Few pressing issues aggregate as much consensus in national discourse in Nigeria today as the need to strengthen our Primary Health Care (PHC) system in order to achieve Universal Health Coverage (UHC) in the country.
Experts and stakeholders in the health sector of the Nigerian economy, representatives of relevant government agencies, intergovernmental organizations, development partners, local and international civil society groups, working in the sector and concerned individuals seems to unanimously agree on this for obvious reasons.
The PHC is the provision of basic essential health services which include, preventive, promotive, curative and rehabilitative. It serves as the first point of access to health care by individuals, families, and communities.
Health experts say strengthening PHC guarantees better population health and reduces the workload on secondary and tertiary healthcare levels as well as reduce out-of-pocket patient spending on health. It is acknowledged in some quarters that 70 per cent of Nigeria’s disease burden can be treated at Primary Healthcare Centres (PHCs), in addition to vital disease prevention and other related health-based projects.
Moreover, bringing health services as close as possible to homes and workplaces and has thus been described as the bedrock of UHC, which is essentially all about ensuring that people have access to the health care they need without suffering financial hardship. Its primary goal is to provide high-quality health care to everyone, regardless of socioeconomic status.
Notably, UHC movement has gained global momentum, with the first-ever UN High-Level Meeting on UHC held in September 2019. A Political Declaration was unanimously adopted by member states, affirming their high-level political commitment to UHC and outlining a number of necessary actions.
In January 2020, the second UHC Forum was held in Bangkok, aiming to enhance political momentum on UHC in international fora. In spite of the global push, findings from empirical studies however, indicate that up to 5 billion people will still be unable to access health care in 2030.
Within the Nigerian context, there has been a number of previous and ongoing efforts aimed at revitalizing the country’s PHCs with a view to achieving UHC.
Nigeria’s health minister, Dr. Osagie Ehanire said the foundation of any strong health system, particularly for the attainment of UHC rests on a robust, resilient PHC system, adding that the country must recommit to strengthening its PHC systems.
“The PHC message itself is not new, because it is underpinned by the Alma Ata Declaration and has been amplified in Nigeria ever since the ministerial term of Ransome Kuti: but despite all that, it somehow has not found the required resonance, when it comes to implementation”, he said.
The minister also called for more efforts to ensure UHC for everyone, adding that the administration is dedicated to making progress towards attainment of UHC and the Sustainable Development Goals (SDGs) in Nigeria.
Corroborating the minister’s assertion, the Vice President, Prof. Yemi Osinbajo said a lot more is needed to reposition the PHC system in the country, noting that the health system of any country is only as strong as its PHC system.
Prof Osinbajo also observed that the support of the private sector is needed for Nigeria to achieve UHC and boost the country’s chance of providing quality health services to the people. “There is a great need for synergy from private sectors, partners, and the federal government to avoid duplication of PHC facilities”, he added.
Similarly, the Minister of Finance, Zainab Ahmed posited that quality health care services is indispensable to achieving UHC in Nigeria, adding that strong partnership between the government and private sector will improve efforts and yield positive results in health care delivery.
She said the use of electronic medical records, telemedicine and use of drones in hard-to-reach areas, have helped in streamlining ease delivery to most PHCs in Nigeria.
Challenges
Since the 58th World Health Assembly issued a resolution encouraging countries to transition to UHC in 2005, Nigeria responded by developing a robust national policy for the realization of this lofty initiative, regrettably not much has been achieved in terms of implementation.
The underlying factors bedeviling implementation of the extant framework and policies include, poor governance, inadequate financing, poor human resources for health and under-utilization of the PHC facilities by individuals and communities, lack of political will amongst decision and policy makers and poor intersectoral collaboration without proper coordination and monitoring.
Another major challenge that has been identified is the low level of awareness amongst majority of Nigerians as far as the tenets of UHC are concerned. This knowledge gap and public support, according to experts, has inadvertently resulted in a situation where there is very little or no pressure on government to address the issues head-on.
