URBANIZATION, DEVELOPMENT AND PUBLIC HEALTH SYSTEM IN NIGERIA | THE COMPLETE VERITY

Department of Social Science and Humanities, Federal Polytechnic Idah, Kogi State.

Abstract
The increasing quest for improved standard of living, access to greener pastures, white-collar jobs and improved socio-economic wellbeing have made interest on urbanization germane. However, its attendant consequences of population explosion, over-stressed of the existing infrastructures, environmental degradation and increase crime rate have posed serious challenges to the public health system in Nigeria. This paper, therefore, is written to explore the verity of urbanization and public health system in Nigeria. The researchers elicit data from both primary and secondary sources while the data were analyzed using the simple percentages, the mean score, standard deviation and coefficient of variation. A sample size of 399 respondents out of a total population of 28, 2254 was adopted using the Yaro Yameni statistical formula. The paper concludes that the public health system in Nigeria has been adversely affected due to urbanization. Thus recommends that: basic infrastructure and employment opportunities should be made accessible at the rural areas, more health personnel’s be employed with health facilities upgraded to suit the current realities.

Keywords: Urbanization, public health, infrastructure, diseases.

Introduction
Contemporary globalization and urbanization is reproducing classic conditions historically associated with the emergence of infectious diseases and the periodically recurring pattern of epidemics and pandemics. The dynamics of contemporary globalization has contributed to various institutional gaps that make dealing with infectious disease increasingly difficult and threaten concentrated human populations with potential calamity (Gibson and Gumer 2012). Over the past few decades, there has been a rapid urbanization of the world’s population. The United Nations (2013) defines urbanization as movement of people from rural to urban areas with population growth equating to urban migration. It can also be seen as, change in size, density, and heterogeneity of cities which could be as a result of rural to urban migration or a national population increase due to a decrease in death rates while birth rates remain high. Global population trends in the 21st century reveal increased migration from rural to urban areas of the world and rapid population growth in urban centers’ (Vlahov et al., 2007; Raskin & Kemp- Benedict, 2004). The United Nations Department of Economic and Social Affairs indicated that, in 2007, 74% of the population in more developed regions lived in urban areas, compared with just 44% in less developed regions. The pace of urbanization continue to raise in both developed and under develop countries, as the estimate shows that, 70% of the world’s population will be living in an urban area by 2015. In Nigeria, the Human Development Report (2004) shows that, 45.9% of the 120.9million (2002estimates) working population of Nigeria resides in urban centers. According to Mabogunje (2002), residents of urban centers in Nigeria in 1950 were less that 15% of the population. By 1975, this proportion had risen to 23.4% and by 2000 was 43.3%. According to him, urban population growth rate is 4.8% annually; which is higher than the national annual growth rate of 2.2 % (HDR, 2004).
The implication is that by 2015, more than half of the nation’s population would be urban dwellers. This rapid rate of urbanization has over stretch the public health facilities in most urban center resulting from environmental noise, air pollution, reduction of soil moisture, intensification of carbon-dioxide emissions, strain in the cities’ infrastructure, unplanned and congested residential areas, and the shortage of safe drinking water, which lead to environmental changes that affect Public Health systems in Nigeria. Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals” (Winslow C.E.A 1920). It is concerned with threats to health based on population health analysis. Lokoja is the capital city of Kogi State and has been experiencing an accelerated shift of population from rural to urban areas. Record has shown that, Lokoja as a state capital has a population of 106,423 people in 1991, 187,200 in 1995, 237,920 in the year 2000, 28 2,245 in 2006, and 314,264 in the year 2011. It was estimated that the population of the city as a state capital will increase to 391,498 by the year 2020 (KSRDA. 2012).

Table 1: Projected Population Growth of Lokoja Kogi State Capital
Year Population of Lokoja as
Local Govt. HQ (000)
Projection of Lokoja
Population as State
capital. (000)
1991 96,423 106,424
1995 117,202 187,300
2000 149,583 237,921
2006 195,261 282,254
2011 213,121 314,264
2020
(Projection)
237,920 391,497
Source: (KSRDA. 2012).
 

