Globalization is one of the major enhancement of our time and its scope is very extensive and versatile affecting factors such as economics, political, cultural, lifestyle and most especially science and technological advancement, the world today is often regarded as a ‘global village’. Although countries have well defined geographical territories and their citizens live in separate apartment and neighbourhoods in their areas, yet there has been in increased level of human proximity across national boundaries over the yours. People are now living in each other’s metaphorical pocket and issues that ordinarily may affect one group, now has supra-territorial dimensions and transcends the geopolitical boundaries of each nation. The network of connection of organization and people across national and cultural borders, the quick flow of information, human traffic, money, good and services across the globe, and the situation where economic, political and cultural activities are not only interconnected but individuals and nations increasingly find themselves influenced from a distance, are development that have for reaching implication for the political, socio-economic and health status of states The mission of Nigeria’s Federal Ministry of Health is to develop and implement appropriate policies and programmes and to undertake other necessary actions that will strengthen the national health system. All these are in its quest to deliver effective, quality and affordable health services to Nigerians, [4]. Unfortunately, despite Nigeria’s well-articulated health system missions, world Health Organisation [3] ranked the country a dismal 187th position among 191 United Nations members’ states in 2000. Furthermore, Nigeria has one of the lowest national health budgets in Africa. Above all, there are also differences in the capacity of Nigeria’s 774 local governments to provide primary healthcare which ought to be cornerstone of the delivery system. Thus under-funding of the health sector contributes to low quality of health services in the country. Many health facilities at primary, secondary and tertiary levels are dilapidated, totally dysfunctional or operating below average capacity. The health referral system, to say the least, is simple not efficiency operating. To compound the problems, poor remuneration and low motivation of health personal prevail. All these translate to ineffective health care delivery, many health workers have also left the country to work elsewhere on account of poor remuneration. The obvious victims of this state of healthcare services are the health consumers who have become disillusioned and dissatisfied with low quality of healthcare. Such consumers also have to contend with problems of fake, sub-standard, adulterated and unregistered drugs as safe and affordable drugs and consumables are irregular. Only about a quarter of health spending in Nigeria is through the public sector. So it is not surprising that the poor suffer the most from lack of access to health services. Nigeria’s development efforts have over the years been characterized by lack of continuity, consistency and commitment (3Cs) to agreed policies, programmes and projects. The objective of this study was to examine the globalization and its impact on health development in Nigeria, the case study of Kano State. The specific objectives are: i. to examine the economic effect of globalization on the Nigeria healthcare system in Kano State. ii. To analyse the changes in the Nigeria healthcare financing in Kano state. iii. To examine the structural changes that can take place in Nigeria healthcare sector with the emergence of globalization in general. The study will would focus on healthcare system in Kano State-Nigeria, and it is limited to economic effects of globalization on the healthcare development in Kano State-Nigeria.

Conceptual Globalization

The literature stemming from the debate on globalization has grown has in the last decade beyond any individual’s capability of extracting workable definition of the concept. In a sense, the meaning of the concept is self-evidence, in another, it is vague and obscure as its reaches are wide and constantly shifting. Perhaps, more than any other concept, globalization is the debate about it. Refer to globalization as “the growing economic interdependencies of countries worldwide through the increasing volume and variety of cross-border transaction in goods and services and of informal capital flows, as through the widespread diffusion of technology and information” Globalization involves economic integration; the transfer of policies across borders; the transaction of knowledge; cultural stability; he reproduction, relations, and discussion of power; it is global process, a concept, a revolution, and an establishment of the global market free from socio-political control. It has helped to liberalize national economies by creating a global market places in which all nations must participate directly or indirectly; this undoubtedly led to growing activities and power of international financial investors mainly, presented by multi-national corporations.

Concept of Health

The general condition of the body or mind with reference to surround and vigor’s, world health organization. WHO defined health as a complete state of physical, mental and social wellbeing and not merely the absence or infirmity [3] in more recent years this statement has been modified to include the ability to lead a socially and economically productive life.

Primary Healthcare

Primary Healthcare (PHC) refers to essential health care that is based on scientifically sound and socially acceptable methods and technologically, which makes universal healthcare accessible in all individuals and families in a community. It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. Federal ministry of health [2].

Global Health

Global health is the health of populations in the global context; it has defined as “the area of study, research and practice that places a priority on improving health and achieving equity for all people worldwide”. Problems that translated national borders or have a global political and economic impact are often emphasized. Thus, global health is about worldwide health improvement (including mental health, reduction of disparities and protection against global threats that disregard national borders. Global heath is not to be confused with international health, which is defined as the branch of public health focusing on developing national and foreign aid efforts by industrialized countries. Global health can be measured as a function of various global diseases and their prevalence in the world and threat to decrease life in the present day, [1].

Health Issues with Global Influence

Global influence on health issues with particular references to non-communicable diseases manly cardiovascular diseases, cancers, chronic respiratory diseases are the biggest causes of death worldwide. More than 36 million die annually from NCDs (63%) of global deaths), including 14 million people who die too young before the age of 70. More than 90% of these deaths from NCDs occur in low and middle income countries, and could have largely been prevented. Most premature deaths are linked to common risk factors, namely tobacco use, unhealthy diet, physical inactivity and harmful and use of alcohol, Scott, et al [1].

