Ghana, Thailand point way for Nigeria to revitalise primary healthcare centres

 Nigeria can draw on considerable practical lessons from other countries’ reforms in managing primary healthcare centres (PHCs) with positive equity outcomes.

Since the flag-off of the Federal Government revitalisation programme on primary healthcare, services are still on the blink.

Experts say that Nigeria must move beyond the phase of planning, policy making and health system strengthening activities to putting into place legal and institutional frameworks and systems to aim effective and efficient implementation in primary healthcare reforms which is countries like Ghana and Thailand are adopting.

Also, experts say there must be more attention in promoting preventive care at the primary healthcare level such as family planning and health education which should be covered by the National Health Insurance Scheme.

According to experts, strengthening the primary healthcare system with government investment will improve efficiency in recognising the funding task in the sector and also gives opportunity to shift some of the at the tertiary level to PHC.

“There is need to make the primary healthcare centre functional so as to make them available to provide some level of delivery services when needed, the current backdrop and next steps for improving the quality of health care in Nigeria is through collaboration and addressing the gaps in the primary healthcare,” Doyin Odubanjo, chairman, Association of Public Health Physicians of Nigeria, Lagos Chapter said.

Reflecting on Ghana’s primary healthcare model, analysts say there is a need to devote more funds to the centres while also training and re-training medical personnel who will take pre-eminence in this task are important.

Similarly, Thailand has a very deep primary care system with over 10 000 public health centres (approximately 1/6 000 population).

In addition to nursing and public health officers, each health centre has up to 30 community health volunteers who also work closely with health centres and local government on prevention and promotion.

The Thai capitation system used an interesting contracting unit called the CUP (Contracting Unit for Primary Care), which is the district hospital along with its referring primary care centres.

 Also, substantial investments were made in infrastructure for rural health centres, often using attractive but standardised design options, lowering infrastructure costs.

In a far-sighted funding arrangement, every CUP and therefore district hospital and health centres receives a dedicated funding stream for prevention and promotion activities from the Universal Coverage (UC) Fund.

Francis Faduyile, president Nigerian Medical Association (NMA) said that the key problem of the health sector is at the level of the primary healthcare centres where the majority of 70 per cent of Nigerians live.

“There is a need for the government to hasten their plans for the primary healthcare centre in area of prevention of many of the diseases that will cause more complications at the secondary level. So if we can meet it at the board, at the primary healthcare centre, it will improve it,” Faduyile, said.

Nigeria has been ranks the lowest or second lowest in all Primary Health Care Performance Initiative (PHCPI) indicators in a recent survey compared to its African peers (Uganda, Kenya, and Tanzania, and Senegal) but has high levels of health facility density and health worker density, which are often thought to be the major cause of underperformance of PHC systems.

Primary health care is the first point of contact for most Nigerians. It is mainly provided by general practitioners, but community pharmacists, opticians and dentists are also primary healthcare providers.

ANTHONIA OBOKOH