BY JIDE AYOBOLU<\/p>\n
The Minister of Health, Dr. Osagie Ehanire, says additional 10,000
\nPrimary Health Centres (PHC) will be rehabilitated to boost healthcare
\ndelivery across the country.<\/p>\n
The minister made this known while addressing State House correspondents
\nat the end of the meeting of the Federal Executive Council (FEC),
\npresided over by President Muhammadu Buhari at the Council Chamber of
\nthe Presidential Villa, Abuja, on Wednesday. According to him, the
\nBuhari administration has so far resuscitated 4,800 PHCs.<\/p>\n
He said \u201cat the inception of the current administration in 2015, less
\nthan 20 per cent of PHCs were working, maybe about 1,000 were working.
\nAs of now, 4800 are functional. \u201cSo many of the health centres have
\nbeen revitalised, they are working; not only are they working, the
\ngovernment has provided the Basic Health Care Provision Fund with which
\nservice can be paid at the primary healthcare centre for those who
\ncannot afford it for the poor. \u201cThe aspiration is to increase the
\nnumber from 4,000 to something near 10,000, one per political ward in
\nthe country.\u2019\u2019 While reacting to a question on the identity of the
\nCovid-19 index case in Nigeria, the minister dismissed speculations that
\nthe government was hiding the identity of the patient.<\/p>\n
According to him, it is medically unethical to reveal the identity of
\nthe Italian currently quarantined in a medical facility in Lagos. News
\nAgency of Nigeria (NAN) reports that an Italian, who is yet to be
\npublicly identified, tested positive for the virus on arrival in Nigeria
\non Feb. 25. The minister said unlike the index case of Ebola, Patrick
\nSawyerr who was known, the Italian could not be exposed because his
\nprivacy must be respected.<\/p>\n
In line with his administration\u2019s vision to provide quality basic
\nhealth care services to Nigerians, irrespective of their location,
\nPresident Muhammadu Buhari PMB has pledged to revitalize 10,000 primary
\nhealth care facilities in the country, using a phased approach. Buhari
\nsaid the focus would be more on people living in rural areas and
\nvulnerable population in the society such as women, children under five
\nyears of age and elderly in collaboration with national and
\ninternational partners.<\/p>\n
According to him, provision of National Health Act, 2014 for Basic
\nHealth Care Provision Fund is in the process of being implemented,
\nadding that his administration would fulfill all promises made to the
\npeople. He said \u201cLet me state clearly, that this revitalization
\nprogramme is in alignment with the agenda of our party, the All
\nProgressive Congress (APC). We did promise to provide succor to the poor
\nwhile at the same time providing for all other segments of the society.
\nI am aware that out of pocket payment for health constitutes over 70 per
\ncent of total health expenditure. This is more than the globally
\nrecommended 30-40 per cent. \u201cHowever, only less than 5% of the total
\npopulation is covered by any kind of health insurance or risk protection
\nmechanism which is against the recommended 90% coverage by the World
\nHealth Organization. Our vision is to reverse this unsatisfactory
\nsituation and better care for the poor and needy. \u201cOur Administration
\nin recognition of this promised to revitalize one Primary Health Care
\nCentre in each of the political wards in the country. So far, we have
\ncommenced the revitalization of one Primary Health Care in each
\nsenatorial zone in the country. \u201cOur vision is to revitalize 10,000
\nPrimary Health Care Facilities in Nigeria using a phased approach. The
\nfirst phase of this approach is what we are flagging off today. It will
\nsignal the revitalization of the first 109 Primary Health Care
\nfacilities across the 36 states and the FCT.\u201d<\/p>\n
People turn to the primary health care system in their communities both
\nto stay healthy and to get care when they fall sick. From primary health
\ncare providers they seek prevention of disease, management of chronic
\nconditions, access to treatment of various ailments and conditions, and
\nfamily planning. When the primary health care system performs well, it
\nmeets the vast majority of people\u2019s health needs, and that is
\nessential if we are to make progress toward our nation\u2019s health goals.<\/p>\n
The primary health care (PHC) facility is often all that rural
\ncommunities have in form of a formal health system. How then do we
\nimprove the quality of care when attention has consistently been on
\nexpanding the reach of PHC services to rural populations and hardly on
\nquality of services? The presence of a PHC facility does not guarantee
\nits use and there is a wrong assumption that a minimal level of input
\n(i.e. infrastructure and staff) is essential before one can discuss
\nquality. Even when quality becomes a real issue, it is often about
\nsupervision; but supervision is a poor proxy for quality. The quality of
\nsupervision itself is what matters. Handled poorly, this becomes a
\nvicious circle: poor supervision results in low quality of services and
\nlow quality of services set a low standard for supervision. Health
\nservices in Nigeria mirror political organization. The federal
\ngovernment is responsible for tertiary care, state governments for
\nsecondary care, and the local governments run primary care. The
\nfinancing of (but not the responsibility for) public health is tied to
\nthe flow of funds from the federation account. Funds are shared between
\nlevels of government according to an allocation formula that keeps about
\nhalf at the federal level, allocates a quarter to the 36 states, and
\ngives the other quarter to the LGs. These resources are not sectorally
\nearmarked and the states and LGs are not constitutionally required to
\nprovide budget and expenditure reports to the federal government.