As the population continues to increase without corresponding increase in the existing health infrastructure/facilities, this has engendered several Health challenges and problems like shortage of health personnel, inadequate provision of health facilities, infectious diseases, poor sewage/solid waste disposal, poor sanitation and hygiene, air/noise pollution etc; which has a negative effect on the quality of life that urban people experience in Lokoja. Despite the quantity of studies carried out on this topic, no study of this nature has been conducted particularly in Lokoja, Kogi State, to determine the impact of urbanization on the health of the urban populace. It is to this end that this work will study urbanization and public health system in Lokoja, Kogi State, Nigeria. The study will be useful to urban planners and health policy makers in the areas of policy formulation and implementation in the State. 

Statement of the problem
The rapid rate of uncontrolled and unplanned urbanization in the state has brought with it complex urban health related problems. This implies a situation where health facilities become overcrowded and inadequate for the growing population, the distribution of health personnel and institutions are also inadequate. One of the most serious environmental problems facing Lokoja town is the uncontrolled heaps of refuse in open spaces, stream/water channels, road sides and market places, which resulted to poor sanitation and hygiene leading to the spread of various infectious diseases within the metropolis. It is against this backdrop that this research seeks to explore the consequences of urbanization on public health with Lokoja metropolis as a reference point.

Objective of the StudyThis research will empirically explore the verity of urbanization to public health system in Nigeria. Meanwhile, the researcher shall also make sound recommendations which will create a balance between public health system and urbanization.

