The Nigeria’s Primary HealthCare is epileptic. Unlike other climes where priority attention is paid to their health sector, in Nigeria it is a different kettle of fish, as neither the primary nor secondary health care is working optimally, a situation that has endangered majority of its citizens. Worsening the situation for the citizens is the prevailing high cost of medicines occasioned by inflation. Health care is generally unaffordable by a significant per cent of Nigerians, worst hit are the masses in the underserved areas throughout the length and breadth of the country. Juliet Jacob takes a holistic look at the development.
Nigeria’s Health System in Reverse Gear
“Health is Wealth” endures for a reason: health is the foundation of human existence. It is vital to survival and flourishing, making healthcare facilities essential for sustaining life on Earth. Unfortunately, in Nigeria, the healthcare system is severely under-resourced, leaving many citizens at risk.
According to the World Health Organization (WHO), Primary Health Care (PHC) is a comprehensive approach that addresses the broader determinants of health and focuses on the overall health system, rather than merely the treatment of specific diseases. It encompasses a wide range of services including health promotion, disease prevention, treatment, rehabilitation, and palliative care. This approach ensures that healthcare delivery is tailored to individuals’ needs, preferences, and life circumstances.
PHC in Nigeria
PHC is recognized for its inclusivity, equity, and cost-effectiveness, making it a fundamental strategy for achieving universal health coverage (UHC). By providing accessible and affordable care, PHC helps eliminate disparities and ensures that everyone, irrespective of their socio-economic status, can access the health services they need. Furthermore, PHC plays a critical role in enhancing the resilience of health systems, crucial for maintaining continuity of care and protecting populations’ health during emergencies.
PRHC In Niger Lacks Doctor, Nurse
According to research by Africa health report (AHR), across some States.In Shakwata, a village in Bosso LGA of Niger state, the primary healthcare center constructed in 2015 is managed by two community health extension workers. There’s no doctor or nurse, and the facility, which has only three beds, can admit only three patients at a time. Despite the dire state of the center, women from surrounding villages visit Shakwata for antenatal care and immunization.
Women report a scarcity of medicine at the facility. Basic services such as family planning and laboratory tests are unavailable, necessitating a 30-minute journey on rough, untarred roads to Maitumbi, a town on the outskirts of Minna, for hospital visits and drug purchases. In emergencies, pregnant women are attended to by traditional birth attendants at home. If complications arise, the woman is transported 15 kilometers to Maitumbi on a motorcycle or tricycle.
Voices from the Community
Mallam Shehu Yusuf, the ward head of Shakwata, expressed the challenges faced: “The only thing we do there is provide immunization services for children. The women usually help themselves deliver babies, especially when labor comes at night.”
Hajara Abdullahi, a 25-year-old resident of Shakwata, shared her experience: “I don’t go to the hospital every time. I started going when I got pregnant and had to enroll in antenatal care. Most of the women in the village rarely go to the hospital. We usually have to go all the way to Maitumbi during emergencies at night because the health workers close from work at about 2 pm every day. They don’t give us any medical advice at the hospital or what kind of foods to eat as pregnant women. They only touch our stomachs and prescribe drugs that they don’t have. The crowd is always massive.”
Even in cities, the cost of drugs has soared. As medical professionals leave the country in droves, major pharmaceutical multinationals are also departing. The rising cost of living and the volatility of the foreign exchange market, on which drug importation relies, have increased medicine prices. Rural dwellers struggle with the waning affordability and accessibility of healthcare.
The Struggle for Resources, Resort to Traditional Medicines
Aisha Isah, the 54-year-old wife of Shakwata’s village head and a traditional birth attendant, said the women often resort to alternative medicine, using herbs to treat illnesses like typhoid and malaria. She is more worried about the non-availability of drugs and health workers at night.
The primary health center in SHE village, Shiroro LGA, Niger state, faces similar issues. Hadiza Shehu, a birth attendant, said women rarely visit the facility due to a lack of necessary services and supplies. The center has no equipment, water, electricity, or proper toilet facilities. Sometimes, patients sleep on the floor due to the shortage of beds.
In Oyo state, mission houses—maternity homes run by religious centers—offer a primary alternative. These mission houses employ nurses and midwives and provide a combination of medical care and prayer, which attracts many women. Their services are also cheaper and more empathetic than those at government hospitals.
Cultural and Economic Barriers
In Kano state, poverty exacerbates the issue. Many women prefer to give birth at home due to the high cost of hospital services and the lack of female medical staff. Cultural factors and financial constraints often deter women from seeking professional medical care.
The exodus of medical professionals from Nigeria, known locally as ‘japa’, has significantly impacted the healthcare sector. Many doctors cite poor remuneration, an inefficient work environment, and security concerns as reasons for leaving. The primary destinations for these migrating healthcare workers are the UK, the US, Canada, and the Middle East. As a result, rural and urban healthcare facilities across Nigeria face severe shortages of staff and resources, placing a heavy burden on the remaining healthcare system and the population it serves.
