Experts in the health sector have urged the Federal Government to pay attention to the improvement of Nigeria’s primary health care (PHC) system to enable improved access to adequate medical care.
They unanimously made this call today (July 22, 2022) during the NexTier Health Virtual Dialogue on ‘Revitalising Nigeria’s PHC System’ in continuation of the Nextier Universal Health Coverage (UHC) series.
In his keynote address, the Lagos State Commissioner for Health, Prof. Akin Abayomi, highlighted the urgent need to address the challenges in the country’s PHC system.
Abayomi, who was represented by the permanent secretary, Lagos State PHC Board, Dr. Ibrahim Mustapha, 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.
In his remarks, the head of operations, Health Policy Research Group, Prof. Chima Onoka 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.
The expert 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 present performance scorecards at universities and similar independent institutions that can objectively assess the performance of PHC programmes and interventions.
Onoka, however, said that development partners, relevant stakeholders, CSOs and the public should be allowed to review the reports and ask the right questions. This approach, he said, will enable stakeholders to ask the right questions and review performance more objectively.
“This is in contrast to the current practice in which performance scorecards are presented to the board of the same organisation or public without giving room for effective engagement and unbiased assessment of PHC performance,” he said.
He encouraged increased sustainable investments in the primary healthcare system with a focus on results.
Onoka 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.
Earlier, the senior health advisor, Foreign Commonwealth Development Office, Nigeria, Dr. Sam Agbo, reiterated the need for a clear definition of roles and responsibilities.
Agbo recommended that the National Primary Health Care Development Agency (NPHCDA) considers 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.
The expert advised that local governments have financial autonomy to enable them 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.
Also, he 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.
“Furthermore, the people are responsible for applying basic health education principles.
“Countries like China, India, Pakistan, Rwanda, Mali, and Niger with high-performing primary healthcare systems all have a people-centred and driven system,” he said.
He called on stakeholders like NGOs and CSOs to be people-oriented and advocate for interventions that mitigate disparities and protect vulnerable groups.
According to the head, PHC, Kuje area council, Dr. Emmanuel Okpetu, instead of directly implementing programmes, national and state government agencies should provide technical support and oversight for LGAs.
Okpetu also said that a clear distinction between the implementation and oversight roles of different stakeholders was important.
He said that most of the oversight functions expected from national and state agencies had been overlooked because these stakeholders paid more attention to programme implementation at the expense of their oversight functions.
Okpetu acknowledged the role of a well-trained and motivated workforce in a functional PHC system.
He said that the number, distribution and quality of human resources in the country’s PHC system were sub-optimal.
The health expert attested to the value of task-shifting and sharing as a strategy to bridge human resource gaps, based on his experience managing 47 PHC facilities in the council.
He recommended that the government expand the scope of task shifting and sharing beyond maternal health services to include other conditions like non-communicable diseases.
Okpetu called on the government to make the necessary policy changes, to make it easier for people to get trained to take up roles in the PHC system.
Similarly, a health policy and financing expert, Dr. Uju Onyes, harped on the need to reduce the fragmentation in the health governance structure.
Onyes said that this challenge of fragmentation was further complicated by the absence of clear roles, responsibilities and accountability systems for PHC’s stakeholders and institutions.
