Sone health experts have called for urgent revitalisation of Nigeria’s Primary Health Care (PHC) system to enable improved access to adequate medicare.
The experts made the call on Friday at the Nextier Health virtual dialogue on “Revitalising Nigeria’s PHC System“ in continuation of Nextier Universal Health Coverage (UHC) Series.
The News Agency of Nigeria reports that Nextier UHC Series is one of the flagship programmes of Nextier Health.
The series draw attention to contemporary health issues in Nigeria and globally through the views of health system experts and practitioners.
Akin Abayomi, the Lagos State Commissioner for Health, in his keynote address, 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 major challenges facing PHC services included inadequate financing and human resources.
He said that other challenges were weak governance and accountability structures, poor data collection and transmission systems, limited access to medicines and essential infrastructure in PHC settings and supply chain.
Abayomi said that PHC system would require significant improvement to achieve UHC.
“All relevant stakeholders across the public and private sectors need to intensify their efforts and build sustainable partnerships to rejuvenate Nigeria’s PHC,” he said.
Chima Onoka, Head of Operations, Health Policy Research Group, said there was need for a clear delineation of roles and responsibilities of all tiers of government to ensure accountability processes.
Onoka, also a Community Physician, said each tiers of government should have financial autonomy to ensure it had the resources to perform its roles and responsibilities.
He said that local governments had not been able to effectively provide PHC services partly because they did not have direct control over their resources.
Onoka advised stakeholders at Federal and state government 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.
He called for a review of the scorecard for assessing performance in the Primary Healthcare System with best practices from other countries as bench mark.
Onoka recommended the need for stakeholders to present performance scorecards to the universities and similar independent institutions, that could assess the performance of PHC programmes and interventions objectively.
He said that for more objective review performance, development partners, stakeholders, CSOs and the public should also be allowed to review the reports and ask the right questions.
“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.
Onoka said that health system leaders and stakeholders needed to remove bureaucratic bottlenecks and create platforms that could enable them leverage available resources to achieve health system goals.
He called on state governments to create opportunities for stakeholders, including the private sector, to contribute to their health systems, particularly at the PHC level.
The expert said that the government must bridge the human resource gap by revising the training curriculum of health workers.
He said the government could also save money on capacity-building workshops for fresh graduates by incorporating the training content into the academic programmes curriculums.
Onoka said it was pertinent for government to build trust in the system as that would encourage more access to funds both domestically and externally.
He said there should be increased sustainable investments in the primary healthcare system with a focus on results.
onoka said there was also need to learn from past failures and best practices, and advised stakeholders to provide health system leaders with financial and technical resources they required to perform optimally.
Dr Sam Agbo, Senior Health Advisor, Foreign Commonwealth Development Office, Nigeria, said there was need for a clear definition of roles and responsibilities.
Agbo said National Primary Health Care Development Agency (NPHCDA) should consider acting more as a supervisory agency and focused less on programme implementation.
He said there was also need to improve coordination and synergy between State Ministries of Health and Primary HealthCare Development Agencies.
Agbo said Local Governments financial autonomy would empower them to take responsibility for organising PHC system while Federal and State governments provide the needed oversight and support.
He said professional organisations, Nigerian Medical Association (NMA), National Association of Nigerian Nurses and Midwives (NANAM), Association of Medical Laboratory Scientists of Nigeria (AMLSON) and Pharmaceutical Society of Nigeria PSN) should be encouraged to drive accountability.
He said the people, who were foremost stakeholders in a PHC system, must know their rights, demand them, and hold leaders accountable.
“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.
”NGOs and CSOs should be people-oriented and advocate for interventions that mitigate disparities and protect vulnerable groups,” he said.
Agbo said that private sector should be given enabling environment to support the government to deliver on its mandate of ensuring that PHC system was built on the pillars of appropriateness, acceptability, accessibility, availability and affordability.
He said that the activities of development partners must be aligned and harmonised with government plans and people’s needs.
Agbo said that aligning programmes of development partners with on-ground priorities, remained a crucial strategy to ensure that donors’ catalytic investments made a difference and had far-reaching sustainable impact.
He said that before the Alma Ata declaration on PHC in 1978, Nigeria had a functional village healthcare system that provided services to the people at the community level.
Agbo said that in spite the present challenges being experienced, PHC system could be revitalised if all stakeholders were committed, worked tirelessly, acknowledged health as a human right and made it a political priority.
He described health as a business with a great return-on-investments and should be seen as such.
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.
Okpetu said that a clear distinction between implementation and oversight roles of different stakeholders were important.
He said that most oversight functions expected from national and state agencies had been overlooked because they paid more attention to programme implementation at the expense of the oversight functions.
Okpetu said the number, distribution, and quality of human resources in PHC system were suboptimal, adding that task-shifting and sharing were great strategy to bridge human resource gaps.
He said that government should 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 necessary policy changes that would make it easier for people to get trained to take up roles in the PHC system.
“The system is in dire need of human resources to provide clinical, laboratory and surveillance services,” he said.
Okpetu said that government should go beyond personnel recruitment and redistribution to ensure that appropriate incentives were in place to motivate PHC workforce and encourage personnel retention.
He said that community health extension workers were not motivated with ceilings which limit their career advancement.
“Incentives to be provided include career advancement opportunities and government-sponsored training with signed agreements for trained health workers to work for a specified time frame within the system or repay the cost of training,” he said.
Okpetu said there was need to allocate resources to carefully selected and clearly defined priorities.
He said that donors and development partners should avoid duplication of efforts and build trust with local stakeholders and focus on addressing real challenges within the health system based on priorities identified by the government.
Okpetu advised all tiers of government to consider innovative strategies to improve health system efficiency.
He added that governments could contract private sector to run non-performing PHC facilities and institute a pay-for-performance remuneration and financing system.
Dr Uju Onyes, a Health Policy and Financing expert, said there was need to reduce fragmentation in the health governance structure.
Onyes said the challenges of fragmentation was further complicated by absence of clear roles, responsibilities and accountability systems for PHC’s stakeholders and institutions.
She said that the deplorable state of PHC system and failed projects were due to poor accountability mechanisms in all tiers of government.
The expert said that stakeholders must work in synergy and deliver on their mandates as their collective action would strengthen the PHC system and make it resilient.
Onyes said although financial resources within national PHC system were inadequate, the inefficiency in resource utilisation was a challenge.
She said that governments and stakeholders should work towards revitalising the system as investments in PHC were cost-effective and would help Nigeria inch closer to UHC.