Efforts to improve primary health care facilities in Nigeria

In a developing country with high rates of both communicable and non-communicable diseases, the provision of primary health care (PH) is imperative. PH focuses on the treatment and prevention of the most common diseases – such as malaria and tuberculosis – as well as maternal and child care, health education and the provision of essential drugs. PH clinics do not require particularly expensive equipment, but the treatments and information they provide can significantly reduce costs to the overall health system.

Access

The provision of PH is the responsibility of the 774 local government areas (LGAs), with support from state ministries of health. However, LGAs have limited funding, and it is estimated that only 20% of Nigerians have access to a fully developed PH facility. An investigation by local NGO, the Public and Private Development Centre, showed that in November 2016 only about 20% of the 30,000 PH centres in Nigeria were functional, while those in operation faced major challenges regarding staffing, supplies and infrastructure.

Outside Help

The signing of the National Health Act of 2014 created the Basic Health Care Provision Fund (BHCPF), which draws at least 1% of its capital from the Consolidated Revenue Fund International, the body that amalgamates the state’s major revenue-generating companies and agencies. The BHCPF earmarks half of its funds for the expansion of health insurance to the lowest-income groups, and the remainder is split between the procurement of drugs, the provision and maintenance of equipment, and the training of primary health care workers. As part of the Saving One Million Lives initiative, a programme aimed at preventing one million deaths between 2012 and 2015, the government spent $500m on improving reproductive health, child health and nutrition. The initiative improved many health indicators, such as the increase in the number of births attended by skilled health staff.

In addition, international organisations and corporate actors play a major role in the provision of PH in Nigeria. In August 2017 General Electric (GE) announced the launch of its second Healthymagination Mother and Child Programme. The first, in which GE partnered with US Agency for International Development as well as Nigeria’s Ministry of Health and eight other African countries, involved a five-year $20m investment in policies and technologies to prevent maternal and child deaths. This included the provision of portable ultrasound devices to regional PH centres, as well as other forms of equipment and assistance to improve maternal and child health. The Bill and Melinda Gates Foundation is another prominent donor, working in family health, nutrition and vaccination programmes.

Response

The state intends to boost access to and the quality of PH in Nigeria. In January 2017 the Ministry of Health, along with the National Primary Health Care Development Agency – the government body charged with providing technical and programmatic support to states and LGAs for the planning and implementation of PH services – announced a programme to build and/ or renovate 10,000 PH centres. President Muhammadu Buhari launched the National Primary Health Care Revitalisation Initiative (NPHRI) in Kuchigoro, where a model PH centre was officially unveiled. The first phase of the programme will involve refitting 109 PH centres, one per senatorial zone. The successful implementation of the scheme would provide services to the country’s lowest-income citizens and reduce strain on hospital infrastructure, as preventative care through quality PH is nearly always less expensive than treatment. “The PH centres will be able to take care of 80% of cases requiring medical attention, with patients required to register at their nearest PH centre,” Isaac Adewole, the minister of health, told OBG.

The decision to place the development of PH at the heart of Nigeria’s health care reform programme is a welcome one. If this ambitious scheme is successful, it will save many lives, and could also significantly reduce secondary and tertiary public sector health care costs.