Booster Jabs to Enhance Primary Health Care System

Tajudeen Kareem and Julieene Manga

The roadmap unveiled last year by the Federal Ministry of Health, the “Health Sector Next Level Agenda”, admits huge gaps in the health sector and the need for concerted efforts in the race to attaining Universal Health Coverage.

The nine-point agenda presented by President Muhammadu Buhari expectedly aspires to propel the country towards the attainment of universal health coverage when “all individuals and communities receive the health services they need without suffering financial hardship”.

The Minister of Health, Dr. Osagie Ehanire has listed the agenda to include implementation of mandatory universal health insurance in collaboration with state governments and the FCT administration; operationalization of the basic health care provision fund in collaboration with partners and agencies; recruitment and deployment of 50,000 community health extension workers; revamping federal teaching hospitals across the country and collaboration with private sector investors to establish high-quality hospitals in Nigeria.

The rest are reduction of gaps in all health-related SDGs by at least 60%; reduction in the current imbalance between primary, secondary, and tertiary health care; active collaboration with the private sector to create a large number of well-paying jobs for Nigerian youths; and contributing to the realization of taking 100 million Nigerians out of poverty in the next ten years.

Perhaps the most troubled part of the health sector is the primary health care system which ordinarily should provide treatment for common diseases and injuries, provide essential drugs, render basic and essential services for women, especially maternal and child care and complications arising during birth.

Present realities indicate the absence of a fully developed and functional primary health care system which constitute a development challenge in Nigeria with a large population living in rural areas where access to basic health care system is crucial. Poverty, long distance, bad road networks and high cost of travel are obvious hindrances to seeking medical services in urban or more developed areas by people in remote settlements.

Experts have said repeatedly that reaching people in hard-to-reach areas requires a health care system that caters to the needs of a relatively small population and which delivers essential preventive and curative medical services to the communities at affordable cost. To this end, primary health care is widely recognized as the most cost-effective way to reach the goal of universal health coverage and address comprehensive health needs close to people’s homes and communities.

Presently there are over 33, 000 primary health care centers across the country, but fewer than 20% are functional. Escalating poverty coupled with a high level of illiteracy in Nigeria makes the case for an efficient and sustainable primary health care system even more urgent.

The National Primary Healthcare Development Agency, NPHCDA, is saddled with the task of ensuring that primary health care services are available and accessible to all citizens. However, the current primary healthcare system is under-utilized with a significant burden transferred to the secondary and tertiary health systems. Indeed, system which is expected to provide quality healthcare services for at least 70% of Nigerians currently carters for about 20%, even as secondary and tertiary facilities are overwhelmed by hapless Nigerians.

Owing to inadequate funding, inadequate staffing and a myriad of logistical problems, primary health care facilities are operating at different levels of functionality with shortages of critical human resources. Despite these challenges, the NPHCDA has made significant progress in the last few years. In August 2020, Nigeria was certified free from the wild polio virus even as immunisation coverage jumped from 33% in 2016 to 71% in 2019.

The agency has supported initiatives to reduce the impact of COVID-19 in Nigeria, training over 220,000 health workers and community volunteers at the national and state levels, working in collaboration with the Nigeria Centre for Disease Control and other stakeholders at all levels of government, and supporting the provision of personal protective equipment to health care workers.

Projecting ahead, the NPHCDA has plans to work with states, local governments and other critical stakeholders to deploy a four-point agenda to fast track progress towards achieving UHC. These are revitalization of all PHCs with optimal human resources to improve services; improved technology for PHC data, services and vaccine distribution; up-scaling social and behavioural change communication and strengthening Post-Polio PHC System.

The strategic plan at the NPHCDA has received the support of President Buhari and his consent to host an international summit on Primary Health Care. Health managers are fine-tuning details of the global summit which is expected to leverage on efforts in kicking the wild polio virus out of the country and the deft management of COVID-19.

