A declaration by the Federal Government that Primary Health Care centres across the country will soon be revived is a piece of good news. The Minister of State for Health, Osagie Ehanire, who gave the hint penultimate week in Benin, Edo State, said the decision was motivated by the desire to provide quality health service delivery. As a sub-sector of the health care delivery system in serious neglect, revamping it will undoubtedly bring a breath of refresh air to rural communities where most Nigerians live.
The renewal programme will affect 10,000 centres, for which the government has secured a foreign facility of $500 million. According to the minister, each of the 36 states of the federation will be allocated $1.5 million for this purpose. A robust PHC system is the foundation for effective life-saving health service architecture in most countries. But efforts to graft this into Nigeria’s health service code have not been successful due to policy inconsistency, lack of political commitment and corruption. The country’s best shot at this venture was under Olikoye Ransome-Kuti, a paediatrician, as Health Minister between 1986 and 1991. He implemented a national policy that accentuated preventive health care. Through it, an aggressive child immunisation and Oral Rehydration Therapy programmes were pursued, which helped to save the lives of millions of children.
Unfortunately, the story has since changed. The country has one of the worst health indices globally. The statistics are scary. UNICEF says,“Every single day, Nigeria loses about 2,300 under-five-year-olds and 145 women of childbearing age. This makes the country the second largest contributor to the under-five and maternal mortality rate in the world.”
Similarly, it holds the unenviable record of being the third country with the worst tuberculosis epidemic globally, next to India and Indonesia. The CIA World Factbook records that Nigeria’s maternal mortality profile is the 11th worst in the world with the death of 630 mothers in every 100,000 births as of January 1, 2014.
But countries with efficiently managed PHCs have done better. Many rural women in labour give birth to their babies at home, unattended, while those assisted get such from untrained birth attendants. Health complications often arise and they lead to long-distance travels to access medical assistance. Many of them die in the process.
Preventable diseases such as diarrhoea, measles, malaria and pneumonia have continued to kill children and adults alike. Even dog and snake bites; wounds from sharp objects such as nails and bottles, that should not progress to rabies and tetanus, lead to avoidable deaths, as local dispensaries or the PHCs are non-existent.
These awful pictures will continue to interrogate why the National Primary Health Care Development Agency sprang up in 1992 in the wake of the 1978 Alma Ata Protocol on PHC, signed by 134 countries and aimed at tackling community health, as well as preventive and curative medical challenges.
But how the ministry will carry out the rehabilitation of the PHCs, efficiently run and sustain them in such a manner that the system does not collapse again, remains a big concern. Personnel in our health care system are plainly in short supply. Medical doctors, nurses, midwives and other ancillary personnel are required in critical mass for the PHCs to deliver quality service. As of July 2010, a total of 2,622 midwives were deployed in these centres.
A needs assessment of the Nigeria health sector, carried out by the International Organisation for Migration, Abuja, in 2014, put the number of medical doctors practising here at 28,370, as of 2011. This represents a density of 0.17 doctors to 1,000 persons. This is certainly not good enough when compared with figures from other African countries like Libya, Algeria, and Tunisia, which have 19.0; 12.1; and 11.9 to 1,000 people respectively.
Clearly, primary health care is a social responsibility within the purview of the 774 Local Government Areas, while secondary and tertiary services belong to the states and Abuja. This explains why health is on the Concurrent Legislative List.
However, the takeover of states’ PHC responsibility by the Federal Government makes a loud statement on the broken state of our health care system, and the opacity of the federalism in practice here. The country needs radical structural reforms that will enthrone responsive governance at the grass roots. Both the states and local councils must be involved in the new PHCs revitalisation scheme, as tiers of government closer to the people. Institutional frameworks for training/retraining of personnel and sustainable funding plans should be put in place to achieve the ultimate goal.
The Minister of Health, Isaac Adewole, who is in charge of this renaissance in grassroots health service delivery, should ensure that thieves in the health sector that often suck away funds provided by donor agencies do not undermine the $500 million PHCs rehabilitation project.
Global Fund, which had in the past four years disbursed $800 million to Nigeria, recently suspended its financial support on account of lack of accountability and outright stealing of funds. The charity says there are “challenges of grants not achieving impact targets, poor quality of health services, treatment disruptions, fraud, corruption and misuse of funds.”
Cuba, globally acclaimed as a model in primary health care, should serve as our guide in this renewed effort to deliver quality primary health care. In that country, doctors typically spend half of the day out in the community, ensuring that patients at the remotest parts get the care they deserve. Dr. Lee Dresang of the University of Wisconsin School of Public Health, said, “It has really been nice for us to see the benefits it can have.”