A declaration of state of emergency on public health in the country recently by the National Primary Health Care Development Agency (NPHCDA) has added to the blacklist of issues that governments at all levels have failed to address for decades. This one is grave because it speaks specifically to sensitive matters of maternal, newborn and child death occurring at primary health centres, which have failed to cope adequately with health-care needs.
The health concern was raised concomitantly with reports that Nigerian health indices rank among the worst in the world, especially in the areas of maternal and child mortality. Some recent newspaper headlines attest to this worry – ‘‘Why Nigeria loses 2,300 children, 145 women daily’; ‘Fed government moves to tackle high maternal, child mortality”; and “Fed government declares emergency on pubic health” among others.
This newspaper has in recent months commented several times on the recurrent health sector challenge and there is still no glimmer of hope. We have repeatedly noted that obviously, progress in terms of improvement of health indices in Nigeria remains limited. Some of the major reasons frustrating significant improvements in health sector in the country remain the limited and inequitable coverage with proven, cost-effective high impact interventions because of limited implementation of the plethora of relevant health policies; poor funding; lack of robust public health infrastructure particularly inadequate and poorly maintained health facilities; human resource gaps that manifest as poor patient to doctor ratio, and inequitable distribution of health personnel at various levels, especially the rural and hard-to-reach areas; poor patient-client relationship; lack of comprehensive public education and infrastructural, institutional and financial barriers to access; poor patient-client relationship; out-of-stock drug syndrome; lack of consumer awareness of their rights regarding health service delivery; dearth of public health leadership capacity and limited investment in research at all levels, that will provide evidence for rational decision-making, amongst others.
To tackle these inhibitive factors, the Nigerian government designed a National Health Policy in the 1988, which was revised in 2004 and 2016. The document enunciated the fundamental principles underlying health service delivery in Nigeria; and stated that the key to the development of the National Health Policy is Primary Health Care (PHC).
So, PHC was a response to 1978, the landmark Declaration of Alma-Ata, adopted by nearly all member states of the World Health Organisation (WHO) and UNICEF, where PHC was identified as the key to the attainment of the laudable goal of Health for All (HFA) – a 1977 call by World Health Assembly that by the year 2000, each and every individual attain a level of health that will enable them to live a socially and economically productive life. This brought about a global shift to universal health coverage and a need to strengthen the primary health care coverage.
In addition, with the restoration of democracy in the country in 1999, there was a revitalisation of PHC, and in response to the WHO recommendation that community mobilisation and participation would be greatly enhanced if boundaries of the health districts in the LGAs are the same as the electoral wards, with elected councillors to the LGAs. Hence, the Federal Government introduced the Ward Health System (WHS) in 2000, first advocated by the African Ministers of Health in 1986. The Ward Minimum Health Care Package was also articulated.
Implementation of the WHS commenced in 200 local councils in the country and expansion has been gradual. In each ward, a health centre is to be upgraded and provided with the necessary infrastructure, equipment, human resources, drugs, commodities and logistics to provide qualitative maternal, newborn and child health services commensurate with that level of care, on a 24 hour basis.
While, compliance with the precepts of PHC, as enunciated at Alma-Ata appeared very limited in Nigeria and other WHO member countries, PHC has since provided the philosophical fulcrum for virtually all subsequent international health declarations and activities aimed at advancing health for all, including the attainment of health-related goals in the Millennium Development Goals (MDGs) and the follow-up Sustainable Development Goals (SGDs.
Additionally, Universal Health Coverage (UHC) has been identified as central to the attainment of SDG3, which is good health and well-being. Key to the attainment of UHC, first adopted in 2012 by the World Health Assembly, is the imperative for all countries to consolidate public health advances, with a focus on strengthening health systems, especially PHC.
The PHC approach adopted at the Alma-Ata conference, called for a revolutionary strategy to health care. Instead of the traditional top-down approach to medical service, it embraced the principles of social justice, equity, self-reliance, appropriate technology, decentralisation, community involvement, inter-sectoral collaboration and affordable cost.
Hence PHC as defined in the Alma-Ata Declaration is health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in a community and through their full participation and at a cost that the community and country can afford to maintain at every stage of development in the spirit of self-reliance and self-determination.
As stated in the National Health policy, it is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work; and constitues the first element of a continuing health care process. Thus, PHC is promotive, protective, preventive, restorative and rehabilitative to every citizen of Nigeria within the available resources so that individuals and communities are assured of productivity, social wellbeing and enjoyment of living.
Specifically, PHC encompasses some minimum elements in the realms of public health, basic clinical services and health system working with other sectors like agriculture, water and sanitation, housing, etc. The fundamental aim of primary healthcare is to make universally accessible resources and services, to provide adequate coverage of the most important needs of populations.
This may account for why health services based on PHC are education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; and adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunisation against the major infections; prevention and control of locally endemic and epidemic diseases; appropriate treament of common diseases and injuries; and provision of essential drugs and supplies. It also involves the local health authorities where applicable, seeking the collaboration of the traditional practitioners in promoting health programmes such as nutrition, environmental sanitation, personal hygiene, family planning and immunisations.
Against the backdrop of the Alma-Ata Declaration, the NPHCDA should realise that the provision of health services is not solely humanitarian, but an essential component of the package of social and economic development as well as being an instrument of social justice and national security in a democratic setting. Thus, NPHCDA should equitably distribute health resources giving preference to those at greater health risk and the under-served communities through PHC.
Therefore, given the distribution that 70% of Nigerian population live in the rural areas; and knowing that PHC is the key to efficient health sector in Nigeria, this newspaper supports an emergency declaration for better resource allocation to a ensure modicum of infrastructure needed to attract personnel to the rural areas; and training and retraining of health personnel.
Also, the local governments are responsible for the PHC and the NPHCDA was created to save the PHC. Thus, in tandem with its mandate, NPHCDA recent declaration for a state of emergency on public health over maternal and child death occurring at PHCs should not be taken lightly.
However, NPHCDA should go beyond talk shops, and stop lamenting the magnitude of maternal and child deaths in the country from decade to decade. Instead, the apex body on primary healthcare should walk its talk! The NPHCDA should rise beyond ‘talk’ and make public specific, measurable, achievable, and realistic and time (SMART) bound objectives, notably to all the authorities concerned, in this regard.
Meanwhile, the NPHCDA has disclosed that the country has received $1.31million worth of support to be matched by government’s $1.97 million for 10 years. These funds should be judiciously used now to actualise the expectations of the scheme – and to deal with this emergency.
Again, better access to primary health care requires a comprehensive multi-sectoral input, community involvement and collaboration with Civil Society Organisations (CSOs) in providing health services. Thus, in the activities of different levels of government providing health services, CSOs and other agencies should be properly integrated to provide the citizens with effective health services at all levels. Mainly, this declaration of emergency on public health concern should not just lose steam because the country’s sustainable goals are dependent on its outcomes.
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