Multiple challenges cripple primary healthcare nationwide

More facts have emerged why 80 per cent of Primary Health Centres (PHCs) in Nigeria are non-functional, nearly five years after the Federal Government promised to refurbish 10,000 PHCs across the 774 councils

A new study, commissioned by the Embassy of Kingdom of The Netherlands in Nigeria and put together by PharmAccess Foundation (Nigeria Office), titled ‘Nigeria Health Sector: Market Study Report’, has noted that there are 34,076 PHCs in Nigeria, accounting for 85.3 per cent of total hospitals and clinics in the country.

Of this number, it is estimated that only 20 per cent are functional. Most of them lack the capacity to provide essential healthcare services. They also face the challenges of poor staffing, inadequate equipment, poor condition of infrastructure and lack of essential drug supply.

“The World Health Organisation (WHO) reported that only a quarter of PHCs have more than 25 per cent of the minimum required equipment package. The capacity to provide basic emergency obstetrics services are limited to about 20 per cent of the facilities. Due to the foregoing, N1.95 trillion ($5.4 billion), representing 84 per cent of primary health care expenditure, was spent in non-PHC facilities (that is, secondary and tertiary care in 2017),” the report states.

It adds: “As part of its goal to ensure access to healthcare for 100 million Nigerians, the FMoH (Federal Ministry of Health) plans to build 10,000 PHCs throughout the country, with at least one PHC per ward (that is, an administrative unit with 10,000 people) to facilitate healthcare access across a wide geographic area. It is understood, however, that 4,500 PHCs have been covered so far with support from donor partners.”

Meanwhile, contrary to expectations that the present administration of President Muhammadu Buhari will deliver refurbished 10,000 PHCs nationwide before its exit on May 29, 2023, the government has shifted the date to 2030.

Executive Director/Chief Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, told The Guardian that the administration of President Buhari made a commitment to refurbish 10,000 primary healthcentres in Nigeria, with the goal of improving healthcare delivery in the country, in 2016.

Shuaib, however, said the project can only be completed by 2030 and that several efforts have been made towards fulfilling this promise.

He said: “In 2017, the Federal Government launched the Primary Healthcare Revitalisation programme, which aimed to enhance the quality of primary healthcare delivery in Nigeria. The programme encompassed the renovation and equipping of primary health centres and other interventions.

“The initiative included a phased approach, with the first phase targeting the renovation and equipping of 109 primary healthcare centres across Nigeria, training and deploying healthcare workers to these centres and improving the supply of essential drugs and medical equipment.

“In 2022, the commitment to upgrade 10,000 PHC facilities was reaffirmed at the PHC Summit, as part of ongoing efforts to improve healthcare delivery in Nigeria.”

The public health physician said the target was to upgrade at least one primary health centre in each of Nigeria’s 10,000 political wards. He said since then, the agency and its development partners have launched various projects aimed at revitalising primary health centres to a Level 2 Health facility, with a full complement of human resource for health (HRH).

Shuaib said while the timeline for achieving this goal is set for 2030, initial interventions have been implemented to fast-track the process.

He said the IMPACT project, funded by the World Bank, is aimed at upgrading and refurbishing 3,807 Basic Health Care Provision Funded Primary Health Care Centres across the 14 impact states in Nigeria, as part of efforts to improve the country’s healthcare infrastructure.

He said the solarisation of 400 PHC facilities in zero dose councils across 18 states has been initiated in an effort to improve the reliability of power supply and enhance the quality and affordability of healthcare services in rural and underserved areas

Shuaib said to further support the upgrade of Nigeria’s healthcare infrastructure, the Basic Health Care Provision Funds (BHCPF) have been repurposed to renovate and upgrade at least 300 PHCs to level 2 standard PHCs in all 36 states and theFCT.

The NPHCDA boss said the expanded Midwife Service Scheme (eMSS) has been established to complement the existing healthcare workforce by deploying no fewer 2000 skilled birth attendants to renovated PHCs across Nigeria.

He described Community-based Health Research Innovative Training and Services Programme (CRISP) as an intervention that enables community medicine resident doctors to attend to patients at PHCs within the catchment area of the universities, while also transferring knowledge to health workers at these facilities, and the programme is set to be implemented in 12 states.

