Primary Healthcare Challenges in Nigeria – Pragmatic Solutions

Dr. Onyekachi Ifudu
Email – dodokinase@gmail.com

Primary healthcare is the bedrock of any country’s healthcare system. It is aimed to provide individuals and communities with protective, preventive, restorative and rehabilitative health services within the available resources.

Many of the challenges in our primary healthcare system are a direct result of laying the weight of our entire healthcare burden on the primary healthcare system – then relegating the primary healthcare to local governments, the lowest tier of government which currently lack the technical, financial, managerial, and political capacity to run the core of our country’s healthcare system. Most of the rural people our primary health care facilities serve have not been exposed to high quality health services so they accept what they get as the norm.

The appeal of the prescribed solutions is that the emphasis is on what “we the people” as citizens can do to make a difference and not just what government should do.

Strengthen community involvement

Communities must be galvanized and possibly incentivized by State governments to be more involved in the upkeep of their primary healthcare center (PHC) and ditch the idea that government must do everything. Improved community engagement could start by communities setting up an endowment fund for their PHC which will be funded by levying themselves or conducting fundraising events.

The endowment fund will be managed by the community and the funds used for purchase of medical supplies, infrastructure maintenance and possibly staff training. State governments, through their ministry of health should intensify efforts to educate and inform the ward or village development committees which are designed to strengthen local communities in the hope that they can advocate for themselves.

“Adopt a Primary Healthcare Center” ─ Involve the rich

Many Nigerians at home and abroad are keen to contribute to the development of their community but are often frustrated by the lack of straightforward opportunities that are devoid of red tape, and they definitely would not route their money through any government official.

By “adopting a PHC” individuals, groupings of individuals or organizations can commit their money directly into any PHC of their choosing without handing their money to a government official. State governments can initiate this process by setting up a website with a listing of all the rural PHCs and publicize the program to attract “adopters”.

The adopters would directly fund infrastructure maintenance, equipment procurement, purchase 0f medical disposables and even staff training. They can either do this directly or set up an endowment fund which they will manage. The logistics and scope of their involvement can be worked out, but the key is that the adopters don’t have to hand their money to anybody or government entity. In other words, “the one percent must supplement”.

Continuously retrain primary healthcare workers

The brain remains the most important “equipment” in medical science. Continuously retraining the primary healthcare workers should be a major objective so they can perform their jobs effectively. Even with suboptimal facilities at the PHC, an intellectually prepared primary healthcare worker can go into the community and proffer disease prevention measures in informal setting.

This continuing medical education would be provided by nearby academic medical centers or by licensed continuing medical education providers. Once this provider arrangement is formalized, each primary healthcare worker would be encouraged at the minimum to obtain 20 hours of continuing medical education every two years.

Formalize relationship with referral medical centers

State governments should work in tandem with the federal government to formalize the relationship between PHCs and referral centers so that each PHC will have a designated referral hospital. It may also be helpful to incentivize any of the referral centers with the requisite expertise to serve as the provider of continuing medical education for the PHC whom they serve as the referral center.

Sensitization workshops for local government council leadership

Local governments have the main responsibility regarding the management of primary healthcare, but there is a high turnover rate in the leadership of local governments in Nigeria. Based on the premise that local government leadership can’t fix a problem that they don’t fully appreciate, sensitization workshops are necessary for leadership of local government councils.

The State ministry of local government should organize sensitization workshops targeted at newly “elected” local government chairmen and supervisory health councilors. The interactive workshops will review the major challenges in primary healthcare in the State and offer a template of innovative solutions to improve primary healthcare delivery.

Mandate, verify and enforce a minimum level of spending on health

There should be legislation at the federal and state levels to mandate a minimum level of budgetary allocation by local governments to healthcare. Guidelines should be provided for the deployment of funds to mandate how much goes to medical disposables, infrastructure maintenance, disease prevention efforts, staff training and staff salaries.

The Big Picture ─ Emphasize public health principles in schools

Public health is best distinguished from clinical medicine by its emphasis on preventing disease rather than curing it, and its focus on populations and communities rather than individual patients.

The top ten diseases responsible for most deaths and hospital visits in Nigerians, are all preventable diseases. Therefore, the thrust of our entire healthcare system should be primarily focused on disease prevention.

Federal and State governments must update the curricula of medical schools, nursing schools and schools of hygiene to emphasize public health principles and epidemiology of the major ailments that afflict us.

Also, an immediate impact can be made by providing a two-day intensive public health workshop for doctors starting their National Youth Service Corps before they proceed to their work locations. Considering the frontline role they play in healthcare delivery in the rural areas, once empowered with knowledge base at the workshop, they will proceed to the grassroots where implementation of health promotion and disease prevention initiatives will make an immediate impact.

Finally, State Governors can instantaneously elevate the entire public health enterprise in their State by ensuring that physicians appointed to be commissioners of health also have a degree in public health. This has long been the norm in most aspirational societies, because training in public health equips the individual with the skill set to craft and implement public health policies that will benefit the entire population of the State. In addition, in a situation where there is limited resources, the individual will have the insight to prioritize implementation of public health measures that will profoundly enhance the long-term wellbeing of majority of the residents of the State over the current trend of building hospitals. Furthermore, it will facilitate the ability of the commissioner to interact with international organizations, transnational charities, healthcare grant providers as well as major schools of public health in the west that are eager to partner with us to tackle our public health problems.

None of the above detailed measures in of itself is a magic bullet. But taken together and diligently implemented, they will go a long way in alleviating our challenges in the primary healthcare arena.