Barring last minute changes, the summit will hold in Abuja before the end of October or early November in actualization of the promise made earlier by the Executive Director of the NPHCDA, Dr. Faisal Shuaib to prioritize strengthening the PHC system through a robust revitalization agenda.

Recall that last year, the agency had engaged with the heads of community medicine departments of universities to discuss and receive critical feedback on prevailing issues of interest to primary health care development in Nigeria. It also met other critical stakeholders in the bid to strengthen the PHC system and deliver affordable, accessible and equitable services.

“My vision is to strengthen PHC systems to deliver affordable, accessible and equitable services to all Nigerians. It is in this light that we will be convening a global PHC Summit in 2021 with the theme: Strengthening PHC towards achieving universal health coverage in post-Polio, Peri -COVID era.

“The overall goal of the summit is to galvanize stakeholders and present a compelling investment case for PHC financing, leveraging on the gains made during the polio eradication to strengthen PHC systems from 2021 to 2030. I am optimistic that this event will be a success and a global agenda to be reckoned with,” Dr. Shuaib said.

The summit aligns with the vision of Dr. Ehanire on addressing the inadequacy of primary health care services across the country and the need to revitalise one PHC in each ward in demonstration of prioritizing community based health care and scaling up the Community Health Influencers, Promoters and Services, CHIPS, programme launched by President Buhari in 2018 at Lafia, Nasarawa State.

CHIPS is designed to improve access and equitable coverage to essential health services, especially those relating to maternal, new born and child survival. It will also remove barriers to PHC services; ensure supply of integrated PHC interventions by linking the health workforce at health centres in rural and underserved communities to the households; tackling delays in decision to seek care, reaching care and receiving adequate healthcare.

The summit is coming at a time when government resources alone have become inadequate to fund the health sector, especially with the global COVID-19 pandemic and the resurgence of cholera in many states across the country.

At a meeting with federal lawmakers, the Secretary to the Government of the Federation, Mr Boss Mustapha had said that COVID-19 provided a unique opportunity to x-ray the state of Nigeria’s health care sector which is in dire need of reforms and funding.

“The weaknesses in our health system became more glaring as we see how more established health systems in Europe and America buckled under pressure. There’s no doubt that a strengthened and well-resourced health system will not only place the country in a better position to deal with future emerging infections but will also provide a solid foundation for medical research and development,” said Mustapha.

The summit will also rally the support of the Coalition Against COVID-19, CACOVID – the private sector-led organization assembled by the Central Bank of Nigeria to assist the federal government in combating COVID-19. The coalition of industry giants, banks and several private organisations and individuals raised huge funds to procure essential supplies, equipment while also accelerating tests and treatment for COVID-19.

Before attaining wild polio-free status, after meeting all the criteria for certification which include three years of non-detection of any wild polio virus case in the country, Nigeria, Afghanistan and Pakistan were the only countries harbouring the wild polio virus.

The feat was widely applauded by the World Health Organisation, WHO and United Nations International Children’s Emergency Fund, UNICEF. Both congratulated Nigeria on being declared free of the wild polio virus but stressed that achieving this milestone is not the end of the job – all children under five years must continue to be vaccinated against vaccine-preventable diseases.

The agencies expressed strong appreciation for the role played by all stakeholders, especially the commitment and support of the Nigerian government at all levels, development partners, donors, traditional and community leaders, health workers and caregivers.

“WHO rejoices with the people and government of Nigeria and acknowledges that wild polio-free certification is undoubtedly the greatest public health triumph in the annals of Nigeria and indeed Africa that will bequeath to posterity lessons learnt and best practices for addressing future public health interventions,” said Dr Walter Kazadi Mulombo, WHO Nigeria Country Representative.

*Kareem and Manga wrote in from Abuja.

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Projecting ahead, the NPHCDA has plans to work with states, local governments and other critical stakeholders to deploy a four-point agenda to fast track progress towards achieving UHC. These are revitalisation of all PHCs with optimal human resources to improve services; improved technology for PHC data, services and vaccine distribution; up-scaling social and behavioural change communication and strengthening Post-Polio PHC System