Putting the health back into primary care

The three-tier health system introduced in Nigeria was meant to make health care readily available to all. Tertiary care managed complicated cases, secondary care saw to mid-level health needs and primary care managed routine malaria, immunisation and any other in between. But primary care has taken a beating in years. Neglect, poor funding, lack of […]

The three-tier health system introduced in Nigeria was meant to make health care readily available to all. Tertiary care managed complicated cases, secondary care saw to mid-level health needs and primary care managed routine malaria, immunisation and any other in between.

But primary care has taken a beating in years. Neglect, poor funding, lack of manpower have reduced primary health centres to no-show services in bare buildings-more than 10,000 of them.

Up to half of them do not function at all, health experts have concluded. Disease burden has piled on secondary facilities and overwhelmed tertiary. One in two patients waiting to see a doctor at more than 60 federal hospitals in Nigeria has complaints about malaria.

Now a race is on to revitalize primary health care, starting with renovating the buildings and then refitting the centres to deliver standard service.

“The health system in the country has only favored the rich,” said health minister Isaac Adewole. “The goal of revitalizing the Primary Health Care Centres is to ensure that quality basic health care services are delivered to majority of Nigerians, irrespective of their location in the country.”

President Muhammadu Buhari launched the project this week-just one model centre in Kuchingoro, Abuja [with another in Fuka, Niger]. The plan is to get to all 10,000 centres eventually but in phases.

“The health of any nation is determined by the health of the citizenry,” says Yemi Adeola, chief executive officer of Sterling Bank, which bankrolled some equipment at Kuchingoro.

“You only have to go to any hospital to see the number of people suffering because they can’t afford the cost of tertiary care.

“The problem with projects like these is that they fizzle out after some time so we are going to bring in the private sector determination, innovations, ideas and logistics to make sure that it is hitch free as it moves from state to state.”

The first phase targets 109 centres, one per senatorial zone; the second is for 1,000, estimated to cost N3.1 billion figured into the 2017 budget. It is also taking assistance from private sector to get equipment into health centres.

By 2018, the hope is that up to 5,000 centres would be in place, according to the National Primary Health Care Development Agency, NPHCDA, which oversees primary care.

With private sector helping out, “funding will no longer be an issue, especially now that our development partners are taking the back seat,” says Senator Mao Ohuabunwa, chair of the Senate committee on primary health care and communicable diseases.

“Ordinary budgeting will no longer be enough. We are talking about health care at primary level, the most vulnerable within the country, and they are the wards, women and women. Reviving primary health care is key if we want to develop health care.”

The presidential launch “kickstarts the process of getting primary health care available to Nigerians in rural areas, and it is a great development,” says Dr Emmanuel Odu, acting executive director of NPHCDA.

What matters next is getting communities where the centres are sited to own it.

“It incorporates community engagement through ward development committees,” adds Odu.

Getting it right will “reverse the poor health indices in the country,” President Buhari said when he cut the ribbon on the centre in Kuchingoro, an urban slum area of Abuja.

Hundreds of women die daily from pregnancy complications, because they can’t get access to health care or can’t pay for it. It is the equivalent of crashing three jumbo jets filled with women each day.

“I am hopeful that our women will no more be dying needlessly during childbirth,” said the president. “Our children will no more be dying needlessly as a result of vaccine preventable diseases or common ailments. Access to health care will not be limited because of lack of money to pay.”

Which is good, because nine out of every 10 Nigerians are not “covered by any kind of health insurance or risk protection mechanism,” he noted.