Interventions on PHC strengthening.
In a bid to change the narrative, the Nigerian authorities both at the federal and state level have initiated and implemented a number of programmes over the years and there are some that are ongoing currently. For instance, the National Primary Health Care Development Agency (NPHCDA), which is responsible for PHC development and implementation in Nigeria has been actively involved in the implementation of such programmes.
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Recently, the NPHCDA convened an international summit in Abuja, with the theme: “Re-imaging PHC in Nigeria”. The summit was aimed at galvanising stakeholders to invest and collaboratively implement a PHC revitalisation strategy for the country. It was also geared towards launching a historic programme to transform the under-resourced, weak PHC system in Nigeria by leveraging private sector, international agencies and government collaborations.
A Consultant Public Health Physician, Dr. Augustine Ajogwu noted that the NPHCDA’s renewed efforts towards revitalizing the PHC is a laudable one that provides another opportunity to ensure that primary healthcare is revamped in the country. “It is indeed a laudable step in the right direction, but how it is going to materialize is what we are watching”, he added.
Dr. Ajogwu, a staff a staff of the Department of Public Health, Federal Capital Territory Administration (FCTA) Abuja, noted that if everything goes well as envisaged, the healthcare centres will now bear the shock of all the diseases and epidemics that is happening across the country.
“We will not be having poor indices as we are having now like poor maternal health, poor child health, increase maternal mortality ratio, infant mortality rate. These are the problems we are having because we have poor primary healthcare centres”, he further explained.
He also pointed that there are some other efforts aimed at achieving affordability of health services across the country. According to him, the Federal Government is trying to use some percentage of the Consolidated Fund, as an intervention to reverse the trend.
He said 1 percent of Consolidated Fund under the Basic Health Care Provision Fund is going to be disbursed to National Health Insurance Scheme (NHIS), which will be further appropriated to the states and local governments and primary health centres across the country.
“This is also making money available but it is still not going to be enough if the states and local government fails to key in because political will, collaboration and integration is key to the success of every programme”, he stressed.
While speaking at the recent health summit in Abuja, the World Health Organisation (WHO) regional director, Matshidiso Moeti commended the Nigerian government for the desire to reimagine primary health care in Nigeria.
On her part, the American Ambassador to Nigeria, Mary Leonard said the U.S government stands ready to support the PHC revitalisation in Nigeria, adding that the diplomatic community stands ready to support this move.
Going forward.
In its review of PHC systems in 2019, the WHO cited political will and good governance; promotion of health reforms; access to essential programmatic initiatives; strong partnerships between governments, civil societies, non-governmental organizations and private sectors; and good organizational management as the key enabling factors in PHC implementation.
On what Nigeria should do in order to achieve UHC, Dr. Ehanire stressed that the country must overcome obstacles militating against giving due attention to PHCs and their optimal performance.
While speaking during an exclusive with Metro Daily Nigeria, the Medical Director of Karu General Hospital Abuja, Dr. Osamuede Ojo harped on the need to adopt strategic and realistic planning, prioritize the provision of infrastructural facilities, proper monitoring and stakeholders’ involvement in the implementation of PHC programmes in the country.
“We need to imbibe the culture of planning realistically, the real stakeholders should be involved. You need to have discussions with the people on the field, ask them questions, involve them, bring them to the table. You cannot begin to talk about progress anywhere in the world, if the infrastructural facilities are not provided.
“If you really want to know what is going on in the health sector, the people who are actively practicing are the people you are supposed to engage with, not the political appointees. Some of them don’t even have an idea of what is going on”, she added.
On their part stakeholders in the sector have harped on the need for more commitment to ensuring proper implementation of policies, strategies, regulatory framework and financial commitments as well as intersectoral collaboration and optimization of resources.
Other recommendations for the way forward include, increase in budgetary allocation to the sector, regular training for health workers at the PHCs, improved collaboration between public and private sector in the implementation of PHC programmes, particularly those aimed at achieving UHC for all Nigerian citizens.
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