Research proposition
Urbanization has threatened the public health system in Nigeria due to its attendant
consequences.
Scope of the Study
The study examines the verity of urbanization and public health system in Nigeria. Lokoja, the
Kogi State capital in north central Nigeria was used as a case study, and the period of 2009-
2013 was considered since this period is reasonable enough to ascertain the variables being
considered by the researcher.
Hypothesis
Ho: Urbanization does not significantly affect public health system in Lokoja Kogi State
Nigeria.
Hi: Urbanization significantly affects public health system in Lokoja, Kogi State Nigeria.
H2: The people residing in urban areas do not have access to basic infrastructures.
H3: The people residing in urban areas have access to basic infrastructure.
Review of related literature:
Literatures were reviewed on thematic basis for the of clarity.
Urbanization
Ojogbe (2004) sees urbanization as the process by which large numbers of people become
permanently concentrated in relatively small areas, forming cities. In the same way, Salau
(2012) states that, rural to urban migration means that people move from rural areas to
urban areas. In this process, the number of people living in cities increases compared with the
number of people living in rural areas. Kotz (2009) has noted that, natural increase of
urbanization can occur if the natural population growth in the cities is higher than in the rural
areas. This scenario, however, rarely occurs. A country is considered to be urbanized when over
50 percent of it’s population live in the urban areas (Long 1998).
Migration is the main reason for rapid growth of mega-cities, and this has been going
on over centuries as its normal phenomenon, when considering urbanization rural-urban and
urban-rural migrations are very important. Urban-urban migration means that people move from
one city to another, and this is quite common, for example, in Nigeria (Bilsborrow 2011; Sajor
International Journal of Public Administration and Management Research (IJPAMR), Vol. 2, No 2,
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The Verity of Urbanization and Public Health System in Nigeria
202
Research Centre for Management and Social Studies
2012). The urbanization process has significant effects on the natural and cultural environment,
on housing arrangements and Health/social networks, as well as on housing and employment
patterns, not only in the cities, but also in the rural areas. Access to health care and social
services and cultural activities are in many cases better in the cities, but access may not be
evenly distributed among the blown population (Martin, 2011). Urbanization is a movement
with cultural shifts and is posing new major demands that we must face. The healthconsequences
of political measures must be evolved in multiple sectors, like culture,
environment, and education (Kindig, 2012). Similarly, Oguntola (2011), observe that,
increasing urbanization is responsible for many health challenges, especially those related to
water, environment, crime, injury, non-communicable diseases and other risk factors like
tobacco, alcohol and unhealthy diet. The rapid increase of people living in cities is among the
most important global issues of the 21st century. The rapid rate of urbanization has brought
about in recent times changes in physical and social determinants of health (Garrent, 2010).
Adeyomi (2009) stated that, movement of people whether from rural to urban areas or
from one country to another often alter the characteristic of epidemiological disease profile and
at the same time new diseases appear or old ones re-emerge. Such is the case of HIV/AIDS,
tuberculosis, yellow fever, denudes and Lyme disease. Gbolahan (2013) affirmed that, the
growing trend of urbanization, which encouraged poor nutrition, alcohol and smoking, were
reasons city dwellers also have increased risk for violence, chronic disease and some
communicable diseases. Harpham and Tanner (1995), Atkinson et al (1996) and Bradley et al
(1999) in various studies discovered that urban dwellers in less developed countries are exposed
to the traditional scourges associated with living in a poor country, such as malnutrition,
measles, and malaria; afflictions resulting from newly modernizing societies, such as obesity,
cancer, and road accidents; the deterioration of mental health, increased rates of psychiatric
disorders and deviant behavior that are associated with degraded living conditions,
overcrowding, and rapid social and cultural change in urban areas. All these health
consequences of urbanization are evident on the Nigerian cities.
Public Health
The dimensions of health can encompass “a state of complete physical, mental and social wellbeing
and not merely the absence of disease or infirmity”. As defined by the United Nations’
World Health Organization, Public health incorporates the interdisciplinary approaches of
epidemiology, biostatistics and health services. Environmental health, community health,
behavioral health, and occupational health are other important subfields (WHO. 2005). Just as
Studies on the health impacts of urbanization reveal that urbanization can have both positive
and negative effects on health. Urban life can be rich and fulfilling since it is more diverse,
stimulating, and full of new opportunities. Individual and family mobility make it easier to
escape from oppressive social relationships. Cities are sources of ideas, energy, creativity, and
technology. They can, for example, foster enlightened, congenial, and multicultural living
(McMicheal 2000).
Health Reform Foundation of Nigeria (2012) affirmed that, urbanization should be seen
and addressed as a public health issue to be tackled. There is the need to have urban planning,
decongest the urban areas by ensuring peripheries are provided essential amenities such as good
roads network water, electricity, health facilities and good schools .Also, the issues of
International Journal of Public Administration and Management Research (IJPAMR), Vol. 2, No 2,
March., 2014 Website: http://www.rcmss.com. ISSN: 2350-2231 (Online) ISSN: 2346-7215 (Print)
Attah Amana Philip, 2014, 2(2):199-208
203
Research Centre for Management and Social Studies
environmental sanitation should be adequately tackled, while facilities for recreation and walkways
should be provided on roads for health-walk “he stated. Iyun (2009), also affirmed that the
“health status of urban people is expected to be worse in comparison with those in the rural
areas considering their various health challenges such as poor sanitary conditions, lack of
potable water and high pollution level.
Abiodu (2010) explain the need for Nigeria to explore and strengthen other mechanisms
of health system and shift focus from out-of-pocket payments, address the issues that have
undermined public health care financing in Nigeria, improve on evidence-based planning, and
prompt implementation of the National Health Bill when signed into law. Onwujekwe et al
(2010) explain that, In spite of the various reforms to increase the provision of health care
services to the Nigerian people, health access is only 43.3%. The inadequacy of the health care
delivery system in Nigeria could be attributed to the peculiar demographics of the Nigerian
populace. About 55% of the population lives in the rural areas and only 45% live in the urban
areas. Moe et al (2007) opined that, Provision of timely information aimed at combating
possible health menace among many other things is an important function of public health.
Hence, inadequate tracking techniques in the public health sector can lead to huge health
insecurity, and hence endanger national security, etc.
Ekudayomi and Adekpoju (2008) in their study, “Public Health and Population
Growth” revealed that; the available health facilities/infrastructure in the cities become over
stretched as urban population continue to rise without improving the existing facilities or
providing additional one, they further explained that, failure of the Nigerian government to
respond adequately to the increasing demand for urban Health infrastructural services has had
the following consequences like, deteriorated quality of life in the city, the inadequate provision
of infrastructural services, shortage of drug, decline in the productivity of workers. In the same
way, Harris (2003) advised that in other to avert the consequence of uncontrolled urbanization
on public health, government across the world must, as a matter of priority, devise ways to plan
their cities, improve urban living conditions, like water and sanitation, housing, transportation,
promoting health behavior and safety condition.
Validity of Instrument
To validate the research instrument, the researchers employed the services of two environmental
officers, two employees and two employers of labors from Lokoja the Kogi State capital in
north-central, Nigeria for validity. The questionnaire was validated after thorough scrutiny and
valuable contributions made duly incorporation.
Reliability of the Instrument
To estimate the reliability of the instrument employed for data collection, the instrument was
administered twice to town planning officers, medical doctors, environmental officers,
employees and employers of labours numbering twenty from Lokoja. The second administration
of the instrument was two weeks after the first exercise and the resulting scores were correlated
using Pearson Product Moment Correlation approach. This yielded the co-efficient Pf r = 0.82.
This score indicates that the instrument is very reliable.
International Journal of Public Administration and Management Research (IJPAMR), Vol. 2, No 2,
March., 2014 Website: http://www.rcmss.com. ISSN: 2350-2231 (Online) ISSN: 2346-7215 (Print)
The Verity of Urbanization and Public Health System in Nigeria
204
Research Centre for Management and Social Studies
Study Instrument
The study was conducted in Lokoja local Government area of Kogi State, Nigeria. Sample
selection of respondents located in residential (households) and institutional (Health) facilities
was drawn for the study using cluster sampling. Questionnaires and in-depth- interview were
administered to retrieve information from the households in the cluster and respondents in
selected Health institutions were interviewed. 399 questionnaires were administered out of
which 367 were retrieved and analyzed giving a response rate of 92% For more in-depth
understanding of the social reality of population growth and it impact on the health system in
Lokoja metropolis, 15 in-depth interviews (IDIs) were conducted among the Management and
staff of some selected health institutions, environmental officers, town planning officers,
employers and employees of labors using simple random sampling. The questionnaire was title
“Effect of Urbanization on public health system (EUPHS).” The questionnaire has two sections.
Section “A” demands information on the effect of urbanization on the public system and section
“B” contains the likely measures to addressing such negative effects. The instrument is in the
form of likert five point rating scale. The response options have the values of 5, 4, 3, 2, and 1,
respectively.
Study Area and Population
The study focused on people living and working in Lokoja metropolis. The present Lokoja is
situated at the confluence of the rivers Niger and Benue and nestles at the foot of Mount Patti. It
was said to have been founded in 1860 by Dr. William Baikie who made up his mind to found a
settlement at the site of the land between the confluence and the mountain when he took a clear
view of the area during his Benue expedition of 1854 (Ocheja, 2010: 9). Lokoja was the first
British settlement in the northern part of Nigeria, and it rapidly developed in the 1860s as a
result of the European economic activities and later, political activities, especially at the turn of
the century. The town started as a cosmopolitan settlement which attracted people from various
parts of what is now Nigeria, Sierra Leone, and Europe (Mohammed, 1984:50). The
significance of the town is not only due to its geographical location as the confluence of Rivers
Niger and Benue, but also to the historical fact that it was the first colonial administration
capital of Northern Nigeria with rich tourist attractions. Today, Lokoja is the Capital cities of
Kogi State with a population of about 282254 according to the 2006 national census. It is one of
the seven LGAs in Kogi West Senatorial District. The major occupations of people are farming,
fishing and trading.
Methodology
The Survey research design was adopted in this study. This design was employed because of its
exploratory nature. The researchers also employed both primary and secondary sources of data
collection. Primary data were collected through the administration of questionnaire while
secondary data were gathered from related literatures, textbooks, journals, bulletins and
periodicals. The sample size is 399 out of the total population of 282254 based on judgmental
sampling, and the Yaro Yamani statistical formula was used in the determination of sample size.

