In this post, we take a look at primary health care in Nigeria.
But first what is primary health care?
The origin of PHC can be traced 1978 when the concept was first published. It was conceptualized by the Aima-Ata Declaration of 1978 as a grass-roots management approach to providing health care services to communities.
Subsequently, several countries decided to adopt this model of care. Nigeria joined the bandwagon in 1988 when Olikoye Ransome Kuti was appointed the Minister of Health.
Primary Health Care in Nigeria: A General Overview
When Prof Olikoye Ransome-Kuti was appointed as the Minister of Health in 1985, he redesigned the country’s health structure using the public health policy template. This led to the adoption of the scheme that started with 50 local governments in 1985 which was a significant milestone in the nation’s health sector.
The objective of the model was to address the main health problems in communities all over the world in order to achieve universal health care by providing accessible, preventive, curative and rehabilitative services. The PHC centre is the first level of contact of individuals, families and communities with the national health system.
When the first comprehensive National Health Policy was launched in 1988, the vision of the policy was to further strengthen the collective will of the government to provide accessible health care facilities across the country and by 1990, the scheme had expanded to the grassroots across the country.
This scheme devolved the responsibilities of the PHC to local government areas, which catered for the health needs of over 90 percent of Nigerians and achieved universal child immunization of over 80 percent.
To further sustain this agenda, the National Primary Health Care Development Agency was established in 1992.
The agency emphasized preventive medicine and health care services at the grassroots. Other objectives of this agency include promoting exclusive breastfeeding practice, introducing free immunization for children, encouraging the use of Oral Rehydration Therapy by nursing mothers, ensuring the recording of maternal deaths, encouraging continuous nationwide vaccination and pioneering effective HIV/AIDS campaign.
The giant strides made by the NPHCDA in the country became a model for other African countries to set the course for their future.
Unfortunately, when the tenure of Olikoye Ransome-Kuti elapsed, the agency became lackluster and many years down the line, Nigeria became one of the lowest ranked countries in terms of basic health indicators.
Currently, the state of the PHC system in Nigeria is shocking with only about 20% of the 30,000 PHC facilities across Nigeria working. The rest of the PHC facilities lack the capacity to provide essential health-care services. Also, these centres are faced with the problem of poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, poor condition of infrastructure, and lack of essential drug supply.
The inability of PHC centers to provide basic medical services to the Nigerian population has increased the influx of patients to the secondary and tertiary health-care facilities experience which has led to long lines of queues in these hospitals.
One of the richest men in the world, Bill Gates was critical about the health system in the country when he visited the country in 2018. The billionaire revealed that Nigeria was one of the most dangerous places in the world to give birth with the fourth worst maternal mortality rate in the world ahead of only Sierra Leone, Central African Republic and Chad. He further revealed that one in three children was chronically malnourished, deprived of a diverse diet and the services of a strong primary health care system.
During the discussion, Gates highlighted six key features of a functioning Primary Health System as adequate funding, good facilities located in the right places, skilled and dedicated health workers, ample stock of essential equipment and medicines, patients who know about the system and want to use it and a mechanism for collecting the data needed to improve quality.
Currently, the Nigerian Government spends less than 4 percent of its budget on healthcare, while the country majorly depends on donors and NGOs to finance its health projects and response and management of diseases are left in the hands of foreign partners.
Also, the increasing brain drain and the deficiency in the health workforce has put a major strain on the primary health care system with the existing workforce finding employment in the secondary and tertiary healthcare system and leaving the PHC systems underequipped.
In 2011, the PHC under one roof (PHCUOR) policy was formulated to address the problem of fragmentation in PHC and ensure the integration of PHC services under one authority. But its impact is yet to be felt on the health status and utilization of PHC in the country.
The 2018 budget allocated 64 percent to primary health care. This is expected to improve the overall level of health care services throughout the country because primary health care is not only curative but also preventive.
The decision of the Minister of Health to improve the primary health care system by increasing funding is certainly the way to go. The Minister further revealed that prior to his tenure the budgetary allocation to PHC was a mere 8 percent.
The Ministry also launched a technical support program (TSP) which was set up to strengthen coordination of technical supports to states so as to ensure one health plan across Nigeria.
This initiative will also help address the various challenges in the health sector and also ensure the attainment of the goal of one framework, one implementation plan and one evaluation plan for the Nigeria health sector.
To achieve this, it is important that the government embarks on an intensive public health management campaign, which involves a comprehensive review of the Primary Health Care scheme. Also, there is the need to develop policies suited to the social needs and economic conditions of the people especially those in rural areas.
Overall, the three levels of government must combine and mobilize resources to guarantee effective public health service throughout the country.