Re-assessing Nigeria’s primary healthcare sector

…as target for MDGs draws close

The issue of Nigeria’s primary healthcare (PHC) system is one contentious issue as most programmes of the different levels of government that has attracted attention over the years. However, while some critics believe that government has failed woefully in providing this all important essential service, some school of thought are of the belief that what is obtainable currently is nothing when compared to efforts made in this regard in the past.

Inspite of all this, government believes that it has gone beyond expectations considering recent globally accepted indices as regards reduction and/or near eradication of childhood diseases such as measles, poliomyelitis, tuberculosis, diphtheria, whooping cough, tetanus, establishment of primary healthcare centres. Aside this is the gradual coming to terms with the set goals of the Millennium Development Goals (MDGs) which is targeted to be achieved by 2015 by member nations of the United Nations.

Going down memory lane, the era of late Health Minister Olikoye Ransome-Kuti is widely regarded as the glorious era of primary healthcare administration in the country. Ransome-Kuti, who was the former Director of Basic Health Services Scheme (BHSS) before becoming health minister in 1986, placed Nigeria on the worldwide movement for the adoption and implementation of a national primary healthcare programme.

With the World Health Organisation identifying five key elements on the way to achieving primary healthcare which includes reducing exclusion and social disparities in health (universal coverage reforms); organising health services around people's needs and expectations (service delivery reforms); integrating health into all sectors (public policy reforms); pursuing collaborative models of policy dialogue (leadership reforms); and increasing stakeholder participation, reactions have continued to trail how PHCs can become functional in a bid to extend healthcare to the teeming Nigerian population.

Making his assertion known, Okechukwu Ohanyido, a public health physician, said that the Nigerian Healthcare System is fragile and structured on a tripod framework of which the bottom of the pyramid healthcare service is the primary healthcare level (overlaid by secondary and tertiary levels atop).

Ohanyido stated that by virtue of the nature of funding resources accruing to the three tiers of governance there is some relativity of tiers to mandate over segments of this tripod. While acknowledging the fact that the PHC system under the care of the Local Government Authorities (LGAs) is the most fragile and grossly underfunded, pointed out that PHC centers at this level are expected subservice over 75 percent of the healthcare needs of Nigeria’s population.

In his words “The issue of Primary Health Care Financing (PHCF) has been a major threat to the health system, which has not been addressed, or deliberated by stakeholders since the administration of former president Olusegun Obasanjo led Nigeria had embarked on Health Sector Reforms. Under the current 1999 Constitution, only unclear reference is made in delineating the pyramidal interfaces across the three levels, particularly with regards to the responsibility of LGAs for health.

“In Section 45, the Constitution makes provision only for the overriding of individual rights, if it is in the interest of, among other things, public health. In other words, the Constitution therefore, falls short of specifying what roles the LGAs, State and Federal Governments must play in the national health care delivery system, especially where finance one of the key levers of reform is concerned. For the health sector, this is a very serious omission. The impact is heavily felt at the LGAs being the main implementing agents of primary health care,” Ohanyido concluded.

Lending his view, Enrico Liggeri, Country Manager, Pfizer Specialties, Nigeria stated that the challenge of healthcare is not peculiar to Nigeria alone as health personnel in most developing countries. Liggeri pointed out that since Nigeria has one of the highest fertility rates in the world, there is the challenge of everyone accessing healthcare due to the geographic gap.

According to him “The advocacy for increased allocation to preventive services more than the curative services is in the interest of the indigent, most of who have the least means. It is however not intended to relegate curative services to the background as both prevention and cure are important in the delivery of effective health care.

“However, since Nigeria has a relative stable revenue stream (from crude oil), a certain amount of the county’s revenue from oil trade should be dedicated to the health sector. The healthcare system in Nigeria needs increased funding. This can be provided by government and indeed the private sector. If the population growth increases, it might outpace the finance budgeted for the health sector. There should be the expansion of the private sector in the area of insurance. Its vibrant economy could be tapped into in the area of managed healthcare via the involvement of multinationals firms operating in the country,” Liggeri added.

Taking a bird’s eye view of PHC in Nigeria, it is the level of care which is suited for addressing tuberculosis, pneumonia, malaria, measles, acute respiratory infection, diarrhoea, poliomyelitis, etc, to name but a few.

With the secondary and tertiary healthcare system aiding to address more complex conditions, it is imminent that more resources be allocated to primary prevention which is not only cost-effective. This is so because this level of healthcare is capable of preventing up to 70 percent of the disease burden. This doesn’t mean that curative care should be neglected.

Furthermore, as the Government engage in the construction of primary health facilities in some parts of the country in the last few years and health facilities selected for renovation, equipping and provision of drugs, the huge challenge remains the capacity to achieve set targets of increasing the proportion of pregnant women receiving antenatal care from 60-80 percent; reduce maternal mortality from 800 to 250 per 100,000 live births by 2015. No doubt, it is not so late to make the health system perform as it is the only option the nation have in spite of insufficient resources.