Eight factors account for the outstanding success of primary healthcare in Thailand and experts say Nigeria could borrow from the practices in the South East Asian country to improve our scorecard.
Primary health care (PHC) has been successful in Thailand because of community involvement in health, collaboration between government and non-government organisations, the integration of the PHC programme, and the decentralisation of planning and management.
Other success factors are intersectoral cooperation at operational levels, resource allocation in favour of PHC, the management and continuous supervision of the PHC programme from the national down to the district level, and the horizontal training of villagers to villagers.
Additionally, Thailand achieved many of the essential elements of PHC based on improvements in the nutritional status of children under five, households’ accessibility to clean water, immunisation coverage and the availability of essential drugs.
Perhaps, Nigeria has a lot of lessons to learn from the Southeast Asian country. Thailand’s primary care journey has a long history. Before 1978, the PHC in Thailand had been inadequate, trained health workers in short supply and distributed inequitably. It was challenging to sustain the service delivery of community hospitals and problematic as barriers existed at the policy and operational levels, leading to poor access to PHC for all citizens.
Then came the Declaration of Alma-Ata. The Alma-Ata declaration defined primary health care as’… essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford.
Countries of the world through the World Health Organisation adopted the Declaration of Alma-Ataat the International Conference on Primary Health Care, Almaty, Kazakhstan, 6–12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people.
Thailand keyed into the Declaration of Alma Ata and began to implement it. The National PHC programme was implemented nationwide in Thailand as part of the Fourth National Health Development Plan (1977–1981). Since then, its PHC has evolved through many innovative health activities such as a community organisation, community self-financing and management, as well as the restructuring of the health system and multisectoral coordination.
Today, Thailand is one of the great development success stories making progress towards meeting the Sustainable Development Goals, according to the World Bank (2017).
Nigeria needs to plug gaps and strengthen primary healthcare centres as Thailand did. The country must move the needle positively towards achieving universal health coverage, one of the Sustainable Development Goals (Goal 3), say analysts.
Reflecting more on Thailand’s model, the country implemented the PHC using two different approaches to encourage people to use health services at local Health Centres (HCs) and district hospitals, rather than go directly to the provincial or upper-level hospitals.
The first approach involves implementing PHC that is delivered by health workers at HCs or rural health facilities. The government made HCs the front-line health services to cover all sub-districts, and it also increased the number of health professionals, including doctors and nurses, who would provide care to rural people at the district hospitals while health workers or public health officers would provide care at the HCs.
The second approach focuses on community participation involving the mobilisation of local resources to ensure accessibility of healthcare for underserved people; the community maintains the services. The local resources consist of groups of health volunteers known as Village Health Volunteers.
Another lesson is the political adoption of PHC as the cornerstone of Thai health care delivery and, more recently, the commitment of the Prime Minister Prayut Chan-o-cha that Thais will be able to access care from medical practitioners at the PHC level. Thailand, over the past three decades, has increased its medical workforce and, according to Chan-o-cha, “the proportion of rural physicians and has reallocated resources to support extensive primary health care systems and to increase access to services.”
The rapid implementation of reforms is another critical aspect of Thailand‘s experience. Policymakers set ambitious timelines and monitored progress on the ground closely.
Also, the country made substantial investments in infrastructure for rural health centres, often using attractive but standardised design options, lowering infrastructure costs.
PHCs are the first point of contact between a patient and the healthcare system, which makes centres affordable.
Meanwhile, PHC in Nigeria is harassed by a lack of capacity to provide essential health care service, poor staffing, inadequate equipment and infrastructures, as well as poor drug supply. These have resulted in many people avoiding PHC facilities and going straight to hospital out-patient departments where services are perceived to be better.
Implementation has also been a problem, hindering the effective working of about 30,000 PHC facilities across Nigeria.
The Nigerian government has embarked on a campaign to revitalise primary healthcare centres. The most recent pledge is the high-level of revitalisation of 10, 000 PHCs nationwide made at the inauguration of Kuchigoro PHC, Abuja, through the Saving One Million Lives Initiative.
Doyin Odubanjo, chairman, Association of Public Health Physicians of Nigeria, Lagos Chapter, said Thailand, Ghana, Rwanda and some other countries serve as an example of how Nigeria can strengthen its Primary health care,
“There is a need to make the primary healthcare centres functional and make them provide some level of delivery services when needed,” he said.
Odubanjo added that the government needs to fund the PHCs and ensure adequate human and material resources.
Similarly, Nigeria needs innovative solutions to prevent the long queues at the secondary and tertiary institutes. Francis Faduyile, president of Nigerian Medical Association (NMA), said solving Nigeria’s healthcare burden requires going back to the level of the primary healthcare centres.
“There is a need for the government to hasten their plans for the primary healthcare centre in the area of prevention of many of the diseases that will cause more complications at the secondary level,” he said.
Thailand as a Southeast Asia country has provided Nigeria important lessons on how best to improve its primary health care space.
ANTHONIA OBOKOH
