International Journal of TROPICAL DISEASE & Health

Objective: To analyse the perception of healthcare professionals and managers of the institutional structure of four hospitals in Nigeria to successfully implement the health sector reform (HSR) programme in the country. 
Study design: A cross-sectional survey of 507 healthcare professionals and managers in four hospitals located in four cities in southwest Nigeria conducted between December 2007 and March 2008. 
Methods: A self-administered questionnaire was used as the instrument for the assessment of staff perception of institutional structure of the hospitals to successfully implement the HSR programme. The questionnaire had questions ranked on a 5-point Likert scale that explored the respondents’ perceptions of institutional structure and closed-ended questions of socio-demographic nature.
Results: The overall perception of institutional structure was 52.5%. The perception of the four dimensions of institutional structure was design 60.7%, human resources 54.7%, financial resources 50.9% and infrastructure 39.4%. Out of the seventeen items on institutional structure, the qualification and competence of staff had the highest perception (78.3%) and adequacy of staff the lowest perception (28.9%). 
Conclusion: The rather low perception of infrastructure may be a direct reflection of the poor state of the infrastructure available in major hospitals in Nigeria to support the health sector reform programme in the country. The major infrastructural issues were inadequacy and poor maintenance of facilities and equipment, the lack of adequate staff, poor compensation and lack of resources to meet major recurrent and capital expenditures in the hospitals.