Table II Distribution of Respondents in Respect of the Effect of urbanization to public health system
S/No Expected mean =3 Percentage of
Responses
Mean scores of Responses
Variables 5 4 3 2 1 Mean Standard
deviation
Coefficient of
Variation
% % % % % %
1 They have knowledge of
urbanization and public health
system.
55 23 10 8 4 4.17 0.72 17.27
2 Urbanization affect disease
pattern
63 22 11 3 1 4.43 0.84 18.96
3 There are enough medical
personnel in the hospitals
6 8 10 14 62 1.82 1.12 61.54
4 The respondents are affected
by air pollution and poor
sewage system.
58 23 8 5 6 4.22 0.79 18.25
5 There are adequate access to
basic facilities
5 4 21 10 60 1.88 1.14 60.64
6 There is improved standard
living
7 11 6 17 59 1.90 1.02 53.68
7 There employment
opportunities
59 20 9 5 7 4.19 0.81 19.33
Sources: Field Research (2014)
Decision criterion: Accept any value with calculated mean ≥ 3.0 and Calculated Value
≤ 30.0, other wise rejected.
Table II above shows that 78% of the respondents agreed that they have knowledge of
urbanization and public health system; 86% agreed that urbanization affects the disease pattern.
14% of the respondents were of the view that there are enough medical personnel in the
hospital, 81% of the respondents were of the view that they are affected by air pollution and
poor sewage system and 9% of the respondents said that there is adequate access to basic
facilities. More so, 18% of the respondents agreed that there is improved the standard of living
while 79% of the respondents agreed that they have access to employment opportunities in
Lokoja metropolis.
Hence, item 1, 2, 4 and 7 are accepted considering the Mean and Coefficient of Variation values
while item 3, 5, and 6 are rejected.

