Area cope with the aftermath of Boko Haram insurgency. The study has therefore made significant contributions to the knowledge of health services aftermath of an insurgency era. 

1.4   Objectives of the study

The main objectives of the study was how does health services in Jere Local Government Area cope with the aftermath of Boko Haram insurgency. The specific objectives are to: 

1.        To determines the achievement within the Health Services sectors aftermath the insurgency in Jere Local Government Area.  

2.        To examine the extent to which Boko Haram insurgency has affected Health Services in Jere Local Government.

3.        To assess specifically the impact of external donors on health services sectors.

4.        To identify the state of the health services in Jere Local Government Area by exploring the issues involved in the provision of health services, with respect to the organizational and managerial challenges facing the health sector by linking theory to practice.

1.5     Research Questions

The study speaks to the following research questions:

1.     What are the ongoing progress to the health services within Jere LGA aftermath the Boko Haram insurgency? 

2.     What ways does Boko Haram Insurgency influences the damages to health services sectors in Jere Local government.

3.     What practices in health services within Jere Local Government are perceived to be detrimental by the Boko Haram Insurgency?

4.     What are the specific proposals required to strengthen the provision of health services to guarantee optimal provision of health care services in Jere Local Government Area?

1.6     Scope and Delimitations of the Study

The research work is delimitated to “How does Health Services in Jere Local Government cope with the aftermath of Boko Haram insurgency.

1.7     Limitation of the Study

This study is restricted to the extent to which of health services contribute in the realization of health services objectives, with a case study of the Jere Local Government in Borno State. The study limits itself to some selected health services sectors within the Local Government Area. The reasons for these limitations include the following:

Ø     Dearth of data and study reports and research on how does health services in Jere Local Government Area cope with aftermath of Boko Haram insurgency is one of the limitations and challenges faced by this study. Time and resources constraints made it very difficult for the study to be conducted in the entire health services sectors in Jere.

Ø     It was not possible to investigate 100 per cent of the components of the entire population/participants of the subject of the research due to limitations imposed by: costs, time and the sheer amount of work involved which was not practically possible to be accomplished in a single research.

1.8   Definition of terms

Health Services: This consist of medical professionals, organizations, and ancillary health care workers who provide medical care to those in need. They serve patients, families, communities, and populations.

Jere Local Government Area: is a Local Government Area of Borno State, Nigeria.

Boko Haram: An expression in Hausa language, which means, “Western education is forbidden.” Hausa is a major tribe in northern Nigeria and the Republic of Niger

Insurgency: Is a rebellion against authority when those taking part in the rebellion are not recognized as belligerents.