Globalization and Economic Consequences

A lot of research has been done in the past in the globalization but their impacts on the economic development have not been discussed in detail. Globalization is not new concept, in past people use to travel to other places for gaining control on others lands, for finding out the better living style, for fining the new places to earn profits by selling in different regions. These activities were carried out even thousands of years before. But it is said that the earliest form of Globalization was start from Greek, Roman, Egyptian and Babylonian Empires. In the regime of Mongols, the famous Silk Road connected the Central Asia and Europe.

Research design is a term used to describe a number of decision which to be taken regarding the collection of data before other data are been collected. It is pf great importance to identify the method and procedure adopted in this research work, since it gives the reader background on how to evaluate the findings. The data was collected through secondary source of data that had been produced and published earlier. These include journals, textbooks, magazines, periodicals, and conferences, workshops and seminar papers. The researcher used already established data to collect all the necessary information needed to enhance the paper. The data obtained from the secondary sources were analysed using simple percentage. This method is no doubt effective in summarizing details accurately and concisely and thus enhanced the understanding of the readers more.

Global Economic Crisis and Healthcare Delivery in Nigeria

1. Negative Effects of Globalization on Healthcare in Nigeria

The spatial, temporal, and cognitive changes are these core changes occurring at unprecedented rates due to globalization. Spatial changes lead to increased migration of people around the world which facilitate fast spread of diseases across national borders. Nigeria encounters threat of epidemic infections such as Ebola virus diseases, HIV/AIDS, tuberculosis, Severe acute respiratory syndrome (SARS), and COVID-19 through immigrates from other countries and particularly from poorer West African neighbours kike Liberia, Niger, and Togo where such diseases are often prevalent. Such diseases could also flow in a reverse direction. Migrants from other countries, particularly those from poor countries aforementioned above increase the financial burden borne by the Nigerian nation in responding to total number of unhealthy population in her territory. As a host nation in this instance. Nigeria is burdened to cater for her teaming immigrates. Globalization results in extensive import of health risk through tobacco, fast foods, ammunitions and hazardous waste etc. these harmful products are imported from high income countries to other parts of the world. Tobacco pandemic and tobacco related deaths are consequently on the rise in Nigeria. Furthermore, there is increased migration of insufficient Nigerian health professionals which disadvantage the capacity of the national health system to optimally respond to health needs of the populace. Globalization emphasizes liberalization through trade agreements, structural adjustment programmes and lowering of tariffs on imported goods. Nigeria has since keyed into such philosophy. These measures cause reductions in Nigeria’s national revenue and alternative revenue yielding sources. The situation grossly affects ability of the country to provide public health, education, water and sanitation services essential for development. Although globalization and open market had provided wealth to some parts of the world. It has also increased the gap between developing countries with adverse effects for their health indicators. This argument is also true for Nigeria. Tompson notes that globalization disregarded socio-economic development of poor countries while Berger writes that globalization had made more people prone to poverty. This situation compounds the deplorable health standards among third world nations (Nigeria Inclusive).

1. Positive Effects of Globalization in Healthcare in Nigeria

A major positive impact of globalization on health in Nigeria is that it has facelifted the spread of health sector reforms. This practice is a form of cognitive globalization in transferring polices about health services provision and financing across the world. The result is that national health system only face the challenging of adopting these polices to their local contexts. The millennium Development Goals (MDGs), and Health for All Strategies etc. are few examples of global pursuits at improving the health care systems adopted in Nigeria and third world countries. In Nigeria, health reforms initiative aims to restructure and revamp the health system and concomitantly, realize the goals of the recently revised National Health Policy and their health programme, including health related benchmark of the Millennium Development Goals (NDGs). The seven strategy thrusts of the current health reform in Nigeria are:

1. Improving the stewardship of government
2. Development of the health system and its management

iii.            Reduction of diseases burden

1. The availability of health resources and their management, improving access to quality health services.
2. Effects of Globalization on Healthcare in Nigeria

There is enormous implication on health and welfare on Nigerian society arising from globalization. Such effects cut-across positive and negative dimensions, the magnitude of such impact depends on political, social, economic and stock or pre-existing endowment of particular nation.

The Financing of Health Services

The Federal Ministry of Health is planning and coordinating body for health services issues. The state governments though their Ministries of health implement national programmes and run state health institutions while the local government ensure the delivery of health care to the masses. The Federal government “dictates the tune” and provides the bulk of money for paying the “piper.” Over 90% of the money for healthcare services come directly of indirectly from the federal government, which has allowed the states some independence and freedom to spend the money as they see fit. The states, in the same way, allow the local government some freedom in the way they spend the money. Because the federal government provides over 90% of the money for health, a look at the federal allocation to health will give a clear indication of the position that health care occupies in the list of the government’s priorities.