Shuaib said, through collaboration with the Private Sector Health Alliance of Nigeria (PSHAN), the private sector has pledged and initiated upgrades in at least one PHC facility in each of the 774 councils of the federation. He said this is being done through the ‘Adopt a PHC’ model as part of their contribution to the revitalisation drive.

Other key findings by “Nigeria Health Sector: Market Study Report” are that the most populous black nation loses over $1.9 billion (N875 billion) yearly to medical tourism, with 60 per cent of the expenditure going for treatment of cancer, bone-related conditions, kidney and heart transplants.

The report said demand for healthcare, which was valued at $15 billion in 2018, could hit over $18 billion at the end of 2023. It found that 99 per cent of medical devices are imported as segments worth $186 million in 2022 and projected at $202 million in2023.

The researchers also discovered that aggregate budget allocations to health in the 36 states post-pandemic declined by 2.5 per cent from $1.92 billion in 2020 to $ 1.87 billion in 2022.

Buhari

Former Minister of Health, Prof. Isaac Adewole, had on April 7, 2019, told journalists that the Federal Government had rebuilt over 4,000 PHCs across the Federation in line with the 10,000 rehabilitation target of the President Muhammadu Buhari administration.

He added that the current government was reviving the collapsed primary healthcare sector and repositioning it for better delivery.
Adewole had said: “Our target is to rehabilitate 10,000. We have done over 4,000. Federal Capital Territory (FCT) Abuja is doing 225, Osun State, 332 and Kaduna, 250. We are moving towards the 10,000 mark.”

The minister had said that government was to fund PHCs through the Basic Healthcare Provision Fund, supported by the World Bank and British Department for International Development (DFID).

Adewole had also explained that his ministry received $20 million from the global financial institution and another $2 million from the Bill and Melinda Gates Foundation, while government had mapped out a N13.7 billion first-quarter allocation for the initiative.

“The Federal Government wants to rebuild secondary healthcare system with the states, while it concentrates on the tertiary healthcare system. We are hoping that by the next few years, the healthcare system in Nigeria will be back to shape. We can build the human resources required to make it functional,” he added.

Meanwhile, The Guardian investigation had revealed that despite all past and ongoing efforts by the Federal Government, the implementation of PHC in Nigeria has been plagued by several challenges: poor governance, inadequate financing, poor human resources for health and under-utilisation of the PHC facilities by individuals and communities.

Medical experts, who spoke to The Guardian, agreed that Nigeria’s PHC system suffers from fragmented services, weak referral systems and poor infrastructure. They insist that there are serious gaps in access to basic health services. They also said the multiplicity of vertical disease control programmes, with poor integration of services at sub­optimal levels, result in low coverage of high-impact, cost-effective interventions. It was found that there is poor linkage between different levels of care, materials and equipment for service delivery at the PHC facilities.

The Guardian investigation revealed that most health centres no longer have functional drug-revolving schemes, resulting in shortage of essential and critical medicines and commodities at point of service delivery. It was discovered that a good number of the components of PHCare not provided at most service delivery points. The challenges are worsened by professional conflicts within the health system, and by insurgency and Boko Haram conflict, especially in north­eastern Nigeria, which has hampered effective PHC service delivery.

The Guardian investigation was corroborated by a study by the Alliance for Health Policy and Sys­tems Research(AHPSR), in collaboration with the Bill and Melinda Gates Foundation.

They developed a set of 20 case stud­ies of primary health care sys­tems in selected low and middle-income countries as part of an initiative, entitled PrimaryCare Systems Profiles and Performance (PRIMASYS).

AHPSR and WHO published the study by Prof. B. S. C. Uzochukwu of the Institute of Public Health, College of Medicine, University of Nigeria, Enugu Campus, Enugu State.

Also, according to a study published in Frontier PublicHealth and titled “Primary Health Care in Nigeria: 24 Years after Olikoye Ransome Kuti’s Leadership”, policymakers need to strengthen and revitalize PHC in Nigeria.

The study noted that the cur­rent state of PHC sys­tem in Nigeria is appalling with only about 20 per cent of the 30,000 PHC facil­it­ies across Nigeria work­ing.

According to WHO, PHC is the provision of basic essential health services (preventive, promotive, curative and rehabilitative). It serves as the first point of access to healthcare by individuals, families and communities, bringing health services as close as possible to homes and workplaces, and has thus been described as the bedrock of Universal Health Coverage (UHC).