To rank as a developing country usually entails some sort of passage through fire. Many times, this fire burns around the basics that give the faintest hint of quality to life. For Nigeria, the issue of primary health care has remained a burning one.
The WHO on primary health care.
According to the World Health Organization, the fundamental premise of health care is that all people everywhere deserve the right care, right in their community.
Primary health care (PHC) addresses the majority of a person`s health needs throughout their lifetime. This includes physical, mental and social wellbeing and it is people-centered rather than disease-centered.
Proper primary health care then means an all-embracing approach that includes health promotion, disease prevention, treatment rehabilitation and palliative care.
As the first point of contact for many people, it usually involves three components which are: meeting people`s health needs throughout their lives; addressing the broader determinants of health through multisectoral policy and action; and empowering individuals, families and community to take charge of their own health.
By providing care in the community as well as care through the community, primary healthcare addresses not only individual and family health needs, but also the broader issue of public health and the needs of defined populations.
According to the WHO, countries must increase spending on primary health care by 1% of GDP to close coverage gaps.
An agreement in Astana
As universal health coverage has always been the aim of primary health care, the principles of primary health care were first outlined in the Declaration of Alma-Ata in 1978. It was a seminal milestone in global health.
Forty years later, in October 2018, governments, civil society, the private sector and other stakeholders met to reaffirm a global commitment to primary health care.
The Global Conference on Primary Health Care, which took place in Astana, Kazakhstan, endorsed a new declaration emphasizing the critical role of primary health care around the world.
The declaration aims to refocus efforts on primary health care to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health.
A Nigerian nightmare.
For every Nigerian, health is unapologetically wealth. Thus, for a people who have known so much adversity on their road to nationhood, the wealth of health has been needed to weather the impossible storms whipped up by a failing government.
A new report released by ONE campaign, an advocacy initiative focused on addressing poverty and preventable diseases in Africa, has again laid bare the straits of primary health care in Nigeria.
The report which was the product of extensive research conducted by ONE in partnership with the National Advocates for Health, Nigeria Health Watch, and the Public and Private Development Center (PPDC) found that public healthcare facilities in all thirty-six states of Nigeria, including the FCT, were not up to scratch.
A broken Basic Health Care Provision Fund
According to the report, the Basic Health Care Provision Fund which was established in 2014 by the National Health Act to address the gaps preventing proper utilization of primary healthcare facilities across the country has been poorly implemented in thirteen states with Zamfara ranking as the most difficult state to access primary healthcare.
The report ranked the Federal Capital Territory, Enugu and Anambra states as the top performing states in primary healthcare service delivery among the lot.
The Basic Health Care Provision Fund(BHCPF) comprises 1 percent of the Nigerian government Consolidated Revenue Fund(CRF) and additional contributions from other sources.
By the report, in spite of the provisions of the National Health Act and the National Health Policy, the fact that Nigeria`s health care system is deteriorating stems from weak governance structures and operational deficiencies.
The implications are truly frightening indeed.
Between dereliction, corruption and terrorism
The pattern which is preying on primary health care in Nigeria is indeed multifactorial.
There is dereliction of duty: indeed, those who occupy public office in Nigeria have only very little incentive to ensure that primary health care is available to the poorest Nigerians. They barely need it after all since they form the chunk of those fueling the scandalously costly medical tourism Nigeria is known for.
Only recently, Nurses under the auspices of the University Graduates of Nursing Science Association (UGONSA) expressed worry that Nigeria loses an estimated $2 billion (N1.1 trillion) annually to medical tourism.
There is corruption: in February 2022, the Nigerian Senate mandated its Committees on Health, Primary Health Care and Communicable Disease, Works, and Housing to investigate the abandoned National Primary Health Center Project initiated by former President Olusegun Obasanjo across the 774 Local Government Areas in the country.
The project had cost about N400 billion, drawn from the funds of local governments in Nigeria and would have a well-equipped primary health care center located in each local government
It appears that once the probe was mooted, some of the contractors hurriedly went back to site. But till date, nothing has come out of it.
There is terrorism: only recently, the Executive Secretary of the Katsina State Primary Healthcare Agency, Dr. Shamsudeen Yahaya, revealed that the activities of bandits had forced 69 primary healthcare centers in the state to shut down as health workers feared for lives, fleeing the vulnerable areas. According to him, two recently renovated healthcare centers in Batsari Local Government were razed down by bandits.
The picture so clearly cut is that universal health coverage in Nigeria which has primary health care as its driving vehicle is imperiled by forces loyal to dereliction, corruption and terrorism.
The price Nigeria is paying is in the needless suffering and deaths of millions, including many children, who too quickly and too easily run out of options.
For these,things have to improve and improve fast.
Kene Obiezu,
