Primary Health Care: What, Why and Whither?

The United Nations organizations which included the World Health Organization and UNICEF in 1978, held a joint conference at Alma Ata at which health was described as a fundamental and basic human right to which all people were entitled. In other words, “Primary health care for all”.

Primary health care (PHC) is one of the three-tier system of health care in Nigeria which comprises of the tertiary health care, which the federal government pilot its affairs; the secondary health care, under the control of the state government and the primary health care, under the auspices of the local governments.

According to the World Health Organization ,“Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost which the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.

It is the first level contact for the community people in the National Health System, thus bringing health care as close as possible to where people live and work. This is essentially aimed to promote health, prevent diseases, cure diseases, and to provide both rehabilitative and palliative health services.

What types of services are included in primary health care?

The types of services delivered under primary health care are numerous and these include general practice services, health education concerning prevailing health problems and the methods of prevention and control, promotion of food supply and proper nutrition, material and child care, including family planning, immunization against the major infectious diseases, health screening, early intervention, treatment and management.

Services may be routinely targeted to specific population groups such as older people e.g. screening for hypertension and diabetes , mothers and children for immunization and chemoprophylaxis , young people for Health awareness, promotion and sensitization etc.

Primary health care services may also target specific conditions and health care needs, like sexual health, drug and alcohol treatment, oral health, cardiovascular disease, asthma, diabetes, mental health, and obesity.

Why the interest in primary health care?

Primary health care is strategically positioned to proffer lasting and effective solutions to myriad of economic, technological, and demographic changes, all of which impact health and well-being of the general populace.

Various studies have evidently shown that approximately many of the gains in reducing child morbidity and mortality are health sector unrelated factors (such as, water and sanitation, education, economic growth).

In primary health care, there is always pragmatic approach which takes into cognizance community participation, intersectoral collaboration and draws in a wide range of relevant stakeholders to study, analyze, criticize and change policies to address the economic, environmental, commercial and social health determinants and well-being.

Prevention is always cheaper and much better than cure: The primary care lays much premium on the preventive rather than curative approach and as such early detection and management of health conditions which may include checking blood pressure, blood tests, mammograms, breast examinations, Pap smears for cervical cancer screening. Primary health care implemented in a timely, efficient and effective fashion can largely curtail the need for specialist care, which may be unnecessary and have the potential to harm patients. When primary health care providers are able to institute preventative measures or make prompt and early interventions, referral to a specialist for disease-specific care can often be avoided, thus reducing the risks associated with treatment.

Primary health care has also been shown to be a good value investment, as there is evidence that quality primary health care reduces total healthcare costs and improves efficiency by reducing hospital admissions. Addressing increasingly complex health needs calls for a multi-sectoral approach that integrates health-promoting and preventive policies, solutions that are responsive to communities, and health services that are people-centred.

Primary health care also includes the key elements needed to improve health security and prevent health threats such as epidemics and antimicrobial resistance, through such measures as community engagement and education, rational prescribing, and a core set of essential public health functions, including surveillance. Strengthening systems at the community and peripheral health facility level contributes to building resilience, which is critical for withstanding shocks to the health system.

Primary health care is essential to achieving the health-related Sustainable Development Goals (SDGs) and Universal health coverage (UCH) which emphasizes distributional equity and efficiency in healthcare service delivery, through provision of financial supports to healthcare facilities at all levels. Primary health care will also contribute to the attainment and realization of other goals beyond the health goal (SDG3), including those on hunger, education, poverty, clean water and sanitation, gender equality, reducing inequality and climate action, work and economic growth.

Invariably, primary health care, been the closest of the three level of health care to the community people, affords every primary health care provider the unique opportunity to positively touch more lives and impact greater societal values through Government and development partners funded Programs like free distribution of Long lasting insecticidal treated nets, free distribution of drugs like Mectizan and Albedazole for neglected tropical diseases etc. Despite the huge financial investment that has gone into Vaccination against COVID-19, everyone eligible has an unrestricted access to take it free.

ISSUES AND SOLUTIONS

  1. POOR AND INADEQUATE HEALTH FINANCING
    The World Health Organization has rightly instructed that, a country should spend at least 5% of GNP on health. While most of the developed countries spend at least 10% of GNP on health, the developing countries use from 1.5 to 4% of their GNP on health. The inadequate and poor financing and too much dependence on donors and development partners have a Negative effect on the system of health care in Nigeria. Since primary care is a major tool for advancing and achieving universal health coverage, Investment in health is essential in order to meet the health-related SDGs. Possible solutions: a. Using non-biased and data driven approach to establish in which areas (and in what manner) suitable modifications to staffing should be made to increase efficiency and decrease expenses. b. Reviewing supply chain management costs and expenditures unrelated to labor to determine further opportunities for reductions and necessary adjustments c. Ensuring better operationalization in a such a manner to reduce cost as much as possible d. Outsourcing where necessary and robust partnership with donors and development partners for investment opportunities. e. Social insurance
  2. HUMAN RESOURCE FOR HEALTH
    Qualified, motivated and dedicated human resource (HR) is major ingredient for a qualitative and robust health care delivery. Challenges within the health workforce have been noted one the biggest constraints towards global health system development and efficiency, particularly in Africa. According to the World Health Organisation (WHO), “a strengthened health policy environment is critical to the delivery of quality health care to the population as it creates an enabling environment for the health workforce; and that health services, particularly at the primary health care level, are critical to Maternal, Newborn and Child Health (MNCH), and can be only as effective as the persons responsible for delivering them”.
    Achieving UHC would be feasible if there were adequate human resources to render health services with the right numbers of people (Health workers) with the right skills are in the right place at the right time with the right attitude to provide the right service at the right cost.
    Possible solutions:
    a. Ensuring all staffs are both intrinsically and extrinsically motivated
    b. Capacity building by training and retraining of staffs
    c. Better remuneration.
    d. Providing servant and exemplary leadership.
  3. CORRUPTION IN HEALTHCARE Corruption has become a hydra-headed monster and a quagmire in Nigeria. This is reported by Transparency international to have impeded Nigeria socio-economic growth and development. Unfortunately, healthcare is the third most corrupted branch of the country. A study clearly shows that the following are major loopholes for corruption a. absenteeism, b. Corruption arising from procurement e.g. drugs and medical equipment c. payments under-the-counter corruption d. Corruption from health financing e.g. running cost, maintenance and fueling and e. employment-related corruption e.g. favoritism (preference for incompetence over competence). Possible solutions: a. Deploying Financial tracking tools and technology. b. Ensuring all activities and engagement around the clinic premises are put under strict surveillance with CCTVs. c. Instilling the culture of honesty, trust and transparency among staffs. d. Excellent financial management skills and expertise for profit maximization.

Marius .O. Adeniyi, MD, MSc, is a Physician & Public Health Manager. You can contact him through mariusvictory@gmail.com+2348137601417, +2348074294379

Dr. Marius O. Adeniyi

Dr. Marius O. Adeniyi

Dr. Marius O. Adeniyi, MD, MSc, is a seasoned Physician & Public Health Manager, with a special interest in maternal and child health policy. Dr. Adeniyi is also a leadership expert who has written several articles on various aspects of leadership.