‘Community leaders need to be engaged in primary health care system’

You recently wrote a book titled: ‘Barriers to the utilization of primary health care services in low income settings; implications for health policy and planning.’ What is the thrust of the book?The book just got published by the Lambert Academic Press in Germany, and it chronicles the challenges facing primary health care (PHC) in low […]

You recently wrote a book titled: ‘Barriers to the utilization of primary health care services in low income settings; implications for health policy and planning.’ What is the thrust of the book?
The book just got published by the Lambert Academic Press in Germany, and it chronicles the challenges facing primary health care (PHC) in low income nations with special focus on northern Nigeria; which is a region that has some of the worst health and socio-economic indicators in the world.
The book also suggests practical and realistic means of overcoming these challenges with a view to improving our health care system as a nation. It also attempts to close the gap between the poor who are mostly the recipients of such services and the policy makers therefore serving as a very good tool for policy formulation; diffusion and utilization in low income countries.
The book analysed the barriers that make people not to utilize primary health care  systems and we realized that the state of the PHCs are appalling, the infrastructures are decaying, staff are less motivated and in some cases even absent. You will find a PHC being managed by only one community health extension worker who by his training is supposed to be in the community, not even in the facility but he has been converted into a pseudo doctor where he has to treat every ailment and this has a disastrous effect on the community because when somebody who is not equipped is doing something that he is not supposed to do, the entire essence gets lost.

So what are the barriers and challenges facing the use of primary health care in Nigeria?
Primary health care is the bedrock of every health system, it is the first point of contact to the health care provider and the patient; it is the first impression he has about the entire health care system. If the patient does not get it right at the primary health care level, every other impression he has gets lost because that is what he uses as a yardstick to gauge the dynamics of the health care industry of the country.
PHC is a place where you treat the most common preventable diseases and where patients are given the most basic and urgent care they need and that is why it is critical that the nation get it right at the primary health care level. No nation has been able to advance with a comatose primary health care system. PHC is the bedrock upon which every health care industry stands.
One of the major challenges we are facing is the inability of government to translate policies into action. We have some wonderful concepts of how primary health care can be made better in the country. Typical example is the concept of PHC under one roof, this is a beautiful concept that itemizes how PHC can be managed from the grass root up to the government level but how we translate these policies into practice is very important and is a little bit poor as far as Nigeria is concerned. Government has to make effort to utilize policies they develop and ensure that they are actually translated into actionable points.
Most PHC approaches are coming from top to the bottom. Communities own these PHCs; let their problems and the solution to their problems come from them. In that case, they own up to the system, they take it and utilize it and if anything goes wrong, they will be the first to cry out that this system is not working, let us come together and solve the problem.
You will find out that they will solve some problems before they even approach government, so that is one critical factor that I think is missing, that is, community ownership, participation and mutual accountability of PHC system.

How can the problems ravaging PHCs in Nigeria especially in the north be solved?
You see a famous physician once said; “Health services no matter how efficient cannot change the condition of the marginalized people unless they are helped to become self-reliant and the roots of their problems addressed. People who are poor and illiterates are like uncut gems hidden under dirt and stones. Given the opportunity they can reach their full potentials and live as responsible human beings, possessing the liberty to shed those old customs and traditions that impede health and development.”
And it is here that I think the northern states need to come together and appreciate the gravity of their health care challenges compounded by the negative socio-cultural conundrums  and develop a comprehensive blue print for the revival of primary health care in the region. This should be backed by a very solid plan for ensuring accountability and transparency in health care expenditure in the region. Because the pattern of morbidity and mortality as well as the socio-economic determinants of health and disease in the various geographical zones of the country are different.
Provision of affordable and qualitative health care to the populace can be a very good tool for poverty reduction and empowerment
Community leaders, religious leaders and other community gatekeepers need to be engaged in the PHC systems. If these people are not engaged, you cannot just come up with something and say this is what you want people to do without their own people whom they see as gatekeepers accepting these things first and selling it to the people.
 A typical example is the issue of polio that is raising a lot of dust, especially rejection. So if we really want to be taken seriously as a region and as a nation we must develop a practical, realistic and sustainable health system that will provide affordable and qualitative health care to the generality of our citizens irrespective of their socio-economic status.
There is really no alternative to this. I see primary health care as the major vehicle upon which low income nations can provide affordable and equitable health care to the general populace. This is even more realistic in the north where the triple effect of poverty; illiteracy and disease are daily conniving with bad governance to deprive people of their chance to live a healthy and descent life.

What is your position on polio vaccine rejection in some northern part of the country?
I think there is no doubt at all that immunization and vaccines have played more important role in combating preventable diseases than any other medical intervention in the history of mankind. I believe that the recent outburst on the polio vaccine by some academicians and scholars in the north is a product of misunderstanding based on misinformation and this can easily be settled by absolute honesty; transparency and openness from all stakeholders working in this area.
What I have no doubt about is that as we eradicated small pox using vaccines and immunizations so shall we eradicate polio using the same immunization and vaccines. Deliberate misinformation may temporarily reverse the gains we have made but it can never change the course of history.

2013 is gradually coming to an end; do you see Nigeria achieving the Millennium Development Goals (MDGs) come 2015?
I’m someone who believes it is scientifically, economically and politically impossible to have universal targets and goals for all nations. This is because different nations have different socio-cultural, political and economic variables that will affect how far they go in achieving these goals. It is here that I see the frequent attempt by some low income nations to prove to the world that they have met this or the goal of the MDG as utterly laughable. For deep within them, they know their capacities and capabilities; they know the bottle necks they face as a people and as a nation; they know the resources at their disposal and they also know the commitment or other wise of their political leadership to these goals.  What I think we should do is to look critically into our strengths; opportunities; weaknesses and threats, taking into cognisance the political; economic, socio-cultural and technological peculiarities of this nation and come up with urgent but realistic goals and targets that address the prevailing economic; educational and health problems of our people, this should be the post 2015 MDG agenda of Nigeria and indeed all African nations.