In January 2017, President Muhammadu Buhari, at a fanfare event in the Federal Capital Territory, promised Nigerians that his administration will revitalize 10,000 Primary Health Care Centres (PHCs), but till date, not a single primary health care centre has been revitalized, BusinessDay findings show.
An official in the National Primary Healthcare Development Agency (NPHCDA), told BusinessDay that government has only succeeded in renovating about 4,000 of these facilities, but they are lacking the most basic ingredients that makes a functional PHC, the most basic port of healthcare delivery.
Experts say failure to revatilize these centres and stimulate demand is aggravating access to basic care especially at a time when the country is battling the devastating COVID-19 pandemic and is currently in a more deadly second wave. They note that the centres have not been useful in the battle against COVID-19.
Health authorities are have also admitted that these facilities are in a deplorable state. Osagie Ehanire, Nigeria’s Health Minister said government is working on a new design to remodel these PHCs and make it state of the art.
Meanwhile, the latest data from the National Health Management Information System (NHMIS) shows that outpatient visit dropped from 4 million to about 2 million; antenatal visits from 1.3 million to 655,000, skilled birth attendance from 158,374 to less than 99,000 while immunisation services reduced to about half.
Experts explained that the reason for this is because Nigerians do not have access to other levels of the healthcare system where COVID-19 management is being provided and the PHC facilities are not functional and hence not incorporated in the national COVID-19 pandemic management to provide the gateway to management of common illness and other preventive and promote healthcare.
Obinna Ebirim, Public Health and Health Promotion Specialist and National Coordinator of New Incentives, said if PHCs were functional and playing their role during the COVID-19 pandemic, more Nigerians will not die from the lack of access to care of other diseases than from COVID-19 or hundreds die from a strange diseases in local communities.
Ebirim said PHCs can also be instrumental in contact tracing or diagnosis of COVID-19 and educate community dwellers on preventive measures.
“It is important to note that during COVID-19 pandemic, people will still be susceptible to other infectious diseases so they need Immunization, women will get pregnant and give birth so they need antenatal services and facility delivery by an experienced health worker, and the people will still have common ailments that require management at our primary healthcare facilities.
“It is also key to note that the management of the COVID-19 pandemic does not start with testing, admission into an isolation unit and contact tracing but there are stages of awareness creation of the disease and it preventive measures, diagnosis and referral for testing which ought to be carried out mainly in primary health care facilities if they were functional”, Ebirim explained.
He said a functional PHC will need to have well trained work force on Infection prevention and control (IPC) and case identification of COVID-19 such that appropriate referral is made to testing sites or designated centres for management of COVID-19.
Ebirim also said revitalisation should not only include infrastructural development such as building and equipping health facilities but we need to revitalise along the 6 building blocks of the health system: Leadership / governance (stewardship); health financing; service delivery; health workforce (or human resources); information (and data systems); medical products, vaccines and technologies.
Obeche Abdul, a public health analyst also agreed that functional PHCs cannot be overlooked especially as the country is in community transmission stage of COVID-19. He said PHCs have the ability to penetrate communities than any other health care institution.
He stressed that the best tool to control community transmission is PHCs.
Patrick Dakum, chief executive officer (CEO), Institute of Human Virology Nigeria (IHVN), warned that if PHCs are not involved, community spread can’t be managed and increased transmission will lead to higher morbidity and mortality. He also said PHCs can be an effective tool in managing mild cases especially in people below 50yrs as well as vaccination when vaccine becomes available.
In September 2019, the federal governments in disbursed N6.5 billion to 15 states and FCT, but findings have revealed that none of the states are yet to access the fund and the money has not reached any PHC in the beneficiary states.
The N6.5 billion disbursed in September, 2019 is 50 percent of the N13.775billion Basic Health Care Provision Fund (BHCPF) appropriated in 2018. The beneficiary states are; Kano, Lagos, Katsina, Kaduna. Bauchi, Oyo, Delta, Adamawa, Anambra, Plateau, Edo, Imo, Yobe, Ebonyi, Bayelsa and the Federal Capital Territory.
Olayinka Oladimeji, an official at the NPHCDA said what he been done so far are simply renovations as a good number of the facilities lack the basic facilities.
According to him a functional PHC goes beyond standard rehabilitation to having the facilities equipped with laboratories, personnel, uninterrupted supply of consumables, efficient logistic chain, and basic amenities among others. He said a functional PHC should be able to stimulate demand from the citizens.
He disclosed that some PHCs in Lagos, the epicentre are being shut down despite the ongoing pandemic.
Oladimeji also noted that the BHCPF is not enough to keep PHCs running. In addition, the guidelines to accessing the fund are difficult and cumbersome. He said the fund is still lying idle while citizens are dying.