A report the other day that most of the states’ primary health centres remain in a decrepit state leaves a residue of sour taste in the mouth just a few months after stakeholders mulled a declaration of emergency in the primary health subsector.
This is a story that our political leaders at all levels should be ashamed about. In 1988, the Nigerian government designed a National Health Policy, which was revised in 2004 and 2016 to tackle some inhibitive factors frustrating significant improvements in the nation’s health sector. Again, 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). Sadly, about 30 years after, recent media highlights from the six geo-political zones on Primary Health Centres (PHCs), show a gloomy picture as the inhibitive factors frustrating significant improvements in the nation’s health sector have grown ‘tap roots’. The reports revealed, for instance, that 23 doctors are manning over 800 PHCs in Oyo State; Ogun PHCs are dying of neglect and personnel shortage; Enugu PHCs are taken over by bushes and snakes and women patronise traditional birth attendants (TBAs); no water, no electricity at Alausa, Lagos PHC; no drug supplied in Jos North PHC in the last two years; Bauchi PHC has three bed spaces for 6,000 residents; and 13 doctors, 135 nurses man Ekiti’s 300 PHCs, etc.
The above examples indicate that our nation’s PHCs are in ruins and are on the ‘‘verge of extinction; with many of them not functioning, while others are dilapidated.’’ This reported criminal neglect of PHCs by the states and local governments is a show of shame by the most populous country in Africa. Again, it accounts for why most Nigerians have resorted to self-medication by patronising poorly unregulated patent medicine stores, herb sellers, traditional birth attendants (TBAs), and religious houses or faith healings. In the process, many avoidable deaths have occurred.
In capturing this, the Mo Ibrahim Foundation in its 2018 Report titled, “Public Service in Africa” stated that no sound governance in Africa would be achieved without strong public services and health care delivery, which is one that is abysmally, shamefully low, of all public services.” Little wonder Nigerian health indices rank among the worst in the world, especially in the areas of maternal and child mortality and other poor health indicators.
Generally, one inhibitive factor to quality health care in Nigeria as outlined in the National Health Policy is brain drain. This is buttressed by reports that Nigeria is believed to be one of the countries most affected by migration of medical professionals, with about 12 doctors leaving the country every week. Others are 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. There are issues too such as 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. Besides, we can’t ignore challenges including 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, among others.
To reduce poor health outcomes and avoidable deaths, local governments need to take PHCs seriously and make it a major priority in view of its critical importance to the citizens’ lives; and quality of governance. Also, in search for solution to the sorry state of the nation’s PHCs, the view of Mo Ibrahim Foundation on governance and health; and various studies point to continuous governance support, remarkable investment, active community involvement and funding as critical variables for improvement in the quality of primary health-care facilities.
Since, PHC is within the purview of local councils and funding has been a major issue; now that the Nigerian Financial Intelligence Unit (NFIU) has introduced a new measure to restore financial autonomy to the third tier of government since June 1, 2019, the issue of unavailability of financial resources for PHCs, is now ameliorated because the joint account in use by state and local governments is only for the receipt of allocations from the federation account, but not for disbursement. Essentially, local councils will no longer be financially handicapped as they now have financial empowerment to meet their minimum responsibilities to the constituents; and do what they are supposed to do to make PHCs efficient and purposeful.
Against this backdrop and recent development in local government administration in Nigeria, particularly as funds will be disbursed directly to local councils, a major first step towards improving the PHCs is now in place; and the onus is on local governments to revamp PHCs which is under its purview because they are now ‘sovereign.’
Therefore, to reposition PHCs and make them more robust to deliver excellent returns – in terms of serving as strong support bases for secondary and tertiary health institutions by ensuring early detection and referrals for diseases and in terms of lives saved, chairmen of local councils must wake up and ensure judicious use of health budgets to build and renovate buildings, recruit more medics, procure essential medicines and provide electricity. They should ensure that in each ward, a health centre is upgraded and provided with the necessary infrastructure, equipment, human resources, drugs, commodities and logistics to provide qualitative maternal, new-born and child health services commensurate with that level of care, on a 24-hour basis. This will convince the citizens that disbursing money directly to local councils is not transferring old ‘‘centres of corruption.’’
Again, better access to primary health care requires a comprehensive multi-sectoral input, community involvement and collaboration with Civil Society Organisations (CSOs) because CSOs are recognised as vital forces in strengthening governance processes so they should work towards gaining the commitment of local governments; and develop their capacity to apply the principles of accountability, transparency and openness, by actively seeking effective performance and accountability from local governments on PHCs.
Employers and individuals should key into the National Health Insurance Scheme (NHIS); while health management organisation (HMOs) should pay hospitals within three months to facilitate the purchase of drugs and services.
Finally, National Primary Health Care Development Agency (NPHCDA) was created to save the PHC. Thus, in tandem with its mandate, NPHCDA and LGAs should jointly work, set specific, measurable, achievable and realistic and time (SMART) bound objectives for PHCs aimed at improving the outlook of health indicators particularly maternal and child deaths in the country.
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