The goal to unite primary health care under one roof (PHCUOR) got just a little closer, and the civil society groups behind it have been sharing lessons from the last one year of advocacy.
They are from Oyo, Lagos, Nasarawa, Bauchi, Gombe, Katsina, Cross River, Abia and Niger.
Take Oyo state. It signed a law establishing a Primary Health Care Development Board in December 2016, enabling the board autonomy after years of advocacy.
Last August, a governing board was set up, giving PHCUOR a base in Oyo.
Experts say a unified PHCUOR will help clear up the problem of unclear roles and responsibilities of health workers resulting from multiple management of primary health system, which has “long been a cog in the wheel”.
Help came from uniting civil society groups into larger, stronger coalitions to amplify their voice and strengthen their advocacy.
“There are a lot of things you can’t get done formally, and you have to find informal ways to do them, and one of them getting access to get the governor to sign things,” said Waheed Abbas, executive secretary of Oyo state Primary Health Care Board.
Bauchi is expected to be able to budget for primary health care in 2018, after knowing its responsibility to the system, thanks to pressure from a network of civil society groups working there.
Its primary health care development agency has developed a minimum service package, enabling users of primary health care to know what services to expect and demand from every health facility.
Cross River gazetted a law establishing its primary health care agency, and prompting both state and local government authorities to commit to contribute 40-60 quotas to operationalise PHCUOR.
Hundreds of civil society groups in larger coalitions are checking their respective governments—and each state’s progress on PHCUOR is documented by the National Primary Health Care Development Agency on a public portal.
The coalitions looked at their state’s performance and picked one of nine pillars of PHCUOR they considered lagging to focus on.
One was uniting the fragmented services of PHC, run by different ministries, and getting all under a single board as stipulated in the National Health Act. Another was to demand financial autonomy for the board.
“The initial suspicion [from government] is ‘what are they coming to do?’” said Tunde Segun, country director for Mamaye Evidence for Action, which facilitated CSOs forming coalitions under a one-year project funded by Bill & Melinda Gates Foundation.
“That was overcome when they [governments] realized it was to advocate for specific pillars of PHCUOR. The other thing is PHC is so fragmented; so trying to make them see they all have to come together under a board was challenging.”
Gombe’s health ministry and primary health agency have united, enabling the ministry to post midwives to primary health centres—a thing unthinkable before.
Lagos included a Local Government Health Authority as a key structure for community participation and opened a budget line for it in its strategic health plan lasting until 2021.
Niger developed a costed minimum service package, a health service delivery plan focusing on outreaches and is expected to inaugurate a board for its primary health care agency shortly.
The goal is to get CSOs “to amplify primary health care voice in Nigeria, to ensure that woman, that child gets basic health care,” said Segun.
“But over the past one year, different states have been able to show success,” he added at a meeting for CSOs to disseminate what they have learnt.