\nNigeria thus leaves the most important and consequential level of health
\ncare \u2013 primary health care \u2013 to the weakest level of government.
\nThis results in poor coordination and integration between levels of
\ncare, giving rise to a weak and disorganized health system, in which
\nwidely varying patterns of outcomes depend on local situations.<\/p>\n
The decentralization policy that makes local governments run primary
\nhealth care in Nigeria rests on the imported notion that services are
\nmost efficient when governance is close to the people, an assumption
\nthat is premised on the existence of a well-functioning participatory
\ndemocracy where the electorates are neither hungry nor ignorant. Most of
\nthe rural people our PHC facilities serve have not been exposed to high
\nquality health services so they accept what they get as the norm or,
\nwhen they imagine it not to be the norm, without complaints. When they
\ncannot put up with low quality services they ignore the PHCs by staying
\nat home, and they consult quacks, only to present in the PHC or other
\nhospital in emergency, often too late for life-saving interventions.
\nThis is not a new problem, and Nigeria has responded in two important
\nways to the disjunction between finances and responsibility on the one
\nhand, and between communities and the political administration of health
\non the other. The National Primary Health Care Developing Agency
\n(NPHCDA) is one such Nigerian innovation, albeit as usual, not
\ncompletely well thought out. NPHCDA is a federal government agency with
\npolicy and oversight roles on PHC implementation at the state and local
\ngovernment levels in Nigeria. The major drawback is that a federal
\nagency has no binding constitutional role to implement programmes or
\npolicies at the state and local government levels. The governments must
\nbe willing to cooperate or nothing happens, and cooperation often has to
\ncome with financial commitments, which for every government are highly
\ncontested grounds.<\/p>\n
The second innovation, also poorly thought out for the short term, is
\nthe creation of Ward or Village Development Committees (WDCs or VDCs).
\nAn initiative of NPHCDA, they are designed to strengthen local
\ncommunities in the hope that they can advocate for themselves. The
\ncommittees are made up of influential community members who can help to
\nenhance community participation and ownership, and promote demand for
\nquality services. The problem here is that people can only demand what
\nthey are really passionate about. People may be empowered by knowledge,
\nbut it takes a deeper level of knowledge that can translate into passion
\nand commitment to get people to act and change their behaviour. It is
\nmuch easier to ignore community participation when the issue is
\nimproving input \u2014 infrastructure and staff. But for quality, it is
\nclear that we either find a way to get communities actively engaged in
\nthe health system that serves them, or we establish structures and
\nprocesses that will allow us to temporarily bypass community
\nparticipation on the road to improving the quality of care at the PHC
\nlevel in Nigeria.<\/p>\n
Health professionals are often in the position to set the standards for
\nthemselves, and then police themselves to ensure their practice is up to
\nthose standards. Health workers in Nigeria as in many other countries,
\nrather than police themselves, are more likely to protect their
\ncolleagues from complaints of negligence, malpractice that may lead to
\nlitigation. In a situation where people are not empowered to detect poor
\nquality, speak up and fight, there is need for the health system to fill
\nthat role on behalf of the people. This gap in behaviour means that the
\nsolution to the quality issues in primary care has to be innovative. We
\nmust think of structures, both government- and civil society-led, to act
\non behalf of communities in the hope that by so doing, members of the
\ncommunity can learn to make demands in their own voices. This may happen
\nthrough continuous supportive supervision through the use of
\nstandardized checklists. It is also important to openness, while
\ndiscouraging a culture of blame and fault finding in quality assurance.<\/p>\n
Nigeria lacks the technical, financial and political sophistication and
\nrobustness required for a complete decentralization of health services.
\nTo streamline the health system, it may be necessary to bring PHC under
\nthe federal roof, and add tertiary care to the responsibility of state
\ngovernments. The role of supportive supervision can then be left to the
\nlocal governments who will function independently with verification of
\ntheir activities by civil society. I am afraid this proposal may only
\nlook good on paper. Implementation in reality will be difficult, and
\nthere are great political hurdles to reorganizing a system, especially
\nwhen such reorganization involves huge financial commitment by the
\ndifferent tiers of government.<\/p>\n
All said and done, it is commendable that the president has identified
\ncritical areas in the healthcare system of the country and he has made
\ncommitments to drastically improve the situation on ground, in the
\noverriding interest of all Nigerians, especially those residing in the
\ndifferent\u00a0 rural parts of the country.<\/p>\n
BY JIDE AYOBOLU The Minister of Health, Dr. Osagie Ehanire, says additional 10,000 Primary Health Centres (PHC) will be rehabilitated to boost healthcare delivery across the country. The minister made…<\/p>\n","protected":false},"author":1,"featured_media":72055,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[7],"tags":[],"class_list":["post-72054","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles-opinions"],"yoast_head":"\n