Faustina Onyenwe, a 24-year-old nursing mother experienced some health challenges during her pregnancy, and to make things worse, there were financial constraints that limited how much of quality healthcare she could afford to seek. The difficulty in accessing basic, affordable maternal care made her pregnancy a stressful one.
There was a Primary Healthcare Centre (PHC) close to Onyenwe’s residence in Bwari Local Government Area of Abuja, but she couldn’t convince herself to visit the health centre, because the state of the facility heightened fears for her safety and that of her unborn child.
“I had some complications during my pregnancy, I couldn’t go to the PHC because I don’t trust them, the state of the facilities discouraged me and I couldn’t endure the long wait at the general hospital. So I was forced to raise money to go to a private health facility,” she tells Businessday.
Onyenwe’s case is one of several arising daily on account of non-functional PHCS which President Buhari had promised to fix in a fan-fare event at Kuchingoro, a suburb of Nigeria’s Federal Capital Territory. As millions of Nigerians are left with no choice but to seek alternatives, they are confronted with the economic burden of paying to get care in mostly private facilities. For those unable to pay, they face consequences in health complications and even death.
The importance of PHCS to efficient health care delivery cannot be over emphasized, especially for Nigeria, which is struggling with a weak economy and a dilapidated health care system, where access to good services is mostly for the rich. While some experts have described PHCS as the bedrock of health care, others call it the pillar without which it would be impossible for Nigerians to have access to the quality and affordable health care services they require.
Auwal Musa, executive director, Civil Society Legislative Advocacy Centre (CISLAC), said 70 to 80 percent of ailments and diseases are expected to be managed through adequately financed and functional PHCS, describing them as the first contact at levels of care.
Today, Nigeria is clamouring for Universal Health Coverage, which experts say can only be achieved if Primary Healthcare Centres are functional. This is because PHCS are the first level of care and port of call for people at the grass root level.
The Federal Government in an effort to address some of the challenges in healthcare delivery, pledged to revitalize 10,000 PHCS across the country. President Muhammadu Buhari kicked off the scheme in January, 2017 at an event tagged “Revitalization of PHC for Universal Health Coverage” (UHC).
The President said at the time that the aim is to ensure quality basic health care services are delivered to the majority of Nigerians irrespective of their location in the country.
Under this revitalisation agenda, the federal government is expected to revive one PHC centre per ward to widen access.
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However, as revealed from Businessday interactions with experts in the health sector, the FG’S publicly celebrated plan to revitalize 10,000 Primary Healthcare Centres across the country has achieved meagre success, nearly three years later, because the project lacks a sustainability plan, defined budget, and the required human resource among other challenges.
President Muhammadu Buhari, who kicked off the scheme in January 2017, said the aim was to ensure quality basic health care services are delivered to the majority of Nigerians irrespective of their location in the country.
However, there are concerns that hope of recording remarkable improvement in Nigeria’s deplorable healthcare system using the Primary Health Care project may now be dashed, despite that fanfare launch and heightened optimism.
Olayinka Oladimeji an official at the National Primary Health Care Development Agency (NPHCDA) admitted that many PHC centres are still in such terrible conditions while most lack basic facilities across the country, even with the kick-off of that project. A significant chunk of the population cannot achieve care at the primary level.
Oladimeji explained that the project has recorded minimal success because the key ingredients needed to make it work were lacking. According to him, the project lacks a sustainability plan, defined budget, and the issue of getting the required human resource remains a challenge.
According to him, N3.3 trillion was initially budgeted for the project but was not approved by Kemi Adeosun the then finance minister, due to failure by the federal government to produce a sustainability plan. He added that the NPHCDA also lacks the capacity to fund and sustain the project if implementation kicks off.
However, Buhari rolled out the Basic Health Care Provision Fund (BHCPF) appropriated by the National Assembly in the 2018 budget early this year. The fund which is the one per cent of the federal government Consolidated Revenue and contributions from donor grants, is expected to improve the delivery of essential basic health services and help revive PHCS.