Healthcare Expenditure in Nigeria

It was feared that, the crisis would lead to contribution in national budgets, including budgets for health, due to drop in dividable household incomes, fall in remittances, reduction in external/donor funding etc.in this section, proceed to examine the evidence on ground to determine empirically how the crises has impacted on the funding of healthcare delivery, focusing specifically on Nigerian. In this analysis of implication of the global economic crisis in the Nigerian economy. Ajakaiye and Fakiyesi stated that the share of the health sector in total expenditure between 1985 and 1999 as insignificant. Specifically, it was 1.09% in 1990. This share increased from 1999 until 2002, when it drooped. The rise picked up again, but only gradually, until 2008. They however pointed out that just as in education, the share of health in total expenditure in 2009 dropped from 6% to 4% as is shown below:

Table 1: Health expenditure (1999-2011).

Source: Ema Okechuku Innocent et, all (2019)

Table 1 shows that, the figure from 2008 and 2009 contrary to the World Health Organization (WHO) recommendation and the Abuja declaration by African countries to commit 15% of their budget to health, the allocation for health as a percentage of GDP actually decreased from 6% in 2008 to 5% in 2009. Shows that the sect oral allocation and health in 2009 showed a 16% cut in education 29% cut in health allocations. Similarly, the allocation to Human Immune-Deficiency Virus (HIV)/AIDS as percentage of the health budget decreased from 16% in 2008 to 12% in 2009 budget. Compounding the drop in the domestic budget for HIV/AIDS in Nigeria is the offshore funding from the global power house namely: PEPFAR and Global fund. The US president’s emergency plan for AIDS relief (PEPFAR) was launched in 2003 by former US President George W. Bush to combat global HIV and AIDS pandemic. The fund committed to providing US$ 15 billion over five years (2003-2008) in support of the fight against HIV and AIDS. In July 2008, PEPFAR was reauthorized with an impressive US$ 48 billion approved for the 2009 to 2013 financial years. After assuming office, President Barack Obama announced his Global Health Initiative, which saw PEPFAR’s budget extended to US$51 billion, but available over a six years’ period. Owing in part, to the global economic crisis however, the fund has effectively been flat lined for 2009 and 2010 with similar proposals for the following years, Medicines Sane Frontiers (MSF) and PEPFAR aims to pass on the responsibility of direct funding treatment for parties to countries whenever possible, or else to the Global Fund. It however warned that cutbacks I rich world funding for Aids treatment could be sentence millions of sufferers to death for lack of access to aids retroviral (ARV) drugs.

Summary

Globalization has brought about improvement in the health indices of the Nigeria Population through improvement in health sector reform, knowledge and technological transfer across boundaries as well improvement in the socio-economic condition which also impact on healthcare spending. This evidence by the world bank estimates for instance, that a decline in GDP per capita of one more point’s increases average infant mortality by 7.4 death per 1000 birth for girls and 1.5 death for 1000 birth for boys. The average human life is increasing primarily due to advance technology. Conversely, spatial changes due to globalization let to increases migration of people around the world which facilitate fast spread of diseases across national borders, brain drain, hazardous waste and environmental degradation. The global economic crisis as also lead to reduce of both national healthcare budget spending and donor funding of health. For example, in December 2008, the global fund grants were reduced by 10% from $3.1 million to $2.75 million.

The researchers draw the following conclusions, based on the findings of the study:

1. The researchers conclude that Globalization has positive and negative effects on health. Nigeria and other third 2. World nations are disadvantaged in the new socio-economic order associated with globalization.
2. The study concludes impact of household income on the family health outcomes, self-sustainability in the global world, socio-environmental impact on the life expectancy and child mortality.
3. The role of globalization and violence in developing world, drug use and alcohol consumption and globalization, technology and impact on rural areas must be of constant concern for those in leadership position.
4. The study concludes multinational cooperation intent on seizing hegemonic control over the world both economically and culturally have aggravated the disparities between rich and poor.

Recommendation

Based on the findings of this study, the researchers made the following recommendations:

1. Improvements in health and wellbeing should be central objectives of national economic policy in relation to the international economic system.
2. Nigeria and other developing countries should work toward broader participation and interrogation into the world economy. They should move away from the ‘periphery’ to centre state where decisions are made.
3. Globalization should be people oriented and aim at health and welfare rather than being capitalist driven.
4. Nigeria should drive or manage her expectation from globalization. As a nation should be proactive toward globalization and operating merely on terms and condition set by western nations. Nigeria should operate with clearly defined agenda beneficial to her citizens in the face of her encounter with globalization process.

1. Scott EA. The evolution of healthcare system in Nigeria: which way forward in The Twenty-First Century. 2010; 53-65.
2. Federal Ministry of Health. Primary Healthcare information system. Hand book primary Healthcare department. 1990.
3. WHO World Health Organization 2000. Health system improving performance Geneva. 2010.
4. Federal Ministry of Health. Nigerian National Health Insurance Scheme and Improvement of the health Status of Nigerians. Ministry of Health Abuja. 2001.
5. Federal Ministry of Health Healthcare in Nigeria. Annual Bulletin of the Federal Ministry of Health Abuja Nigeria. 2004.