Primary Health Care took the world center stage in 1978 at the International conference on Primary Health Care where countries signed on to the Alma-Ata Declaration as a major milestone and key for the attainment of the goal of Health for All. Following the strong call by World Health Organization for countries to return back to the Alma-Ata declaration 40 years after, how well has Nigeria fared in achieving a functional Primary Health Care System.

Recently, The ‘Primary Health Care Under One Roof’ (PHCUOR) initiative became a national policy in 2011, when the National Council for Health approved the initiative along with its implementation guidelines. Each State in Nigeria was to create a State Primary Health Care Development Agency/Board that is responsible for implementing primary health care and ensuring its functionality. Furthermore, the National Health Act 2014 made the establishment of state PHCDA/B a condition for states to participate in the Basic Health care Fund established by the Act. However, since 2013, each State has achieved varying degrees of success in the nine domains that formation and advancement is measured against.

A PHCUOR scorecard was initiated to assist States identify, in a systematic manner, areas within the PHCUOR framework in which they need support. The scorecard is a peer review mechanism as well as an advocacy tool to Government and stakeholders for the purpose of facilitating symmetrical and synergistic implementation of the policy nationwide. In 2015, the PHCUOR scorecard assessment emotional support animal highlighted various gaps and challenges that each State Agency was experiencing. However, the scorecard proved to have its own limitations in accurately assessing the progress each State had made. Furthermore, many States face strong opposition as the concept of PHCUOR (which involves one plan, one management and one M&E) is still very alien to key stakeholders.

The health system of the nation cannot function unless Primary Health Care, which is the foundation and base of the health pyramid, is rightly positioned. Key stakeholders do not understand the concept of PHCUOR, there is duplication of functions, wastage, poor coordination, inefficient and poorly funded Primary Health Care system presently in the country. It is against this background that the Cross River State government is eager to host a collaborative summit with all stakeholders involved in the Primary Health Care system in Nigeria.

 

Primary Health Care (PHC) is the first point of contact with the health care system for Nigerians. It is the level at which short-term, uncomplicated health issues should be resolved. It is also the level at which health promotion and education efforts for illness prevention are undertaken, and where patients in need of more specialized services are connected with secondary care. When the PHC system performs well, it meets the vast majority of people’s health needs, which is essential to make progress toward the nation’s health goals and indicators.
Unfortunately over the years, the existence of multiple administrative structures at the State level with concurrent and overlapping responsibilities have created challenges for the effective and efficient delivery of PHC services.
Health indicators in Nigeria are some of the worst in Africa. According to a WHO estimation in 2015, under- five mortality ratio was 105 deaths per 1,000 live births in Nigeria, equaling about 760,000 deaths per year. Ranked 152nd out of 187 countries globally, Nigeria has one of the worst infant mortality rate in the world. The maternal mortality ratio was 575 deaths per 100,000 live births, ranking Nigeria as the 11th highest rate in the world.
The country accounts for an estimated 23% of malaria cases worldwide and a third of all malaria related deaths. Deaths due to malaria were 106 per 100,000, with malaria being the main cause of death for children under the age of five. Malaria cases overwhelm Nigeria’s health system causing 60% of the country’s outpatient visits and 30% of hospitalizations among children under the age of five.

There is lack of confidence and trust by the public in the health services resulting from the poor state of facilities and low standards of delivery. The poor working conditions have resulted in a mass exodus of health care professionals over the years, reducing the health work force at the PHC level to an abysmal state. As a result, the PHC system is currently catering for less than 20% of the potential client. The health pyramid, which should have PHC at its base is now inverted, with people going to tertiary health institutions to treat rashes, malaria, or even diarrhea disease.
Response
Recognizing the slow development of PHCUOR in spite of the national policy being focused on Primary Health Care revitalization, the National Primary Health Care Development Agency, working with the Forum of Chief Executives of State PHCDA/MB is eager to bring all stakeholders together to share challenges and experiences across all State Agencies and boards, to ensure Agencies can meet health targets, and strengthen the health system as a whole. This has led to the call for a national health summit for PHC.
The goal of the summit is to x-ray the national PHC development 40 years post Alma-Ata declaration, Identify gaps and work out solutions, improve collaboration in PHC, identify all relevant partners and their mandates, and pinpoint the challenges and barriers present to achieving PHCUOR. The four-day health summit will take place in Calabar, Cross River State, with the nine pillars forming the basis of the agenda and discussions. At the end of the summit, it is expected that Federal and state Governments as well as partners roles in PHC will be spelt out clearly, overlap in PHC coordination, activities and program be reduced, and State Agencies/Boards will have the opportunity of learning from one another on how to advance effectively in implementing PHCUOR. Furthermore, a communiqué will be drafted arising from all resolution at that meeting, which will be presented for adoption at the next National Council on Health meeting.