Revitalising PHCs across the country using NSHIP, By Kazeem Akintunde

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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 Nasarawa State Governor, 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 Nasarawa State capital from Abuja took Professor Isaac Adewole, Nigeria’s Health Minister, the whole day. But even at that, he was happy he went on the tour.
The One- day facility inspection of three PHC facilities to test run the NSHIP in Nasarawa state and it 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 staffed 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 Health Care 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 health care needs of Nigerians could be provided for at the PHCs level, over 80 percents of Nigerians would have been covered and adequate health care guaranteed for millions of Nigerians.

This way, there won’t be much pressure on Secondary and Tertiary level of health care 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 health care 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 governors, 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 in rendering assistance to the country in the provision of health care facilities for the people.

His plan is to revitalise three health care facilities in three different pilot states of Adamawa, Nasarawa and Ondo States in order to determine which model of funding to recommend to state governors and should be implemented by the people who are expected to own and manage the 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 across the country and would probably adopt the Decentralised Facility financed model.

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

“Investing in Primary Health Care 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 will support the State’s School of Nursing in its bid to provide middle level man power 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 in the deployment of medical doctors on the employ of the federal government to assist the state government in its health care 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 utilization of basic health services. Since then, primary health care has evolved through various stages of development.

In 2005, primary health care facilities were found to make up over 85% of health care 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 – 79) and was structured along ‘basic health units’ which consisted of 20 health clinics spread across each LGA, which were backed-up by four primary health care 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. This led to the inability to sustain the Scheme 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 characterized by the development of model primary health care in 52 pilot local government areas all of which were implementing all eight components of primary health care.

A key result of this dispensation was the attainment of 80 percent immunisation coverage for under-five children.
Since then, there hasn’t 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 health care 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 once the basic health care needs of the people can be taken care of at the PHC level, 80 percent of health care 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 health care needs of most Nigerians would have been covered”.

He has been preaching the gospel of revitalised PHCs to state governors, assuring the chief executives at the state level that once there is 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.

“I have been preaching to Governors that they don’t need to give money to voters during campaigns or Election Day. Once you provide basic health care 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 health care sector in the country around for the better.

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

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