We deed a comprehensive Research about The Future of Primary Health Care in Nigeria
The Future of Primary Health Care in Nigeria
When I took office in 2007, I made clear my commitment to direct WHO’s attention towards primary health care. More important than my own conviction, this reflects the wide spread and growing demand for primary health care from member states. This demand in turn displays a growing appetite among policy makers for knowledge related to how health systems can become more equitable, inclusive and fair Dr. Margaret Chan(director of WHO).
This peculiar statement was made by this visionary expert who wanted to put all hands on deck to see that primary health care was attainable, easily standardized and accessible to individuals after many years of the Alma-Ata declaration of 20th Sept. 1978 Kazakhstan (former USSR) which postulates that the primary health care; reflects and evolves from the economic conditions and socio-cultural and political characteristics of the countries and its communities, addresses the main health problems of the community providing promotive, preventive, curative and rehabilitative services accordingly, includes at least health education concerning prevailing health diseases, immunization, family planning, maternal and child health, sanitation and provision of drugs, coordinates or collaborates with other sectors e.g. food, animal husbandry, housing, education, shall also involves community and individual participation etc. This report was explicit with possible suggestions of promoting, maintaining and sustaining primary health care in the member states including Nigeria.
All items of the paradigm were planned in order to hold fixed the roots of the establishment but on the contrary I would say that “the future of the primary health care in Nigeria” is likened to a dry wood in a burning furnace if proper, adequate and meticulous measures are neglected. This is because the factors that has held it captive from extensive development and progression are yet to be resolved completely. It is not far-fetched, that lack of medical personnel as well as their uneven distribution has contributed to the failure of primary health care giving it a no future. Health practitioners have become limited in meeting the demands of individuals and communities.
They are unevenly distributed having a larger concentration in the secondary and tertiary health cares. In fact these days, they no longer want to work in the primary health cares because of the benefits attached to other levels. So, they prefer to resist its services. It has become an eye sore to them when they can’t behold the services to humanity but rather the roses that follow suit. Many today have neglected the services of the primary health cares in Nigeria due to the fact that medical practitioners are absent, not ready to work due to laxity, or those that are present are quarks who have taken the mantle upon themselves as a result of the absence of the trained and qualified medical personnel who ought to have occupied those positions of services.
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So when those clients face harm, injury, harassment or trauma including depression from the unqualified personnel that have impersonated then they lose confidence in the individuals and resist them and the entirety of the health care. Creating a vacuum of no patronization. You find inadequate traditional birth attendants in delivery sessions increasing maternal and child morbidity, infant mortality, blood loss and organ damages.
Inadequate facilities and deterioration in government facilities are also factors that are threatening to bring to silence the future of the primary health care in Nigeria.
In every organization facilities or equipment plays a major role in the achievements and actualization of the goals and objectives of the institution. When facilities are inadequate or deteriorated productive function is retarded. Some of the facilities found in our primary health cares in Nigeria today are inadequate, insufficient and unproductive. Even the little that are present in some primary health cares are deteriorated. It has become a dumping house for old and expired vaccines, including drugs. The drugs that are common are few analgesics such as paracetamol, aspirin, pethidine, pyroxycam, procold, and malaria drugs. Other community health challenges that requires medication above this becomes a problem and cannot be found in the care Center. So, you find on daily basis high mortality and morbidity that minor diseases whose drugs ought to have been available are absent. Lack of good storage facilities has also been an issue of contention.
The few drugs present cannot be preventively and adequately stored for future use. After probing into some primary health cares in Nigeria like primary health clinic Jikwoyi, primary health care Karu in Abuja I discovered that most of the equipment supplied and the vaccines are inadequate and dumped because they have been deteriorated.
Accessibility and topography of many communities have posed a threat to health practitioners. No good access roads to the rural areas where the primary health cares are located. Individuals have to trek long distances from their homes to the care centers bare footed because cars can’t ply on such bad roads. A rigorous and strenuous kind of lifestyle have prevented many medical personnel from taking responsibility in such areas.
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This detriment and predicament has only created a footpath and is digging a ditch in the future of the primary health care. What this means is that a time is coming when no patient or client will be found in those care centers when medical personnel are not available. Thereby leaving the establishment to be deteriorated and possibly collapsing sequel to lack of activities, care and maintenance.
