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Below are vital operations of the primary healthcare system:
- The availability, accessibility, and affordability of health services for communities to attain universal healthcare;
- Health education and effective immunization programs for the population to ensure their participation in the prevention and control of diseases;
- The public healthcare system aims to find solutions (most often prevention and cure) for communicable diseases to prevent the increase in mortality and morbidity rates in the population;
- The PHC works to equip communities with crucial knowledge, tools, and funds to access water and sanitation to prevent diseases;
- The promotion of mental health and rehabilitation is also an important component of PHC. They also ensure the patient gets access to all health-related services and products without leaving their locality, promoting an effective medicine distribution network.
- Maternal and child healthcare has always been a well-known component of this sector, as it aims to reduce the casualties of maternal and child mortality. Services such as antenatal, postnatal, and safe delivery care are all incorporated into this component.
- The referrals of patients with advanced conditions and effective prevention and control of locally endemic diseases, e.g., dengue fever, Lassa fever, and Ebola;
- Advocacy for proper food and nutrition to prevent a wide range of diseases that often plague societies Also, the prevention and control of non-communicable diseases, as they pose a huge mortality risk to the health sector,
THE PRESENT STATUS OF PRIMARY HEALTHCARE IN NIGERIA
The current state of the PHC system in Nigeria does not look good, as only about 20% of the 30,000 PHC facilities across Nigeria are fully functional. Despite the vital role this system plays in our health sector, most of the facilities cannot even provide essential primary healthcare services. The federal government allocated 5% of its budget to health in 2021, compared to the 15% it pledged as part of the 2001 Abuja Declaration, leaving the sector ill-funded and underequipped. Our healthcare infrastructure is still very underdeveloped and lacks modern medical facilities. The country’s healthcare indicators are some of the worst in Africa, as centers face problems ranging from poor staffing to poor distribution of health workers, poor quality of healthcare services, poor condition of infrastructure, and even a lack of essential drug supplies. Although Nigeria has one of the fastest-growing population rates globally, with 5.5% live births per woman annually, it is even estimated to become the world’s third-most populous country by 2050. Still, we are in short supply of medical professionals, with only about 35,000 doctors despite needing about 237,000, partially due to the massive migration of healthcare workers overseas. This alone leads to an annual loss of about $2 billion to medical tourism.
THE FUTURE: A WAY FORWARD
Health is indisputably an essential component of the fundamental human rights of citizens, but unfortunately, for a heavily populated country like Nigeria, where income inequality is deeply rooted, it is essential to examine the healthcare system through an equitable health lens, which includes accessible, affordable, and functional healthcare for the masses. So far, in a bid to restructure and rebirth a far more functional primary healthcare system and attain health equity, the Federal Government has signed about 10 memoranda of cooperation between the Nigerian Sovereign Investment Authority, Ministries of Health, and other healthcare providers across the country’s six geopolitical zones, and six of these agreements have already progressed into the advanced stages. Also, the Ministry of Health has set goals of ensuring seamless access to health care for 100 million Nigerians across the geographic region of the country and plans to build 10,000 primary health centers throughout the country, at least one in each ward. Interestingly, about 5 years after this project launched, a lot is yet to be accomplished due to a lack of funds, a sustainability plan, and even human power and resources.
In addition to this, the government is considering reducing the barriers to insurance coverage. Introduced in 1999, Nigeria’s National Health Insurance Scheme (NHIS) targeted universal coverage, yet penetration remained persistently low—less than 5% enrolment. In May 2022, President Muhammadu Buhari signed into law the recently passed National Health Insurance Authority Bill 2022, repealing the National Health Insurance Scheme Act. The new law is designed to ensure the inclusion of more than 83 million poor Nigerians who cannot afford to pay premiums as recommended by the Lancet Nigeria Commission. Stakeholders in this sector, such as the NHIS and health maintenance organizations (HMOs), are also calling for the institution of policies that will mandate employers with more than 10 employees to provide health insurance as a key component of the employment package.
Furthermore, the launch of the pandemic has been instrumental in highlighting the need for significant investments in the healthcare sector. Policies are being reviewed to ensure more commitment from political leaders in the implementation of policies, strategies, regulatory frameworks, and better budgetary allocation to improve the primary healthcare system, including better healthcare staff remunerations. Also, policies to help reduce foreign health tourism by individuals include the establishment of adequate supervision, monitoring, and evaluation of programs to ensure that abuse, wastage, and misappropriation of funds are avoided in the system. The Ministry of Health is tirelessly working on these and more, in collaboration with other relevant government departments, to transcend the state of primary healthcare in Nigeria and promote health equity.