There is a broad agreement that Primary Health Care (PHCs) is one of the legs of the tripod on which the Nigerian health care system is founded. Its strategic role is to act as a major factor responsible for universal health access, being the people’s first point of contact with the health system.
Therefore, if primary health care is revitalised, well- equipped and improved in availability, accessibility and quality for better maternal health care, it will lessen the challenges that women face in giving birth in Nigerian communities.
State governments’ commitment and public-private partnerships must be prioritized in revitalizing primary health care in Nigeria. Engagement of traditional and religious leaders will help in resolving non- compliance in safer and better health care practices. However, health education and facilitating local media advocacy at the community level will help to address the challenges of religious biases as well as knowledge gaps that currently exist in the sector.
Delivering quality primary health care to large populations is always challenging, and that is certainly the case in Nigeria. While the country’s primary health care system is struggling to provide services, a number of factors are impeding those who need the care, especially women, from getting the needed help.
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Today, Nigeria’s primary health care centres are a far cry from what was originally planned. Despite the country’s huge population, put at about 200 million, and experience since the Alma-Ata declaration of 1978 that was adopted at the International Conference on Primary Health Care (PHC) that 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. Implementing the envisaged primary health care has not been straightforward. This is despite the global commitment.
The Alma-Ata declaration gave impetus to the expansion of these centres within the country. Forty- two years after the leadership of Professor Olikoye Ransome-Kuti, the need to strengthen the PHC in Nigeria is relevant as ever before.
However, the Federal Government, on January 10, 2017, through the Saving One Million Lives Initiative, desirous of reversing the poor health indices and ensuring universal health coverage initiated the revitalisation of 10, 000 primary healthcare centres (PHCs) nationwide by inaugurating Kuchigoro Clinic, Abuja.
Sadly, more than two years after the promised revitalisation of PHCs nationwide, many states are yet to experience revitalisation in their PHCs. Meanwhile, data show that 70 percent of health burden and deaths in Nigeria are as a result of conditions that can be managed at the PHC level. This includes maternal health issues.
Maternal and Primary Health Care in Nigeria
Since maternal and child health care are regulated by public policies, it should therefore be the government’s priority to reorganize and strengthen women’s health care and reduce maternal deaths in Nigeria. Reducing this is contingent on certain factors, including revitalizing infrastructure and capacity of primary health care centres to provide quality maternal health care, identifying the social determinants of health and the needs and rights of vulnerable individuals and groups, and promoting the comprehensiveness of and access to health systems.
The Federal Government has revealed that the current maternal mortality rate currently stands at 512 deaths per 100,000 live births in the country. Women make up 49 per cent of Nigeria’s population and also play an indispensable role in the labour force. Good primary health care for women is not only vital for promoting economic stability, but also critical to limiting costs across the health care system.
Local culture significantly influences the health-seeking behaviour of younger women who rely on the decision-making role of older women in communities like mothers and mothers-in-law. There are other factors at play here: a high level of trust in Traditional Birth Attendants (TBAs) in these communities; the cultural influence of the man as the key decision-maker; as well as the significant reliance on faith-based maternal care over facility-based maternal care in some parts of the country, particularly in Lagos. These are according to findings from the ‘Why Are Women Dying While Giving Birth in Nigeria?’ report. This project was implemented by three organizations, a consortium consisting of Africare, Nigeria Health Watch and EpiAFRIC and supported by funding from MSD, through MSD for Mothers, the company’s $500 million initiative to help create a world where no woman dies giving life.
Many of the women who rely on faith-based maternal care complain of the unpleasant treatment being faced with health workers, particularly nurses, and increasingly, doctors. A reliance on religious beliefs also contributes to health-seeking behaviours that place faith-based centres before health facilities. There is an emerging need for addressing the above mentioned issues as they present huge challenges to the demand for primary health care delivery for pregnant women and women in postpartum in Nigeria.
On the supply side, primary health care centres in Nigeria lack the capacity to provide essential health care services, in addition to having issues such as poor staffing, inadequate equipment, poor distribution of health workers, poor quality of health-care services, poor condition of infrastructure, and lack of essential medicine supply. Many Nigerians also have perceptions relating to poor quality of care as these centres are fraught with several infrastructural weaknesses, no longer serve as ‘first access institutes’ for the community who rely mainly on local private practitioners and deliver barely only about 20 percent of the 33,000 PHC facilities across Nigeria working.
Recommendations for Maternal Health Delivery Within Primary Health Care in Nigeria
There should be a well-equipped primary health care centre in each of the 774 local government areas (LGAs) in Nigeria, with doctors, nurses and midwives always present. Equipment, infrastructure and supplies such as medicines, beds, wheelchairs, potable water, electricity and security must be available in every PHC to facilitate quality maternal care. These facilities should be easily reached by women, without resorting to rough terrains to access maternal health care. State governments must face the responsibility of providing better health care for women. Every State must commit to facilitating the revitalisation of PHCs in every LGA in their State.
Primary health care has been successful in other countries like 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 factors that may lead to success of primary health care in Nigeria are intersectoral cooperation at operational levels, resource allocation in favour of PHCs, 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.
Nigeria needs to plug gaps and strengthen primary health care centres because the country must move the needle positively towards achieving universal health coverage, one of the Sustainable Development Goals (Goal 3). Thailand, Ghana, Rwanda and some other countries serve as an example of how Nigeria can strengthen its primary health care to be adequate for quality maternal health care.
The need to make the primary health care centres functional and able to provide some level of delivery services when needed is crucial and the government must fund the PHCs and ensure adequate human and material resources are provided.
Political adoption of PHC is the cornerstone and rapid implementation of reforms, a critical aspect that Nigeria needs to experience. Policymakers must set ambitious timelines, ensure implementation of grand plans and ensure measures are in place to monitor progress on the ground closely.
