Adopting a “Primary Health Centre” – A modest step with potentially huge impact

Quite often, commentary on our healthcare system usually begins by enumerating and dwelling on the challenges. No doubt, our healthcare system, just like in many other societies, has its challenges, but I want to start this essay by acknowledging and celebrating the good news about our healthcare system in Nigeria. Firstly, we have established an […]

Quite often, commentary on our healthcare system usually begins by enumerating and dwelling on the challenges. No doubt, our healthcare system, just like in many other societies, has its challenges, but I want to start this essay by acknowledging and celebrating the good news about our healthcare system in Nigeria.

Firstly, we have established an expansive physical infrastructure for the provision of healthcare in Nigeria. Government health institutions include over 20,278 primary health centres, at least 33,303 general hospitals, and more than 60 teaching hospitals and federal medical centres. The federal government is responsible for tertiary care, state governments are responsible for secondary care, and local governments run primary care.

Additionally, since 1999, we have witnessed an explosive increase in the number of privately-owned healthcare facilities (hospitals, diagnostic centres, clinical laboratories), many of which have infrastructure, equipment and staff as good as the best healthcare facilities anywhere in the world.

Furthermore, compared to many African countries, Nigeria has created special cadres of primary healthcare personnel and dedicated schools to train them. Government has made a gallant effort to ensure staffing of primary health centres. Also, Nigeria has a relatively large network of primary health care facilities that are evenly distributed around the country.

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Recently, we have recorded improvements in the percentage of one-year-olds who were fully immunised and in the percentage of children under five years who slept under an insecticide-treated net. Furthermore, the spectacular work of the Nigerian healthcare personnel who tackled the Ebola outbreak and the COVID-19 pandemic reaffirms our capability and validates that when challenged, we can perform as well, if not better than, healthcare workers in more developed countries.

Perhaps the most impressive but underappreciated piece of good news is that over the past half century, we have accumulated an intellectual tour de force of highly skilled and well-trained women and men in every speciality and sub-speciality in medical science. I stress this as the most important because, ultimately,y no matter where you are on earth, the “brain” remains the most important “equipment” in healthcare.

How that brain power can be deployed to help the motherland, especially by those healthcare workers who reside outside the country, is a work in progress.

The Challenges

Primary healthcare is the foundation of any country’s healthcare system. Primary health centres (PHC) form the first level of Nigeria’s healthcare system. PHCs aim to provide individuals and communities with protective, preventive, restorative and rehabilitative health services within the available resources.  They play a crucial role in providing basic medical care to all Nigerians, especially in rural areas.

The challenges we face in our healthcare system at every level include, well  the usual suspects  inadequate funding by government, lack of equipment, unmaintained physical infrastructure, and lack of qualified clinical/managerial personnel. These challenges are most pronounced at the primary healthcare level because PHCs are run by local governments, many of which lack the managerial and political capacity to run the core of our country’s healthcare system

Adopting a “Primary Health Centre”

What are the solutions to the challenges at the primary healthcare level – Well, I do not want to bore you by giving you a list of the usual “government must do, etc”. The impetus for this humble prescription is to emphasise what “We the people” as citizens can do to make a difference and not to recite the predictable “What government should do”.

Individuals and communities often demonstrate their priorities by how they allocate their resources. The widespread idea that government must “Do everything” has lulled many communities into complacency and thus unable to ensure that their PHC is the best it can be.

For example, there are many communities, like mine – Eke, in Enugu State – that have spent over half a billion Naira in building and furnishing houses of worship, but failed to invest even one per cent of that sum in their PHC.

Many Nigerians at home and abroad are keen to contribute to the development of their community but are often frustrated by the lack of straightforward opportunities that are devoid of red tape, and they would not route their money through any government official.

As currently envisaged, once an individual or an organisation adopts a PHC, they would directly fund infrastructure maintenance, equipment procurement, purchase of medical disposables and facilitate staff training. The logistics and scope of their involvement can be worked out, but the key is that they do not have to hand their money to anybody in government. The idea is not to usurp the role of local governments in running PHCs but to supplement what the local governments do.

The primary healthcare agency in each state can galvanise this endeavour by listing their PHCs on their website, beginning with rural PHCs and then aggressively soliciting individuals, corporate entities, and organisations. In addition to kind-hearted individuals adopting PHCs, it would be inspiring for our stupendously profitable banks, mobile phone companies and oil companies to each adopt at least 10 PHCs in each state of the federation. Also, organisations like Doctors Foundation for Care, WIMBIZ, ANPA, MANSAG, Rotary, people’s club, social clubs, foundations and Nigerian social organisations in the diaspora can get in on the action by each adopting at least one PHC in each state of the federation.

On the surface, adopting a PHC sounds modest and perhaps insufficient considering the enormity of the problems in our primary healthcare system. Also, it is not glamorous and flashy, and is unlikely to get those who adopt on the front page of newspapers or television. However, it has the potential to positively impact a lot of lives for years. To tackle our primary healthcare challenges, we must start somewhere. Holding out for “Magic bullet” or “colossal” solutions and “What government must do” will only lead to inactivity and perpetual disappointment with attendant human suffering. It only takes a few individuals or organisations in each state to start the ball rolling, and soon adopting a PHC will become fashionable. It is a modest first step with a potentially giant impact.

 

Dr Ifudu can be reached via [email protected]