Reviving The PHC Scheme in Nigeria
The recent flagging off of a revitalisation programme to revive Primary Health Care (PHC) in Nigeria could not have come at a better time. President Muhammadu Buhari, while inaugurating a model PHC clinic in Kurchigoro, Abuja, declared that the federal government is set to revitalise 10,000 PHC facilities in the country using a phased approach. He added that the first phase, which the inauguration of the model PHC clinic in Kuchigoro signposts, is expected to lead to the revitalisation of 109 PHC facilities across the 36 states in the country and the Federal Capital Territory (FCT).
The president emphasised that the ultimate objective in revitalising the PHCs is to ensure that quality basic health care services are delivered to Nigerians, irrespective of their location, adding that the facilities will provide services at minimal or no cost and focus specially on people living in the rural areas as well the vulnerable populations.
This initiative of the Buhari administration is highly commendable. A functioning PHC system is an invaluable asset in the quest of the nation to provide affordable and accessible health care to millions of Nigerians who need it.
However, in embarking on this laudable venture, it behoves the government to take a holistic look at the various systemic problems that have plagued and crippled the scheme over the years, in order to make the revitalisation effort to not only be effective and comprehensive but also sustainable.
There’s no denying that the PHC scheme, which became an important policy of the World Health Organisation (WHO) after the Alma Ata Declaration in 1978, and was formerly launched in Nigeria by the Ibrahim Babangida administration in 1987, has over the years failed to play its expected role of providing accessible and affordable quality healthcare to Nigerians at the grassroots.
Following successive periods of shoddy attention from the government and defective management policies and practices by the personnel in charge – who themselves are either not qualified or are not well remunerated and motivated to deliver quality health care services at that level – most of the PHC centres in existence are in serious state of disrepair, poorly equipped and not stocked with essential medicines.
But aside from the fact that the government has abysmally failed to ensure that PHC centres are of standard in line with best global practice to deliver care, the failure of the nation to ensure community buy-in for the facilities has also been a major albatross for the PHC scheme. The PHC will definitely achieve better results if it is embraced more by the community. Nor has the scheme been helped by the nation’s haphazard health system which often results in some health cases moving from homes straight to general hospitals or even teaching hospitals, instead of the PHC centres because of a non-functional referral system.
We reiterate therefore that tackling this multifarious problem of the PHC requires an all-inclusive approach that goes beyond merely building model PHC clinics. To begin with, the National Primary Healthcare Development Agency (NPHCDA) must be strengthened and encouraged to partner with other stakeholders to deliver on its mandate of supporting the implementation of the PHC guidelines. This agency should be doing more than it is presently doing to provide the needed support for planning, management and implementation of PHC guidelines.
Also while the FG must be commended for its resolve to strengthen the PHC as encapsulated in its revised National Health Policy 2016, the government must go beyond media rhetoric and demonstrate the political will to implement this policy. The bane of the PHC, the health sector in general and even the nation at large for decades has been the poor implementation of policy documents and not their formulations. As long as this continues, the revitalisation programme will be merely superficial.
It should be added also that based on provisions in the 1999 constitution, health care delivery at the local level through the PHC and within the national health policy is more of a responsibility of the local government. Authorities in the various local governments must therefore be awakened and encouraged to see this as a cardinal responsibility to the people in their councils. While the FG must play its role of monitoring the PHC scheme and in the formulation and implementation of the necessary guideline, the local government and people at the grassroots should own and drive the PHC scheme.
Above all, intensive enlightenment campaign must be carried out by the government to educate all the stakeholders involved in PHC implementation on why all should work towards making this scheme to succeed. The success of the PHC scheme is a success for Nigeria and Nigerians.