Seye depicts the true picture of the state of Primary Health Care (PHC) in Nigeria and what could be done. The outlook is not totally bad. however, PHC and and management need be revisited as this is the bedrock of achieving the Millennium Development Goals (MDG by 2015). 

My experience as a PHC service provider with the local government and currently working as a development worker reveals low community involvement and participation, more of facility based service provision than touching community directly. Since management involves people; the policy makers, service providers, clients, patients and community, I think there is need for re-orientation of all PHC stakeholders in Nigeria.

The gaps I observed shows that primary or community health workers lack health project development (proposal) skills and do not work much with the people to conduct community, mapping, formative research through Participatory Learning Approach (PLA) and findings do not necessarily influence policy or health budget. Findings may even be different from community to community, wards, LGAs and states. PHC covers many areas; MNCH, School Health, Elderly Care, Mental Health services, Disease Control, Essential Drugs and management, Management, Quality Assurance, Standards, Protocols and Policy and of cause accessibility which could be; geographical, financial and cultural. 

Many states in Nigeria are good in PHC service delivery but more of peoples’ involvement is necessary.

The remunerations, benefits and welfare of community health service providers especially those working in the rural areas should be looked into. Community Health Insurance and Drug revolving Fund should be looked into.

Our organization; Community Health Information Education Forum (CHIEF) through 2006-9 collaborated with Community Participation for Action in the Social Sector (COMPASS)/ USAID, in the program COMPASS enjoined community based association form an umbrella body; Community Coalition (CC) and to register with the LG, mobilize community resources and demand for improved quality services, create access and enabling environment, it was a successful program as the Community Coalition (CC) provided, land, energy generating sets, involved in Immunization programs etc. this program could be a model for community involvement and participation.

PHC is the surest way to achieve the Millennium goals and I feel all stakeholders should be re-orientated.

This article may shed more light: http://www.euro.who.int/__data/assets/pdf_file/0004/74704/E82997.pdf [*see note below]

Best Regards

Remi Akinmade, MCommH
Founder/CEO, CHIEF
Lagos
http://www.chiefngo.org 

I was a speaker at a symposium organized by the editorial board of DOKITA, the journal of the medical students association of the University of Ibadan which took place on 9th November 2011. My paper was titled REJUVENATING PRIMARY HEALTH CARE IN NIGERIA – THE IBARAPA EXPERIENCE. This paper can be downloaded at http://www.ifrs-rural.com/REJUVENATING%20PHC%20IN%20NIGERIA.pdf

The conclusion to the paper is:

‘We have shown that the Ibarapa Community and Primary Health Programme of the University of Ibadan has achieved its stated objectives in the spirit of community participation and the public/private partnership. What is left to be done is for all the ministries of health in the nation to take the bull by the horn and replicate the programme in all the local government areas.

‘The training programmes of the postgraduate institutions MUST BE RELEVANT, FLEXIBLE, AND ADAPTABLE TO REFLECT OUR NEEDS AT ALL THE THREE TIERS OF THE HEALTH CARE SYSTEM while we cannot lose touch with new developments and technologies that can be used to manage the changing patterns of disease or the emergence of a new pandemic of diseases common in industrialized countries. The ability to make virtue out of necessity is the greatest and immediate challenge of all’.

Thanks.

Yombo.

Oluyombo A Awojobi is a Consultant Rural Surgeon at Awojobi Clinic Eruwa, Oyo State, Nigeria

Thanks very much for your piece

Professor Abosede, a Professor of Primary Health Care, at the College of university of Lagos, gave a talk to us sometimes ago about why primary Health Care is not working maximally in Nigeria. She put the blame on weak or non-existent community participation. Whatever system is adopted, huge investment must go on the tripod of Community mobilisation, community advocacy and community diagnosis (the tripod on which community participation stands). For Primary Health Care, emphasis has to be on a bottom up approach. Strong Primary Health Care teams consisting of Community Health Workers supported by appropriately trained Family Physicians and general practitioners must be put in place. That is why Britain succeeded in universal Primary Care coverage for its populace both urban and rural.

Dr.Olayinka O. Ayankogbe MBBS (Ib) FMCGP (Nig.)FWACP(FM)(West Africa)
Senior Lecturer & Head , Family Medicine Unit
Department of Community Health & Primary Care
College of Medicine, University of Lagos, Nigeria

You may also want to look at the two pilot projects in Lagos state on community-based health insurance (CBHI) scheme, one of which is a mutual trust between the provider and the Community Development Association. The State Ministry of Health is still subsidizing the capitation.

It is important to also deal with the issue of Drug Revolving Funds (DRF) still operating at the PHCs in Ifo LGA and possibilities of political pronouncements on “free health services”.

There is a dire need for aggressive community awareness and mobilization as many may still be thinking that it is better to pay for service received rather than pay for future services!! CBHI is probably the best option but the challenges are frightening. We will get there some day and I pray it will be soon.

Olayinka Akanke Abosede is consultant in Community Health (Primary Health Care) at the Lagos University Teaching Hospital, an Associate Professor at the College of Medicine, University of Lagos, Nigeria 

We are thinking the same way! We are on the same page! In fact we have started a community based health insurance scheme as an intervention at Ifo Local Government, Nigeria in our area of operations as an interventional research. We would be extremely grateful if you could get us the report of the Ghana scheme earlier than November, pleeaaaaasee!!!!!! It would help us tremendously! we must scientifically prove the bottom up approach to the strengthening of Primary Health Care in Nigeria and by extension West Africa (and the rest of Africa?)!

Dr.Olayinka O. Ayankogbe MBBS (Ib) FMCGP (Nig.)FWACP(FM)(West Africa)
Senior Lecturer & Head , Family Medicine Unit
Department of Community Health & Primary Care
College of Medicine, University of Lagos, Nigeria

I
appreciate your excellent and articulate post. I believe you quite
eloquently summarized the primary health care delivery problem for not
only Nigeria, but many other developing countries as well. We had a
problem with “ghost doctors” when I lived in Ghana in 1999-2004, with
most of the medical care, even in towns, being provided by drug peddlers
on bicycles and traditional health providers.

I will be in Ghana
for several months soon, after an absence of many years. In the
interim, their National Health Insurance Scheme was implemented, using
donor funding. This funding may be coming to an end. While my purpose is
to discover wound management practices in the most remote villages, I
may also learn how well their health insurance system seems to be
working in reality, rather than only on paper. If I learn anything
helpful, I will report back in November.

Sometimes it is easier to see changes when one is not living through them.

Blessings,
Linda Benskin, BSN, RN, SRN (Ghana), CWS, CWCN, DAPWCA
Doctoral Nursing Student, University of Texas Medical Branch, Galveston

HIFA2015
profile: Linda Benskin is a Doctoral Nursing Student, University of
Texas Medical Branch, Galveston, USA, Ghana, and tropical developing
countries. Professional interests: wound management, teaching village
health workers, teaching nurses, pediatrics. lindabenskin@utexas.edu