Millions of Nigerian children, particularly under the age of five, are at risk of diseases that could result in death or life deformity as the federal government has yet to fulfil its pledge to revitalise primary healthcare centres (PHCs) across the country.
Health authorities recently described the immunisation system as weak, a situation that can put the country at risk of outbreaks of vaccine-preventable disease.
Currently, at least 64 percent of children aged 12-23 are not fully immunised against diseases, while 18 percent of children have not received any immunisation, the 2021 Multiple Indicator Cluster Survey and National Immunisation Coverage Survey show. It is also revealed that one out of every 10 children dies before their fifth birthday.
In addition, the COVID-19 pandemic widened the immunisation gap further; at least 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 globally.
Osagie Ehanire, minister of health said at a recent review meeting on PHCs that Nigeria did not invest enough in the centres.
President Muhammadu Buhari had six years ago promised to revitalise 10,000 primary healthcare centres in the country. The Nigerian government planned to revamp one PHC per ward across the country.
The minister acknowledged that the poor health indices in maternal and child mortality and morbidity are generated largely in rural areas because they do not have access to any form of healthcare.
Nigeria overtook India to become the world’s highest contributor to under-five deaths after recording an average of 858,000 deaths in 2019 out of 5.2 million under-five deaths globally, according to the United Nations Children’s Fund.
Public health experts who spoke to BusinessDay expressed concerns that the gap will further widen and more children will be left without protection. They said without urgent action, millions of children would be exposed to more outbreaks.
They said the outbreak of diphteria, measles, vaccine-derived poliovirus type 2 exposed the gap in immunisation.
Obinna Ebirim, national coordinator of New Incentives – ABAE Initiative, said the failure to revitalise the PHCs has left citizens without access to quality care. He added that routine immunisation would be impacted negatively, leading to an increase in vaccine-preventable diseases and deaths.
He expressed concern that the immunisation gap created by the COVID-19 pandemic would widen.
“Sixty percent of ailments can be addressed in PHCs; so this means secondary and tertiary health institutions will be overburdened with these ailments because PHCs are not functional,” he added.
The experts also pointed out that revitalisation goes beyond renovating the building and providing physical facilities, to ensure an adequate number of health workers, a steady supply of medical consumables and putting in place an appropriate monitoring system for optimal performance.
Routine immunization is a standard service at primary health centres and 60 percent of ailments can be treated in these centres. The World Health Organization lists Cholera, diphtheria, hepatitis, haemophilus influenzae type b, human papillomavirus, influenza, measles, poliovirus, and yellow fever, etc. as some of the vaccine-preventable diseases.
Olayinka Oladimeji, former director, primary healthcare systems development at the National Primary Health Care Development Agency, told BusinessDay that 4,000 PHCs had been renovated, not revitalised, across the country.
He attributed this failure to a lack of plan and adequate funding by the Nigerian government to achieve the goal. As a consequence, PHCs remain understaffed, lack drugs and the infrastructure needed to provide basic health services, he said.
Some Nigerians who spoke to BusinessDay expressed dissatisfaction over the state of PHCs. Some said they would rather visit a community pharmacist than go to a PHC.
Nkechi Odemena, a mother of three and resident in Bwari Local Government Area, said she couldn’t bring herself to go to the PHC in Bwari or even take her children for immunisation.
“When I was pregnant, I visited the general hospital. I had all my children there. I did not like the PHC close to me; they did not have drugs and personnel. So I was not encouraged to go,” she said.
In Bauchi State, Rilwanu Mohammed, executive chairman of the Bauchi State Primary Healthcare Development Agency, said the state was battling with low immunisation uptake, adding that lack of personnel in PHCs was also crippling the process.
Onyechi Adaobi, a public health expert, warned that Nigeria cannot build its health system or make any meaningful progress if PHCs remain in bad condition.
She said, “There is a lack of confidence in our PHCs, these centres are supposed to address most of the ailments and serve the most vulnerable. Fixing our PHCs have too many effects that must not be ignored. Apart from the fact that our children will have access to quality immunization and other childcare services, general, teaching hospitals and medical centres will not be overburdened; medical personnel are not overwhelmed. This could even curb brain drain. And very importantly, it will reduce out-of-pocket expenses as citizens can now access affordable and quality healthcare.
“If government is interested, PHCs will work. When Nigeria wanted to build rail lines, they went as far as borrowing loan from China and pursued the project. Imagine if such commitment and resources was channelled to the health sector. It is a shame that despite the impact of COVID-19, we still don’t know the importance of health yet as a country “, she cried.