There’s A Lot More Happening With Our Primary Healthcare Than You Think

The healthcare system bears a great deal of responsibility, and rightly so. Furthermore, Adam Smith famously stated that a nation's wealth is dependent on its people because there is evidence of a link between health and economic advancement.


The Primary Healthcare Journey (PHC)

Policymakers and political actors tried unsuccessfully to expand healthcare facilities until Professor Olikoye Ransome-Kuti became Minister of Health in 1985. The Basic Health Services Scheme (BHSS) was implemented from 1975 to 1983, and the District Health System (DHS) was implemented from 1986 to 1992. Unfortunately, instead of focusing on prevention, these failed endeavours focused on curative medicine.

Professor Olikoye worked tirelessly to implement the PHC policy based on the Alma Ata Declaration of 1978 from his appointment in 1985 to 1992, and he made significant progress. Under his leadership, he implemented a comprehensive national health policy focused on PHC, emphasised preventive medicine and healthcare services at the grassroots level, mandated exclusive breastfeeding, free immunisation for children, and oral rehydration therapy for nursing mothers. He also made maternal deaths mandatory, promoted continuous nationwide vaccination, and pioneered an effective HIV/AIDS campaign.


The State of Nigeria's Primary Healthcare System: PRE-COVID

The coronavirus outbreak exposed the pitiful state of Nigeria's healthcare system and its flaws, despite the fact that the decay had been evident for years.

Prior to the covid pandemic, there was the Ebola virus, which severely shook our already shaky healthcare system. However, the government made few to no efforts to improve its situation, and with the emergence of the covid 19 pandemic, these issues have worsened.

Since the first case of covid was reported in Nigeria on February 27, 2020, there have been 133,552 cases, 1,613 fatalities, and 107,551 recoveries, raising concerns that the new COVID-19 strain is fueling Africa's second pandemic wave.

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In terms of healthcare delivery, our country presently ranks 187th out of 195 countries. According to WHO statistics,  “between March and August 2020, 362,700 women in Nigeria missed antenatal care, resulting in 310 maternal deaths.” This figure is nearly double the number of maternal deaths reported in August of this year.

The Covid-19 outbreak should have signified a turning point in Nigeria's healthcare system, but no measures to improve its deteriorating situation appear to have been made. As a result, the situation continues to deteriorate, from a lack of key hospital equipment to a lack of necessary drugs on the shelves, epileptic power supply, and low medical professional remuneration.

As a result, most PHC facilities in Nigeria are unable to deliver crucial healthcare services, further stressing the system and lowering services.

Part of the reason for the difficulties in implementing PHC in Nigeria is that in the 1980s, the federal government handed over control to the local government administration, the lowest level of government. The impact of local government management on Nigerians continues to be a point of contention.

 

Nigeria's Primary Healthcare Centres in the Post-Covid Era

At the moment, the PHC system is quickly deteriorating, with only one out of every five PHC centres operating. In addition to limited personnel, inadequate equipment, poor distribution of health workers, poor quality of healthcare services, bad infrastructure, and a shortage of necessary drug supplies, there are a slew of other issues.

 

Factors and Issues in Developing a Strong PHC System

Implementing policies to address the underlying issue of insufficient funding is one way to significantly improve the healthcare system. The Abuja Declaration, in which African heads of state pledge to devote at least 15% of their annual budget to improving the health sector, is one such policy that could help.

Health is rarely considered a fundamental human right in Nigeria, which explains why the Abuja Declaration has not been implemented.

Using practical approaches like the Abuja Declaration will result in more domestic health resources and better financial allocation for PHC administration.

Governments should also transfer healthcare resources from curative to preventative treatments in order to strengthen PHC infrastructures and encourage healthcare staff to migrate from urban to rural areas. 

They can also provide an acceptable level of healthcare for all, decreasing health inequities. Political actors and policymakers may ensure that everyone has access to health care by signing and adopting the necessary legislation.

Another alternative is to increase Nigerians' access to healthcare. According to a survey by the World Health Organisation (WHO), only 4% of Nigerians have health insurance.

Furthermore, the majority of out-of-pocket healthcare costs made up over 76 percent of overall healthcare spending in the average Nigerian's budget. To overcome this issue, the government must work with private parties to improve healthcare access for all Nigerians.

Now, many state governments struggle to mount the required funding to support their health systems.

In many instances, when there are limited functional PHC facilities within communities, the private sector fills the service delivery gap in the form of for-profit services (for those who can afford it), non-profit services (by non-governmental organisations [NGOs] and faith-based organisations sometimes aimed at individuals who cannot pay for services) and informal service providers.

To develop the overall health system landscape in Nigeria, it is important to strengthen the public sector (especially at the PHC level) and expand the capacity of private sector providers to increase their competitiveness in terms of breadth, quality, and cost of services.

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