MDG target spurs need for primary health sector re-assessment
MDG target spurs need for primary health sector re-assessment
FRIDAY, 11 MARCH 2011 00:00 ALEX CHIEJINA
The issue of nation’s primary healthcare (PHC) system has, over the years, become very contentious. However, while some critics believe that successive governments have failed woefully in providing this all-important essential service, others are of the opinion that what is obtainable currently pales into insignificance when compared to efforts made in this regard in the past. Despite the opinions expressed, government believes it has made some positive marks considering recent globally- accepted indices as regards reduction and/or near eradication of childhood diseases such as measles, poliomyelitis, tuberculosis, diphtheria, whooping cough, tetanus, establishment of primary healthcare centres. Stakeholders in the health sector believe that there is a lot more to be done if the country must meet the Millennium Development Goals (MDGs) which is targeted to be achieved by 2015 by member nations of the United Nations. Going down memory lane, the era of the late Olikoye Ransome-Kuti, a former Health minister, is widely regarded as the glorious era of primary healthcare administration in the country. Ransome-Kuti, who was the former director of Basic Health Services Scheme (BHSS) before becoming health minister in 1986, placed Nigeria on the worldwide movement for the adoption and implementation of a national primary healthcare programme. With the World Health Organisation identifying five key elements on the way to achieving primary healthcare(PHC) which includes- reducing exclusion and social disparities in health (universal coverage reforms); organising health services around people’s needs and expectations (service delivery reforms); integrating health into all sectors (public policy reforms); pursuing collaborative models of policy dialogue (leadership reforms); and increasing stakeholder participation- reactions have continued to pour on the possibility of PHCs becoming functional as to extend healthcare to the teeming Nigerian population. Okechukwu Ohanyido, a public health physician, said the nation’s healthcare system is fragile and structured on a tripod framework of which the bottom of the pyramid healthcare service is the primary healthcare level (overlaid by secondary and tertiary levels atop). While acknowledging the fact that the PHC system under the care of the Local Government Authorities (LGAs) is the most fragile and grossly underfunded, Ohanyido pointed out that PHC centres at this level are expected to subservice over 75 percent of the healthcare needs of the nation’s population. “The issue of Primary Health Care Financing (PHCF) has been a major threat to the health system, which has not been addressed, or deliberated by stakeholders since the administration of former president Olusegun Obasanjo embarked on Health Sector Reforms. Under the current 1999 Constitution, only unclear reference is made in delineating the pyramidal interfaces across the three levels, particularly with regards to the responsibility of LGAs for health. “In Section 45, the Constitution makes provision only for the overriding of individual rights, if it is in the interest of, among other things, public health. In other words, the Constitution therefore, falls short of specifying what roles the LGAs, state and Federal Governments must play in the national health care delivery system, especially where finance, one of the key levers of reform, is concerned. For the health sector, this is a very serious omission. The impact is heavily felt at the LGAs being the main implementing agents of primary health care,” Ohanyido said. Lending his view, Enrico Liggeri, country manager, Pfizer Specialties, Nigeria, stated that the challenge of healthcare is not peculiar to Nigeria alone as health personnel in most developing countries. Liggeri pointed out that since Nigeria has one of the highest fertility rates in the world, there is the challenge of everyone accessing healthcare due to the geographic gap. According to him, “the advocacy for increased allocation to preventive services more than the curative services is in the interest of the indigent, most of who have the least means. It is, however, not intended to relegate curative services to the background as both prevention and cure are important in the delivery of effective health care. “However, since Nigeria has a relative stable revenue stream (from crude oil), a certain amount of the county’s revenue from oil trade should be dedicated to the health sector. The healthcare system in Nigeria needs increased funding. This can be provided by government and indeed the private sector. If the population growth increases, it might outpace the finance budgeted for the health sector. There should be the expansion of the private sector in the area of insurance. Its vibrant economy could be tapped into in the area of managed healthcare via the involvement of multinational firms operating in the country. Taking a critical view of PHC in Nigeria, it is the level of care which is suited for preventive medicine, for addressing diseases as tuberculosis, pneumonia, malaria, measles, acute respiratory infection, diarrhoea, poliomyelitis, etc. With the secondary and tertiary healthcare system aiding to address more complex conditions, it is needful that more resources be allocated to primary healthcare, which is preventive and which is ultimately the best of all. This is so because this level of healthcare is capable of preventing up to 70 percent of the disease burden. This doesn’t mean that curative care should be neglected. Furthermore, as government engages in the construction of primary health facilities in some parts of the country in the last few years and health facilities selected for renovation, equipping and provision of drugs, the huge challenge remains the capacity to achieve set targets of increasing the proportion of pregnant women receiving antenatal care from 60-80 percent; reduce maternal mortality from 800 to 250 per 100,000 live births by 2015. No doubt, it is not so late to make the health system work as it is the only option the nation has despite insufficient resources.