Over years now since the inception of democracy and the advent of independence, Nigeria has been facing political problems ranging from corruption, economic crisis and political instability. We have had several leaderships who have failed their promises to fund the primary health care. Corruption has made political leaders neglect the health care and the activities are fading off day by day. Failure to fund the PHC in Nigeria has contributed to the retarded growth and is still posing a threat to the future of PHC. Right allocation of resources to various levels of health including PHC has been deprived and so they are still lying in their ruins and dilapidated buildings. No new vaccines, equipment, nor distribution is reaching the PHC.
The strength of any establishment, institution or organization depends on its financing strength. Couple with the economic crisis in the country how do we meet the demand now and how do we intend to solve the problem when in the time that things were better we never gave it much attention?
The future of the primary health care is at stake if these factors continue to tarry or linger. Contracts are no longer awarded to individuals to establish primary health cares. Even the ones that are given are not supervised by the government. So there is lack of supervision of government over the delivery of allocated projects. Just as Jesus saved the world through his death on the cross that those who believe in him will have everlasting life the same approach the government needs to tackle this problem. It needs to give, distribute or allocate funds for the development and management of the PHC affairs, supervise that all monetary or resource allocation have been carried out successfully to the later and finally needs to save the PHC by prosecuting those infidel, culprits and deviants that loot public funds that are allocated to the health cares, primary health care in particular.
Non- governmental and international collaborations is also a factor to consider when trying to visualize or analyze the possible things the future holds for us. Non-governmental organizations were supposed to support the primary health care in funding, material and equipment sourcing and infrastructural development. According to the statement of world federation of public health association (WFPHA) primary health care are funded also by non-governmental organizations (NGOs).
The whole burden is not in the hands of the local government (LGA) alone though they provide the lion share of the funds. But in Nigeria the case is different. NGOs no longer want to invest or even give in support of the establishment. The whole burden has been laid on the local government whom at times may not even receive the allocation meant for them from the state government. Sometimes the available is small inadequate to meet the demands of the PHC. Therefore, leaving it in a state of anomie, mismanagement and wretchedness. In fact if you visit some primary health cares in Nigeria you will be surprised by what you will see because some of them look like grave yards. As a result of insufficient funding to pay salaries of the few health practitioners in the primary health care they steal the few vaccines, drugs and other marketable valuables and sell them in order to meet up the insufficiency of their salaries because most of them have families, relatives and responsibilities to carter for.
This is how extreme it is but I still see no measure taken to improve resilience and efficiency that is why I am saying again that the future of the primary health care in Nigeria is likened to a dry wood in a burning furnace.
Poor inter sectorial collaboration ensues the primary health care as food, animal husbandry, education, communication and housing sectors among others are no longer interested in collaborating with the primary health care in meeting the health needs of families and individuals in the community. The reason is that some of them want entrepreneurship benefits which they are not getting much. So they feel they are losing. Others feel there is no need to collaborate with the PHC because it is already portraying features of crashing.
The future holds nothing for it so why should they invest or collaborate? So these danger signals weird them away leaving the battle for the PHC creating more pressure on it. Many sectors have abandoned the PHC using Jikwoyi in Abuja as a case study and its foot is on the last outermost layer of the soil dancing to its future death. As a result of the pressure there is no focus again. No good roads, bad water, no electricity, no good food, poor communication, poor housing, etc.
The aims and objectives as proposed or reported by the Alma-Ata conference has drastically not been met to the larger extent. Just a little has been met but the factors threatening it are still lingering so the future once again is at stake.
Lack of research is a key factor deteriorating the PHC in Nigeria. Research is one of the acts that keeps a profession, occupation, and an organization going and successful. It finds reasons for failure and generates answers for success. Formulation of health policies and regulations are greatly carried out by the level of knowledge gathered through research work. But how can workers in the PHC who are not well paid, lack facilities, suffer stress and living in dilapidated buildings think of research to boost or foster the development and sustenance of the primary health care? Since research has proven difficult or has been neglected they continue to live and practice in old ways and principles even when it may cause harm to patients. Thereby, investing nothing tangible that will sustain and maintain the future of PHC in Nigeria.
In conclusion, many health practitioners have forfeited their functions, had displeasure in their jobs and have quit their jobs in search of other opportunities just because of the unfavorable conditions and atmosphere created due to the fact that they don’t see any hope of improvement in the recent threatening factors. Let me say at this point that Nigeria has the ability and capacity to triumph and have a glorious future for PHC only if we can tackle these factors effectively. Let the government play its role, improve inter collaborative sectors, and let NGOs act proficiently.
DANLADI AMINU R.N, BNSc, PGDE in view