Table III: Distribution of Respondents in Respect of likely Measures to addressing the Effects of
Urbanization to Public Health System in Lokoja Kogi State
S/No Expected Mean =3 Percentage of
Responses
Mean score of Responses
Variables 5 4 3 2 1 Mean Standard
Deviation
Coeficient
% % % % % Variation
%
1 The existing Law should be
strengthened
61 21 8 6 4 4.29 0.83 19.35
2 There should be proper
environmental surveillance
57 16 10 9 8 4.05 0.79 19.51
3 Upgrade of medical facilities
and increased Medical
personals
64 19 12 2 3 4.39 0.86 19.59
4 Adequate infrastructure and
employment opportunities at
the rural area
50 24 13 9 4 4.07 0.63 15.48
5 Organizing town planning and
health Education.
58 20 11 8 3 4.22 0.77 18.25
Sources: Field Research (2014).
Decision criterion: Accept any value with calculated Mean ≥ 3.0 and calculated value ≤ 30.0
otherwise rejected.
Table III above shows that 82% of the respondents agreed that the existing Laws relating to
urbanization and public health system need to be strengthened, 73% of the respondent agreed that
there should be proper environmental surveillance, 83% of the respondents are of the view that
there should be upgrade of Medical facilities and increased of the Medical personnel.74% of the
respondents agreed that adequate infrastructural facilities vis- a -vis employment opportunities at
the rural area be provided. Finally, 78% of the respondents suggest that there was need to
organize town planning health education to the respondents. Hence, item 1, 2, 3, 4, and 5 are
accepted considering the Mean and Coefficient of Variation Values.
Suggestion for Further Studies
This study can be replicated in other geopolitical zones of Nigeria; this will create room for
comparative analysis of urbanization and public health system in Nigeria.
Conclusion and Recommendations
From the result of the data analysis and subsequent findings made by the researcher, the paper
concludes that the public health system in Nigeria has been adversely affected due to
urbanization. Consequent upon the findings and conclusion, the researchers recommends that:
I. The existing Laws relating to urbanization and public health system should be
strengthened
II. There should be proper environmental surveillance in Lokoja metropolis.
III. The Medical facilities should be upgrades and the Medical personals be increased.
IV. Adequate infrastructural facilities and employment opportunities should be provided at
the rural area to reduce the burden at the urban centers.
V. There should be proper town planning and the citizens be given adequately health
education.
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International Journal of Public Administration and Management Research (IJPAMR), Vol. 2, No 2,
March., 2014 Website: http://www.rcmss.com. ISSN: 2350-2231 (Online) ISSN: 2346-7215 (Print)
Attah Amana Philip, 2014, 2(2):199-208 199
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