I was discussing with a friend sometimes ago, and the issue of health care was our point of discussion.  During the course of our discussion, my friend asked about the situation of primary health care in Nigeria because the incidence of the death of expectant mothers keep rising by the day. 

Well, we both come to a conclusion that every facet of human endeavour in Nigeria has been politicized. Health, as important as it is, has being politicized.  Health is a human right and everyone, irrespective of location or socioeconomic status has a right to healthcare at their point of need. For a heavily populated country like Nigeria where there are income inequalities, there is a need to examine the healthcare system through the lens of health equity, which is accessible, affordable, and offers healthcare for all that need it.

This brings to the fore the importance of primary healthcare which is the bedrock of every health system and should be the first point of call for most Nigerians when seeking healthcare.

The World Health Organisation defines access to health as universal health coverage which means that all people have access to the health services they need, when and where they need them of sufficient quality to be effective, without financial hardship.  The goal should include the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care and beyond to holistic improvement of well-being and quality of life. 

To achieve universal health care, a nation needs policy makers committed to investing in universal health coverage, skilled health workers providing high quality, people-centred care in a health system found on a strong, people-centred primary health care rooted in the communities they serve. This definition encompasses two major pillars of health care access.  The financial access and the quality of the services accessed.  The emphasis on quality of care is very important because it determines the capacity of the service to deliver health to the users.

The reformed primary health care is defined as first-contact, comprehensive, continuing, coordinated, person centred care delivered to the individual within the context of his family and community through a defined regular provider.  It is care delivered by professional health care providers in teams that take primary responsibility for the health of defined population of people and their community. It is therefore expected to have the competence to offer effective, appropriate and safe care to all patients for most of the problems they have most of the time at first contact thereby achieving comprehensive care which integrates personal curative, preventive, promoting and palliative with family and community engagement.

Responsibility for a defined population of people makes them the regular source of care and entry point into the health system therefore offering continuous care over the life course with increased mutual knowledge and understanding between the patient and providers, strengthening provider-patient relationship which facilitates trust, empathy, person-centeredness’ and therefore efficacy of care. 

The primary care provider takes responsibility for coordinating the health care needs of the patients when specialist care beyond the first contact is required and maintains on-going care after the referral has been accessed.  This serves to entrench quality care, efficiency, increased safety, individual utilization and community ownership and participation.  It serves as the foundation of the health system.  This mode of primary care has been evidenced provide high-quality care to the population, achieving the desire health outcomes.

The undergirding principle of the reformed Primary Health Care is that it serves as a means of providing the highest attainable level of health for all citizens maximising equity and solidarity, integrating citizens’ expectations with structures and processes to attain them.

Over the years, Nigeria has developed polices aimed at improving primary healthcare delivery in the country. Some of those policies, include the ‘Saving One Million Lives for Results (SOMLR)’ and the ‘Basic Healthcare Provision Fund (BHCPF)’.

Unfortunately, years after these interventions were initiated, the challenges that limit the effective delivery of PHC services still exist. They include, fragmented governance and coordination, poor and dilapidated health facilities, shortage of human resources and poor funding. In addition to these challenges, insecurity and rising inflation are other factors mitigating the uptake of healthcare services in the country.

Affordability and safety are essential requirements to accessing healthcare. Rising inflation costs are forcing a growing number of families to make the tough decision between using available resources to seek healthcare or purchase other basic needs like food. Also, several states are immersed in some forms of insecurity further hindering access to healthcare for both the patient and the health worker.

Provision of quality, standard healthcare services require resources, epitomizing the importance of private sector investment in the health sector. Primary Healthcare in Nigeria has received little investment from both the government and the private sector over the years.

The COVID-19 pandemic came with numerous challenges for healthcare systems around the world. However, embedded in the challenges were opportunities to improve and strengthen these systems. Nowhere is that improvement more necessary than in Primary Health Clinics. 
Providing quality healthcare, even at PHC level requires resources, and quality healthcare further attracts people.  For PHCs to have the required resources to provide quality healthcare, a cost-effective payment system in the form of capitation should be adopted. Capitation is a method of payment for health services in which a physician or hospital are paid a fixed amount per enrolee, to cover a defined scope of services for a defined period, regardless of actual number or nature of services provided.

The question is: ‘who pays the capitation fee?’ Government, non-governmental organisations or private individuals.  Lack of functional PHCs endanger the lives of people, especially women and children in hard-to-reach communities.

As echoed by health specialists, governments at Federal, State and LGA level in Nigeria have a lot of work to do to improve the country’s primary healthcare system. Funding, governance, coordination, infrastructure and human resource for health are some of the areas that require urgent improvement for everyone, everywhere to enjoy quality, affordable and accessible healthcare services in Nigeria.

So, it appears slow progress has been made improving health outcomes of patients. However, there is still much to do, especially ensuring that there is one fully-functional private or public PHC in every ward in Nigeria, as outlined in the BHCPF guideline document. Stop playing politics with health care delivery in Nigeria!!!

God Bless Nigeria!!!