By Thelma Chioma Abeku & Aloysius Ugwu (Lead Writers)
“Achieving equity in health care depends on equity in health education” — University of Global Health Equity, Rwanda.
Since the global target of Health for All was declared in 1978, Primary Health Care (PHC) is universally recognized as the approach to achieving this goal. A primary health centre should be the first place where people seek healthcare. A functional PHC ensures people receive comprehensive care which begins from promotion and prevention to treatment, curative, rehabilitation, and palliative care that is accessible to everyone in the community.
The centrality of the PHC to health and wellbeing of communities is aptly described by the World Health Organization — It is estimated that throughout the course of a person’s life, primary care can meet 80–90% of his/her health needs. Research has shown that health-seeking behaviour is influenced by various factors including quality of service delivery, proximity of health facility, affordability of services, and availability of drugs amongst others. Unsurprisingly, most Nigerians now resort to patent medicine stores as the preferred place to seek healthcare when they are sick. The associated dangers of this can be overwhelming — people could lose their lives due to poor quality of care and other mishaps.
To improve utilisation of Nigeria’s primary health centres, which are at the heart of the primary health care system, the following needs to be done:
Improving the standards of Nigeria’s primary health centres
PHC revitalization is key in achieving Universal Health Coverage (UHC). The World Health Assembly in 2005, adopted a resolution in which countries were encouraged to develop strategies that will ensure all people have access to needed healthcare services without the risk of facing any financial hardship at the point of care or after accessing care. Nigeria is signatory to the post-2015 SDGs and UHC agenda.
Despite being a signatory to these resolutions, the government of Nigeria and other healthcare stakeholders are still faced with the huge task of providing standardized care for its citizens at the grassroots.
According to the World Health Organisation, scaling-up PHC interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030. To enable PHCs meet the required standard care, a functional primary health centre should have skilled human resources, medicines, infrastructure, Water, Sanitation and Hygiene (WASH) facilities, should be easily accessible to the community, as well as deliver patient centered healthcare services. A report by Nigeria Health Watch, which assessed the WASH services in PHCs in the Federal Capital Territory and Niger State, revealed that 70% of the hospitals assessed do not have running water in the toilets. This shows clearly that there should be an increased sense of urgency for strengthening WASH services as well as improving infrastructure to increase quality of care in PHCs.
Using communication to drive change
To increase community utilisation of primary health centre services, community education is key. Community members need to understand what healthcare means and how it affects them, as well as opportunities to access healthcare in their respective communities.
In 2019, EpiAFRIC supported Niger State Contributory Health Insurance Scheme to develop its communications strategy, to educate Niger State residents on the benefits of health insurance and solicit their enrolment into the scheme. The communication strategy document detailed targeted key messaging to different segments of community groups including farmers, market women, and road transport workers, among others.
The introduction of community health insurance is important and has the potential to solving a wide range of problems with regards to access to healthcare. Some of these problems include high cost of healthcare services and poor quality of healthcare delivery. The benefit of a community health insurance program will be unknown if the concept is not communicated to communities in a manner that they understand. Therefore, a communications strategy for health insurance could help convey clear and easy to understand messaging to community members about benefits of health insurance, package of health services, premiums to pay and ways top demand better health services.
Traditional and religious leaders as advocates
Traditional and religious leaders are considered highly influential people in their communities and are usually revered. Their roles and responsibilities in their communities should transcend beyond traditional and religious affairs. They can act as change agents in communicating key messaging about the health of their community members. The “Why are women are dying while giving birth in Nigeria?’’ report produced by a consortium of Nigeria Health Watch, EpiAFRIC and Africare showed that 25% of women go to faith institutions to give birth in some communities visited in Lagos State. The report documented 133 maternal deaths between May 2019 to May 2020, out of which 18 deaths occurred in faith-based institutions.
Faith-based institutions are not healthcare centres and therefore, do not have the capacity to manage healthcare situations. Traditional and religious leaders can help to discourage such practices in their communities by educating and redirecting sick people to healthcare facilities.
Leveraging community health workers
The impact of community health workers in supporting effective primary healthcare at the community level cannot be underestimated. The Community Health Influencers Promoters and Services (CHIPS) Programme introduced by the National Primary Healthcare Development Agency (NPHCDA) was instituted to deploy community-based health workers across political wards in Nigeria, with an emphasis on hard-to-reach areas. These health workers move from house-to-house to provide first aid care and health education to community members. Both state and local governments must ensure that there is budgetary allocation to pay these community health workers. The CHIPS programme is a laudable initiative that will strengthen the Nigerian health system. It bears similarities to the community health worker program driving the Rwandan health system.
For PHC and UHC to genuinely work for Nigerians, governments at all levels must make an urgent shift from health systems designed around diseases and institutions towards prevention designed with people at the centre of care. It begins with a strong focus on everyone everywhere getting the right health information, so they can make informed health decisions.