Linking Primary Healthcare Policies With Health System for Improved Health Outcomes in Nigeria: Issues, Controversies, Problems, and Solutions

Background

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).