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Primary health care in Nigeria: Time for paradigm shift

According to the World Health Organisation, primary healthcare is the most efficient and cost-effective approach to achieve Universal Health Coverage. It is an integrated and…

According to the World Health Organisation, primary healthcare is the most efficient and cost-effective approach to achieve Universal Health Coverage. It is an integrated and people-centred approach to health and wellbeing that starts with individuals, families and communities. It is the foundation of health systems providing health care to people and ensuring that they receive quality health care whenever they need it.

National Primary Health Care Development Agency (NPHCDA) was created in 1992 to give support to the National Health Policy as it relates to primary health care development. Its mandate includes providing leadership, promoting and supporting the implementation of quality and sustainable primary health care systems through advocacy and resource mobilisation, partnership, capacity building and collaboration with relevant stakeholders, among others.

Over the years, governments in Nigeria have come up with health development plans, which left out primary health care. However, in the 1980s the federal government, under the then Minister of Health, Professor Olikoye Ransome-Kuti, began to make primary health care the core of its public health development plan. Various implementation stages were developed towards achieving the objective of providing quality, effective, efficient, equitable, affordable, reliable, acceptable, comprehensive and accessible health care services at the grassroots.

Part of the achievements of NPHCDA recently include coming with ‘Saving One Million Lives’, SOML, an initiative country-driven and country-led but is implemented with several partners including some development partners, philanthropists and civil society organisations. It also set up the Nigeria State Health Investment Project (NSHIP), which is designed to strengthen accountability and introduce a set of incentives to improve care quality at Primary Health Care facilities, provide managerial autonomy to health facilities and strengthen accountability mechanisms, especially at the local government areas.

It also established National Emergency Routine Immunisation Coordination Centre (NERICC), with the vision to achieve at least 80 per cent immunisation coverage for all antigens in Nigeria by 2028, provide national and sub-national coordination mechanisms to manage the full implementation of the Routine Immunisation programs, among others

The major challenges over the years had been poor governance, inadequate health care financing, human resource for health, underutilisation of primary health care facilities by individuals and communities, and poor workers’ attitude.

But by the greatest challenge facing primary health care in Nigeria, is its neglect of preventive aspects.  We must now shift emphasis from wholly curative aspects of primary health care services to include preventive. We have seen how far we have gone 44 years after, the achievements, the challenges, but still we are not where we are supposed to be.

X-raying all the programs of NPHCDA, it is clearly in favour of curative health services within health facilities premises and not much about outside the premises where the general public is living and endangering the environment.

Now that we know many aspects about health infrastructure, the delivery services among women and children, it is proper to have data from primary health care level about the sources of water supply in our communities. For instance, if it is well, whether the well is standard/sanitary or not, the percentage of premises [residential, industrial, school, hospital, etc.] with toilets [and its type], the percentage of  eateries, regulated and unregulated, the percentage of schools with appropriate building, sanitary facilities, health post or first aid room, the percentage of health post, clinics and primary health care centres with appropriate waste disposal, among others.

The data generated, when analysed and interpreted, will help in addressing many gaps in prevention and control of many diseases. Issues like community sanitation, health, safety and environment, environmental health laboratory, disease prevention and control, can all be worked on and documented.

Environmental health officers who handle this aspect of work, are available in all states but are not being utilised accordingly, since the emphasis is on clinical services only, irrespective of their being primary health care workers practitioners and the relevance of their work at primary health care level. It is estimated that 40 per cent of the world’s death is caused by environmental factors.

There are many policies like national policy on injection safety and healthcare waste management, policy guidelines on school sanitation, policy guidelines on market and abattoir sanitation and laws like environmental health control law, food and drug act. NPHCDA should liaise with them and see how it can key their services in the management of primary health care centres and beyond. The ‘national guidelines for the development of primary health care system in Nigeria’ did not recognise them as partners, but just as part of human resources for health, where their work is mentioned, it is delegated to community health extension workers.

Therefore, as much as ‘using available resources’ is primary health care philosophy, no cadre that is not important, hence, we should look at what we have and utilise it the way we want with task shifting or any other things that will bring the expected result.

NPHCDA should also bring back water sanitation component under the purview of primary health care services now that the majority of states have water sanitation and hygiene department, which is either domiciled at ministries of local government or water resources and/or rural water and supply, depending on the state. The activities of the sector are too important to be left outside primary health care services.

Now that primary health care services will be transformed, reshaped, reformed, re-imagined, it is time we diversify and broaden the scope of its activities to cover essential aspects of health, not only the curative aspect. Since health is defined with the ecological concept, the holistic concept, as well as high-level wellness concept,  primary health care services should not be limited to clinical services only.

NPHCDA should build on the achievements and challenges of primary health care in Nigeria over the years to include every relevant stakeholder in developing future plans with short, medium and long-term goals with a timeline for measuring success against it.

If there is political will and good governance, implementation of the new plan, a strong partnership between government and other development partners, certainly the future of primary health care services will be better.


Sani Garba Mohammed is of Kano State Primary Healthcare Management Board karaye@gmail.com