Analysts decry Nigeria’s poor primary healthcare system

Though standards have been set in place to improve healthcare delivery at the lowest level in Nigeria, the primary healthcare centres (PHCs) in the country have remained in a poor state of operation, performing below expectations, health analysts say.

Asides from some states where primary health care services are even largely sub optimal, primary health care in Nigeria compared with the country’s population is almost non–functional.

Chukwuka Okereke, former medical officer, Department of Internal Medicine, Federal Medical Centre, Birnin-Kebbi, speaking on the metrics of performance for PHCs said the standard of care is uneven in the country as the distribution of infrastructure, equipment and essential care workers often vary.

“In some places, the facility and function of PHCs match. There are a few places where the government has pumped money, equipment, and provided houses, but no personnel. There are also places where they have the personnel and equipment, but because the citizens are not sensitised to the functions of the PHC and how it helps them, so nobody is attending. It’s hydra-headed. The issue is multi-faceted, and a grassroots problem,” he said.

According to a guideline by the Federal Government of Nigeria titled ‘Minimum Standards for Primary Health Care in Nigeria’ the health system operates along the lines of the country’s three-tier system of government, with the primary health care operating at the local government level.

The guide defines primary health care as the cornerstone of the health policy in Nigeria and the first point of contact for most Nigerians with the health care system.

The standards were set to guide the development of PHC in terms of infrastructure, human resource availability, and service provision. Under these basic minimum standards of operation, the functions of PHCs in the country are flawed.

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The 1978 Alma Ata Declaration signed by the WHO members described PHC as the first level of contact of individuals, family, and community with the national health system, bringing health care as close as possible to where people live and work, and constitutes the first elements of a continuing health care process.

Across the 774 LGAs in Nigeria, there are 30,000 PHCs and researchers have found that less than 6,000 of these can provide basic health services. Also, it has been found that about 70 percent of primary health centres lack drugs and workers.

Speaking at an event organised recently to celebrate years of success of a private health facility in Lagos, Oreoluwa Finnih, senior special assistant to the Lagos State governor on health said that the healthcare sector is spending a lot more trying to cure diseases that are largely preventable.

Education on lifestyle choices, frequent health checks, and all the other parameters used to prevent diseases are principally in the jurisdiction of primary health care centres, and are not first of all saddled with curative treatment responsibility.

Enlightenment, awareness, campaigns, screenings, sex education, distribution of mosquito-treated nets, distribution of contraceptives to women, education on hygienic practices, safe water, clean environment, etc., have been de-emphasised.

“I think this is something that we can take away from here, to try and focus more and look at how generally we can prevent diseases,” Finnih said.

The inadequacy of primary health care centres in Nigeria to offer basic medical services has resulted in an influx of patients to secondary and tertiary healthcare facilities. As a result, many hospitals have long lines and poor patient experiences.

“You see women are now showing up in the PHCs for delivery when they have not undergone antenatal. They should have had antenatal services through the 9 months of their pregnancy so that their delivery is smooth or at least, any problem is anticipated and they’re referred to the right places,” Okereke said.

Ideally, PHC focuses on people rather than diseases and is people-centred rather than disease-centred. This is however not the case in Nigeria as PHCs are not doing so much to prevent diseases, Finnih added.

When PHC centres take their place in preventing diseases, everyone is better protected against bearing potentially ruinous costs of treating expensive illnesses.