Strengthening Primary Health Care through Reforms

Health is central to the development of any country. Nigeria’s gross domestic product is the largest in Africa, but its per capita income is very low with a highly inequitable distribution of income, wealth, and therefore, health.

It is a picture of poverty amidst plenty. Nigeria is both a wealthy country and a very poor one. About 40% of Nigerians live in poverty, in social conditions that create ill health, and with the ever-present risk of catastrophic expenditures from high out-of-pocket spending for health.

Even compared with countries of similar income levels in Africa, Nigeria’s population health outcomes are poor, with national statistics masking drastic differences between rich and poor, urban and rural populations, and different regions.

The local government system created in 1976 is still the closest form of government to the grassroots. However, historically, most Primary Health Centres (PHCs) managed at the local government level, are ill equipped to provide the required quality of care.

It should be noted that Nigeria’s health system is experiencing a severe crisis occasioned by a weak primary health system which has severely hindered progress towards achieving Universal Health Coverage (UHC) through primary healthcare.

A strong Primary Health Care (PHC) system is a strong catalyst towards achieving Universal Health Coverage (UHC). It is therefore imperative to identify the key drivers and evaluate the challenges confronting health governance at the local government level.

According to the National Institute for Policy and Strategic Studies (NIPSS) Director General, Professor Ayo Omatayo, “Nigeria is confronting severe crises occasioned by weak primary healthcare delivery. If the situation is not reversed, it will be absolutely difficult to achieve Sustanable Development Goal 3 which is dedicated to ensuring healthy lives and the promotion of the well-being of all citizens at all ages.”

A health system and management expert at the School of Health and Related Research University of Sheffield United Kingdom (UK), Dr. Muhammad Saddiq said that for health systems, including PHC, to be strengthened, the issue of accountability and governance must be addressed because “poor access to governance at the local level is the root cause of the failure of the primary healthcare and indeed the entire health system in low and middle-income countries, including Nigeria.” He added that nation building efforts cannot be successful unless adequate attention is paid to the populace’s health as “efforts to improve health can be a powerful tool for capturing the goodwill of the citizens”.

Good governance is one of the building blocks of a health system and a core component of resilient health systems. According to the ‘State of Primary Health Care Service Delivery in Nigeria’ report, governance manifests through policy guidance, oversight, regulation, and accountability and helps shape a country’s health outcomes.

Major obstacles include ineffective use of available resources, a dearth of robust population-level health and mortality data, insufficient financing for health and health care, sub-optimal deployment of available health funding to purchase health services, and large population inequities. Nigeria’s demographic dividend has unguaranteed potential, with a high dependency ratio, a fast-growing population, and slow reduction in child mortality. Effective, quality reproductive, maternal, and child health services including family planning, and female education and empowerment are likely to accelerate demographic transition and yield a demographic dividend.

High performing health systems recognise the importance of having an effective PHC service as a key driver of achieving universal health coverage (UHC) adding that strengthening PHC strongly relies on the Primary Health Care (PHC) structures across Nigeria, to deliver individual based care and essential public health functions to all.

Although Nigeria has seen some level of improvements in service delivery of primary health care, increasing financing and improving current financing arrangements can catalyse our goal of achieving UHC by 2030.

We therefore advocate that better and more reformed approaches be adopted to finance the Primary Healthcare in the States and LGAs.
It is reasonable to identify the common challenges and policy responses in the Primary HealthCare System in the country.

We recommend that prevention should be at the heart of health policy given Nigeria’s young population. This will require a whole-of-government approach and community engagement. An explicit consideration of equity in the implementation of programmes and provision of social welfare, education and employment opportunities should be paramount.