Oladimeji explained that under the National Health Act, 50 percent of the BHCPF is allocated to the NHIS gateway, 45 percent through the NPHCDA gateway, and 5 percent is set aside to deal with emergencies under the Emergency Medical Treatment (EMT) gateway. So far, N6.5 billion have been disbursed to 15 states and the FCT as first phase of the fund.
But the BHCPF is not enough to cater for 10,000 facilities, he said. According to him, when the money is disbursed some PHCS will end up getting about N300,000 in a quarter which is grossly inadequate.
“What can that do? This is despite the fact that we are using decentralised facility funding where we send money directly to the facilities so they can decide what they want to use it for,” he said.
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Oladimeji lamented that 4,000 PHCS, which the Federal Government claims have been revitalised only had some renovations done, adding that the basic requirement that must be present to make a PHC functional are absent.
He pointed out that for the project to succeed, it must go beyond building or renovating PHCS as a former health minister had conceived.
“Revitalisation means bringing life back to the centres and making them functional”, he stressed.
As he explained, a functional PHC must have the basic infrastructures, a minimum of five rooms, the minimum required number of staff, the required level of logistics and supply support for the centre in terms of drugs and consumables.
He decried that, of all the basic requirement, the most difficult is the human resource because states often find it difficult to recruit health personnel.
The National Health Insurance Scheme (NHIS) was also established to achieve this goal, but most PHCS are in terrible conditions and cannot be accredited by the scheme to render services.
Overall, health authorities and experts have stated that the myriad of problems and challenges confronting the nation’s health care system today can be linked to the inadequacies of primary health care centres across the country. They argued that this has resulted in worsening health indices.
The floundering of PHCS is a major reason why the country’s Secondary and Tertiary health care facilities are overburdened with basic ailments that should have been managed through PHC facilities.
General hospitals are characterized by crowded waiting rooms and long queues while people trickle to PHCS. Mohammed Khalilu, a senior adviser to the Niger state government on PHC system strengthening, even said Nigerians prefer secondary and tertiary health facilities because they lack confidence in the PHC facilities.
This burden also exacerbates the existing high patient-to-doctor ratio. Ekpe Philips, chairman of the Nigerian Medical Association (NMA), Federal Capital Territory said Nigeria will continue to experience frustrations with health care delivery because the doctors are overtasked and dissatisfaction among patients will continue.
The high burden further amplifies delays in accessing minimum level of care including maternal and child health with resultant maternal and child mortality across the country. Nigeria is currently grappling with an alarming burden of maternal and child mortality in the country. Available statistics from the Federal Ministry of health shows that the country records over 40,000 maternal deaths annually.
Faisal Shuaib, executive director of the National Primary Health Care Development Agency (NPHCDA) has decried the alarming statistics and called for prompt action.
“Every day in Nigeria, approximately 145 women die from preventable causes related to pregnancy and childbirth. This is equivalent to having 1 Boeing 737-300 series aeroplane, fully loaded with 145 women crashing every single day in Nigeria, and killing everyone on board”, he said.
Again, the ED said approximately 2,300 children under 5 years die mainly from preventable causes.
Mojisola Odeku, director, Nigerian Urban Reproductive Health Initiative, Johns Hopkins Centre for Communications Program, Nigeria, further noted that a major problem threatening the success of the project is getting quality personnel, a situation she described as a human resource crisis.
She decried that even if funds are eventually released, and all required facilities and structures put in place, a lot of health personnel will not be willing to go into remote areas to work in PHCS. She said the issue of Human resource is critical to survival of the project.
Obinna Ebirim, national coordinator, New Incentives – ABAE Initiative, on his part said the communities must be involved to ensure success of the PHC project.
“The communities must be carried along to own the project else the government will only succeed in erecting beautiful structures which the community will not use.”
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