By Iyemah Ahmad
Health experts have called for urgent improvement in Nigeria’s Primary Health Care (PHC), system to enable improved access adequate medicare.
The experts made this call on Friday at the Nextier Health virtual dialogue on ‘Revitalising Nigeria’s PHC System’ in continuation of the Nextier Universal Health Coverage (UHC) Series.
The Nextier UHC Series is one of the flagship programmes of Nextier Health. It draws attention to contemporary health issues in Nigeria and globally through the views of health system experts and practitioners.
In his keynote address, the Lagos State Commissioner for Health, Professor Akin Abayomi, highlighted the urgent need to address the challenges in the country’s PHC system.
Abayomi, who was represented by Dr Ibrahim Mustapha Permanent Secretary, Lagos State PHC Board, said the foremost challenges identified included inadequate financing and human resources for PHC services in the country.
He cited weak governance and accountability structures, poor data collection and transmission systems, limited access to medicines and essential infrastructure in PHC settings and supply chain challenges.
He said there was a unanimous agreement that the PHC system would require significant improvement to achieve UHC.
“Furthermore, all relevant stakeholders across the public and private sectors need to intensify their effort and build sustainable partnerships to rejuvenate Nigeria’s PHC,” he said.
Prof. Chima Onoka; Head of Operations, Health Policy Research Group, highlighted the need for a clear delineation of the roles and responsibilities of the different tiers of government with unambiguous accountability processes.
Onoka, who is also a Community Physician, suggested that all levels of government should have financial autonomy to ensure they have the resources to perform their roles and responsibilities.
He said that local governments have not been able to effectively provide PHC services partly because they do not have direct control over their resources.
He further advised stakeholders at state and national levels to focus on programme implementation and also provide financial and technical support for the health system leaders.
He, however, said that such health system leaders should be held accountable for expected responsibilities and resources.
Onoka said that the role of Civil Society Organisations (CSOs), and development partners in ensuring accountability emphasised the need for proper incentives to be considered in the design of accountability systems.
The community physician called for a review of the scorecard for assessing performance in the primary healthcare system while citing best practices from other countries.
He recommended that stakeholders should present performance scorecards at universities and similar independent institutions that can objectively assess the performance of PHC programmes and interventions.
He, however, said that development partners, relevant stakeholders, CSOs and the public should be allowed to review the reports and ask the right questions.
According to him, this approach will enable stakeholders to ask the right questions and review performance more objectively.
Onoka explained that health system leaders and stakeholders needed to remove bureaucratic bottlenecks and create platforms that can enable them leverage available resources to achieve health system goals.
He called on state governments to create opportunities for relevant stakeholders, including the private sector, to contribute to their health systems, particularly at the PHC level.
The expert advised that the government must apply contextualised and pragmatic solutions to bridge the human resource gap.
He highlighted the need to revise the training curriculum of health workers.
He said that the government could save money on capacity-building workshops for fresh graduates by incorporating the training content into the curriculum of relevant academic programmes.
Onoka explained that it was pertinent for the government to work assiduously to build a high level of trust in the system as that would encourage more access to funds both domestically and externally.
He encouraged increased sustainable investments in the primary healthcare system with a focus on results.
He recommended learning from past failures and best practices, and advised relevant stakeholders to provide health system leaders with the financial and technical resources they require to perform optimally.
Dr Sam Agbo, Senior Health Advisor, Foreign Commonwealth Development Office, Nigeria, reiterated the need for a clear definition of roles and responsibilities.
Agbo recommended that the National Primary Health Care Development Agency (NPHCDA) should consider acting more as a supervisory agency and focus less on programme implementation.
He emphasised the need for improved coordination and synergy between the state ministries of health and primary healthcare development agencies.
He pointed out that local governments should have financial autonomy to empower them to take responsibility for organising the PHC system while the other tiers of government provide the needed oversight and support.
Agbo encouraged professional organisations like the Nigerian Medical Association, National Association of Nigerian Nurses and Midwives, Association of Medical Laboratory Scientists of Nigeria and Pharmaceutical Society of Nigeria to drive accountability.
He also emphasised the indispensable role of CSOs in increasing accountability within the PHC system and challenged them to be more active and strengthen their capacity to serve as drivers of accountability.
He explained that the people were the foremost stakeholders in a PHC system and that for the system to work, the people must know their rights, demand them, and hold leaders accountable.
According to Dr Emmanuel Okpetu, Head, PHC, Kuje Area Council, instead of directly implementing programmes, national and state government agencies should provide technical support and oversight for LGAs.
“This will bridge gaps at the PHC level with contextually appropriate solutions as that would help the three tiers of government to collaborate more effectively,” he said.
