Revitalising PHCs Across Nigeria with NSHIP  

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By Kazeem Akintunde

The trip to Nasarawa State was meant to be a brief one. The agenda was for the Minister of Health, Professor Isaac Adewole, to inspect three Primary Health Care facilities funded in three different ways to test-run the Nigeria State Health Investment Project (NSHIP), and to pay a courtesy visit to the state Governor, Alhaji Tanko Al-Makura.

A workaholic that he is, he directed his staff to fix other appointments for the day from 4pm, believing that he would have returned to Abuja after the ‘short trip’ to Lafia.

 But the ‘short trip’ to the state capital from Abuja took Adewole the whole day. Even at that, he was happy he went on the tour.

The one-day inspection of three PHC facilities, funded in three different ways, was an eye opener for the Minister.

The tour was part of a mid-term review of the implementation and impact evaluation of NSHIP in the three pilot States of Adamawa, Nasarawa, and Ondo, and was designed to assist the Federal Government in deciding which funding method is best for the management of Primary Health Care Centres, PHCs, across the country.

The inspection took Adewole and his team to the PHC centre in Andaha, Akwanga Local government Area of Nasarawa State; he also inspected the non PBF, non BPF, 10-staff facility at Wulko, Nasarawa Eggon Local Government Area of the state, as well as the PHC at Alizaga, Nasarawa Eggon. And at the end of the day, the tour actually achieved the purpose which it was meant for.

Indeed, there are three models of funding used for the three PHCs visited. These are: Result Based Financing (RBF), Performance Based Financing (PBF) and Decentralised Facility Financing or Direct Facility Financing (DFF).

Since his assumption of duty in 2015, the revitalisation of over 23,000 Primary Healthcare facilities across the country has been the cornerstone of his health care delivery projects in the country. He is of the view that if the basic healthcare needs of Nigerians could be provided for at the PHCs level, over 80 per cent of Nigerians would have been covered with adequate health care guaranteed for millions of Nigerians.

This way, there would not be much pressure on Secondary and Tertiary level of healthcare delivery programmes in the country and the slogan of health for all would have been adequately met.

In consolidation of this fact, he set out to revitalise an already comatose healthcare programme at the local level by ensuring that there are adequate and well-trained staff, drugs and other essential facilities available at most PHCs across the country.

Though most of the PHCs are owned by state governments, Professor Adewole, with support from President Muhammadu Buhari, promised to assist states in getting the required funds from international donors, many of whom are keen on rendering assistance to the country in the provision of healthcare facilities for the people.

His plan is to revitalise three healthcare facilities in three different pilot states of Adamawa, Nasarawa and Ondo States in order to determine which model of funding to recommend to the governors- a model that should be implemented by the people who are expected to own and manage these facilities.

At the end of the tour, a happy Adewole told Newsmen that the essence of the mission was to visit three facilities that are funded in three different ways. “We have visited a PBF supported facility, a DFF supported facility and one that is an orphan with no support, and the different is clear.

“Part of our challenge is to decide which one we are going to use to fund PHCs all over the country. Maybe I am biased, but I am a supporter of DFF, and if you ask me to grade the PHCs I have visited today, the DFF is the best, followed by the one in Akwanga and then the other one at Wulko.

“Our job is to adopt a model that is peculiar to the people as we don’t want to do anything that is strange to them, we want the people to decide on their own, which model to adopt, own it, manage it and then make it work. It won’t be owned by the federal government, the state won’t own it, but they can render support, and we are going to put the policy there; it belongs to the people at the local level.” He added that the federal government intends to have one state-of-the-art PHC in each of the 774 local governments in the country and would probably adopt the Decentralised Facility Financed model.

During his courtesy visit to Governor Al-Makura, Professor Adewole pleaded with governors to allocate more resources to the healthcare sector, describing such a gesture as a win-win situation. He noted that once there was an excellent facility at the local level where people can treat Malaria, attend anti-natal clinic, deliver safely and immunise their children against killer diseases, most governors would not need to give money to the electorate to vote for them during campaigns, as the people would identify with such a government.

“Investing in Primary Healthcare facilities is a win-win, as I have said severally, if you invest in PHCs, it is certain the people will vote for you. They will identify with you because you have identified with them,” Adewole said.

He told the Nasarawa State Governor that the federal government would support the state’s School of Nursing in its bid to provide middle level manpower to the state by ensuring that its programme is fully accredited.

The Minister of Health also promised to promote partnership between the federal government and the state by deploying medical doctors employed by the federal government to assist the state government in its healthcare delivery programme.

“Most of our medical doctors at the Federal Medical Centres don’t do much. They attend to two or three patients in a day and that is it. We have it in Sokoto State and we want to encourage that in most of the states across the country. With little incentive for the doctors, they will be willing to assist you.  In Nigeria, primary healthcare was adopted in the National Health Policy of 1988 as the cornerstone of the Nigerian health system as part of efforts to improve access and utilisation of basic health services. Since then, primary healthcare has evolved through various stages of development.

In 2005, primary healthcare facilities were found to make up over 85% of healthcare facilities in Nigeria.

Historically, there were three major attempts at evolving and sustaining a community and people-oriented health system in Nigeria. The first attempt occurred between 1975 and 1980. The fulcrum of this period was the introduction of the Basic Health Services Scheme (BHSS).

It came into being in 1975 as an integral part of Nigeria’s Third National Development Plan (1975 – 1979) and was structured along ‘basic health units’ which consisted of 20 health clinics spread across each LGA, which were backed-up by four primary healthcare centres and supported by mobile clinics serving an approximate population of 150,000 each.

The drawback of this attempt was the non-involvement of local communities, who were the beneficiaries of the services. Thus, the Scheme became unsustainable at the close of the third national development plan period.

A second attempt, which was led by late Professor Olukoye Ransome-Kuti, occurred between 1986 and 1992. This period was characterised by the development of model primary healthcare in 52 pilot local government areas, all of which were implementing all the eight components of primary healthcare.

A key result of this dispensation was the attainment of 80 per cent immunisation coverage for under-five children.

Since then, there has not been any significant step taken to broaden the scope of PHCs by successive administrations in the country until Professor Adewole came along in 2015.

His approach was that since most Nigerians live in the rural areas with little or no access to healthcare facilities, the best approach to reach them was to revitalise the PHCs across the country. Although health is on the concurrent list, Adewole’s approach saw the need to set up a model PHC in each of the 774 Local Government Councils across the country that would be supported by the Federal Government with funds coming from International donor organisations.

He is also of the view that if basic healthcare needs of the people can be taken care of at the PHC level, then 80 per cent of healthcare needs of most Nigerians would have been taken care of. “Once we can treat Malaria, provide anti-natal, treat children of common ailments, provide immunisation for newborns up to five-year olds, test for HIV and other minor ailments, the healthcare needs of most Nigerians would have been covered,” he said.

He has been preaching the gospel of revitalised PHCs to governors, assuring the chief executives at the state level that once there was a fully functional PHC at the local level, winning elections would become a done deal as the people would vote for those who took care of their health needs.

–Akintunde is the Special Assistant, Communication and Strategy to the Minister of Health

 “I have been preaching to governors that they don’t need to give money to voters during campaigns or on Election Day. Once you provide basic healthcare for your people, your re-election is a done-deal.”

It is hoped that his plan for a revitalised PHC system using NSHIP as a springboard would go a long way in turning the nation’s healthcare sector around for the better.

–Akintunde is the Special Assistant, Communication and Strategy to the Minister of Health