There is no gainsaying the fact that the sustainability of any country’s economic and social growth largely depends on a vibrant healthcare sector. Perhaps in recognition of that fact, preventive medicine which formed the bedrock of the nation’s Primary Healthcare (PHC) system in 1978 was aimed at providing health services, improving the efficiency and effectiveness of service delivery and ensuring widespread coverage and access to basic care, particularly among the rural populace. But 32 years on, its implementation still generates mixed reactions among Nigerians.
A quick review of the nation’s health indices indicates that the infant mortality rate is put at 75 per 1000 deaths, and under-five mortality rates at 157 per 1000 deaths. Needless to say, the majority of these deaths stem from common ailments like malaria, respiratory tract infection, diarrhoea, etc, which could be prevented if all facets of the health sector deliver quality primary care services at optimal capacity. While critics believe that the government has been remiss in providing this all-important service over the years, others maintain that there is a need to revamp the system, which will definitely improve healthcare delivery in the country.
In a recent interview, Mohammed Pate, executive director, National Primary Healthcare Development Agency (NPHDA), said the poor state of healthcare at the PHC level is due to non-utilisation of the PHC platform for effective integration of services, inequality in the distribution of available health workforce staff, financial barriers to health, particularly at the community level, and the absence of an enabling act to guide the PHC implementation, culminating in poor to outright non-utilisation of PHC facilities, among others.
According to Pate, the sector-wide capacity constraints had steadily increased following the provision of PHC into the LGAs, and “it might be argued that the poor performance is associated with low levels of financial resources.” For Adepoju Olusegun, a public affairs analyst, the frequent sojourn of Nigerians abroad in search of quality treatment for minor ailments connotes the state of affairs in the health sector. Olusegun stated that if government officials were satisfied with and could boast of the quality of healthcare at the various health institutions, they should be confident enough to fall asleep under the influence of anesthesia in hospitals without any doubt on their minds.
“Nowadays, local government chairmen are enthralled by the pictures of established health centres which would be used for canvassing for votes at the polls, and not actually meeting the health needs of the host communities. The health services, based on primary healthcare, include education regarding prevailing health problems and the methods of preventing and controlling them, promotion of food supply, proper nutrition material and child care, as well as family planning immunisation against the major infectious diseases,” he said. Doubtless, the importance of the PHC system cannot be over-emphasised given the fact that PHC services which fall under the jurisdiction of the Local Government Areas cover approximately 60 percent of Nigerians living within the rural areas.
Proffering a solution to the problem, Onyebuchi Chukwu, minister for health, remarked that the passage of the National Health Bill would go a long way in addressing healthcare delivery in the country. According to the minister, the National Health Bill which has sailed through the Senate and gone through the first reading in the House of Representatives will ensure that responsibilities are assigned to all the tiers of government.
“Looking at the nation’s healthcare system, the bill is an all-encompassing document aimed at turning around the sector for good because our health indices are poor in relative spending. But there is lot more that can be done in terms of improving maternal mortality and other childhood diseases. The health bill will address these constraints. It will define roles and responsibilities of the three tiers of government as it relates to health. With this in place, Nigerians will know whom to hold responsible if a particular arm is not working,” Chukwu assured.
For Pate, aligning incentives for the implementation of PHC, improving accountability, strengthening inter governmental relations, effective expenditure management, among others, will go a long way in revamping the ailing system.
“What we need is a strong political commitment, increased investment in the health sector and clear policy and administrative guidelines that ensure health programmes are delivered through the Primary Health Systems at LGA levels in a horizontal and vertical manner,” said Pate.
By Alexander Chiejina
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