Abstract
Quality healthcare is a fundamental right of all citizens of any nation. In Nigeria, there are disparities in terms of quality of healthcare provided to different groups in the rural and urban areas. It is this desire to ensure access to potential patients and the existence of a quality healthcare system in Nigeria that necessitates primary healthcare policy. The purpose of this chapter, therefore, is to investigate how primary healthcare policies affect health system performance and health outcomes in Nigeria. The chapter adopted qualitative research approach. Secondary data were collected from secondary sources, such as textbooks, journal articles, newspapers, WHO reports, government records, and internet. Content and secondary data analysis methods were adopted to analyze, interpret, and answer the research questions. Findings show that health outcomes remain poor because of weak health system as infant and maternal mortality are still high and universal access coverage still low. The chapter concludes that a strong health system would improve health outcomes.
TopBackground
When Nigeria gained its independence in 1960, healthcare was not among the first thing government officials thought about. They focused more on the medicine that cured rather than prevented illnesses. However, in 1975, National Basic Health Services Scheme (NBHSS) was created, where primary healthcare served as the basis for the whole area. It was meant to provide medical training and healthcare facilities, although it neglected the use of new technology and community cooperation.
Following Alma Ata declaration of 1978, the Federal Government of Nigeria launched the Primary Health Care plan (PHC) in the National Health Policy of 1988 as the cornerstone of the Nigerian health system as part of efforts to improve equity in access and utilization of basic health services (Chiejina, 2014). Its objectives included among others improvement in the collection and monitoring of health data and ensuring availability of essential drugs in all areas of the country.
Another effort of evolving and sustaining community-oriented health system, which was led by late Professor Olukoye Ransome-Kuti occurred between the year 1986 and 1992. It witnessed the development of model primary health care in fifty-two (52) Local Government Areas (Abimbola, 2012). The third attempt to make PHC accessible to the grassroots was heralded by the establishment of the National Primary Healthcare Development Agency (NPHCDA) in the year 1992 (Abimbola, 2012). NPHCDA is a federal government agency with policy and over-sight roles on Primary Health Care (PHC) implementation at the state and local government levels in Nigeria. The major drawback is that a federal agency has no binding constitutional role to implement programs or policies at the state and local government levels. The government must be willing to cooperate or nothing happens and cooperation often has to come with financial commitment, which for every government are highly contested grounds (Abimbola, 2012). Another initiative of NPHCDA was the creation of Ward or Village Development Committees (WDCs and VDCs). They were designed to strengthen local communities in the hope that they can advocate for themselves. The committees were made up of influential community members who helped to enhance community participation and ownership and promote demand for quality services (Abimbola, 2012).
Key Terms in this Chapter
Health Policy: Describes the goals, structure, strategies, and policy direction of the healthcare delivery system.
Health Outcomes: Health outcomes in this chapter is measured by using these micro-indicators: objective outcomes measured by evaluating goals; subjective outcomes measured by evaluating how healthcare arrangements were understood by beneficiaries and community participation; patients’ utilization of healthcare services measured by evaluating how socio-economic groups utilized healthcare services.
Primary Healthcare: Primary healthcare is a grassroots approach towards universal and equitable healthcare for all.
Health Systems: In this chapter, health systems refer to primary health systems. There are three types of primary healthcare centers are recognized within the primary healthcare system. They include the comprehensive health centers (CHC), the primary health centers, and the basic health clinic (BHC). The primary healthcare centers were placed under local government administration for the delivery of basic health services.