Grim Health Metrics
Despite efforts to improve healthcare, Nigeria’s health metrics remain alarming. Infant mortality stands at 86 per 1,000 live births, maternal mortality at 840 per 100,000 live births, under-five mortality at 89 per 1,000 live births, and neonatal mortality at 37 per 1,000 live births. These figures reflect a healthcare system struggling to meet the basic needs of its population.
55 Million Cases of Malaria and 90,000 Deaths
In April 2023, the Federal Government of Nigeria reported that the country experiences approximately 55 million cases of malaria and nearly 90,000 deaths due to the disease annually. This information was revealed by the Minister of Health, Dr. Osagie Ehanire, during a press briefing for World Malaria Day, themed “Time to deliver zero malaria: invest, innovate, implement,” with the slogan “Act now.” Represented by the Permanent Secretary, Mamman Mamuda, Dr. Ehanire highlighted that Nigeria accounts for 27% of global malaria cases and 32% of global malaria deaths.
Cholera and Other Diseases
The recent cholera report from the Nigeria Centre for Disease Control and Prevention (NCDC) documents 210 new suspected cases and 10 suspected deaths from July 31 to August 27, 2023, across eight states. In 2023, six states—Cross River, Katsina, Bayelsa, Ebonyi, Niger, and Abia—account for the majority (62%) of suspected cholera cases. During the recent reporting period, Zamfara State had the highest number of suspected cases (190), followed by Kano and Bayelsa. Diagnostic testing revealed nine positive rapid diagnostic test results and three positive stool culture outcomes, primarily from Zamfara and Bayelsa.
Government Allocation and the Abuja Declaration
The Federal Government allocated N1,336,263,783,101 for the health sector in the 2024 fiscal year, representing just 4.6% of the total budget. This is a far cry from the 15% recommended by the 2001 Abuja Declaration, which aims to ensure adequate funding for healthcare services and infrastructure development.
Historical Context and Recent Developments
After Nigeria gained independence in 1960, the focus was more on curative care than preventive care. The National Basic Health Services Scheme (NBHSS), conceived in 1975, aimed to enhance medical training and establish healthcare facilities but failed in its implementation.
The turning point came with Olikoye Ransome-Kuti’s appointment as Minister of Health in 1985, which saw significant strides in healthcare, including the introduction of primary healthcare across government areas, free immunization for children, and a national health policy focused on preventive medicine.
Current Initiatives and Challenges
In 2017, the Nigerian government launched the National Primary Healthcare Revitalization Initiative, aiming to upgrade 10,000 existing centers. However, disparities and challenges persist across the country. Reports from various centers highlight issues such as inadequate staffing, insufficient funds, and lack of essential infrastructure like power and water.
Case Studies from Various Regions
Ogui Community, Enugu State Severe resource constraints, including inadequate staffing and insufficient funds, hinder effective patient care. Persistent electricity shortages necessitate using torchlights for night deliveries.
Kuduru, Bwari Area Council, Abuja. The center has operated without power or water since its inception in 2013, relying on water vendors and rechargeable lamps for illumination. This has limited their operational hours to one shift daily.
Idu Karmo, Federal Capital Territory, Staff have taken the initiative to purchase a solar facility, ensuring power availability despite the absence of a standby generator.
Budgetary Allocations and Future Prospects
The allocation of over N19 billion to the National Primary Health Care Development Agency (NPHCDA) in the 2017 Budget was seen as a significant step towards addressing the longstanding issues within Nigeria’s primary healthcare system. The funds were earmarked for various initiatives, including the rehabilitation of primary healthcare centers (PHCs) across the country. However, despite the initial optimism, many Nigerians have observed that there has been little to no visible improvement in the state of these healthcare facilities since the allocation.
The lack of progress can be attributed to several factors:
Mismanagement and Corruption:
There have been concerns about the mismanagement of allocated funds, with reports of corruption and inefficiency hampering the effective utilization of the budget.
- Bureaucratic Delays, The bureaucratic processes involved in disbursing and utilizing the funds can cause significant delays, often resulting in the projects not being executed on time or at all.
3.Lack of Accountability, Without stringent monitoring and accountability mechanisms, it is challenging to ensure that the funds are used for their intended purposes.
4.Inadequate Oversight, There might be insufficient oversight and follow-up from relevant authorities to ensure that the allocated funds are properly utilized and that the projects are completed satisfactorily.
- Capacity Issues, Sometimes, the local implementation agencies may lack the capacity or expertise to effectively execute the rehabilitation projects.
The failure to see tangible improvements despite significant budget allocations has led to frustration among Nigerians who continue to face inadequate healthcare services at the primary level. This situation underscores the need for improved governance, transparency, and accountability in the management of public funds, as well as more effective oversight mechanisms to ensure that budgetary allocations translate into real improvements on the ground.
The High Cost of Medication
One of the most pressing issues is the high cost of medication. Despite the establishment of new boards and agencies like the Nigeria Centre for Disease Control (NCDC), essential medications often do not reach remote and underserved areas, leaving many without necessary treatments.
Broken Promises and Unrealized Agendas
Despite numerous government initiatives and promises, the primary healthcare sector continues to fail the people it is meant to serve. For example, the promise to establish one PHC per local government.
