Improving primary health care centres in Nigeria

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The Minister of State for Health, Dr Mohammed Pate, recently announced that the running of Primary Health Centres in Nigeria will soon become the responsibility of the State Governments.

The minister, who made the announcement during a one-day sensitisation meeting organised for commissioners of health and directors of Primary Health Centre (PHC) on Subsidy Re-investment and Empowerment Programme (SURE-P) and maternal and child held in Abuja, said that Primary Health Centres, which have been under the care of local government authorities have not been doing well, hence, the need to leave them under the care of state government.

To say that the primary health centres are not doing well is to say the obvious.  In some states, they (PHC) only exist in name because nobody visits the centres for treatment.

Granted that the local government administration is the closest to the people and having the PHC managed by the local government should transform them to properly monitored, coordinated and efficient service delivery centres.The fact that the local government is the weakest tier of government with limited resources makes it incapable of managing the PHC.

The attendant result of this is that, arguably the most important level of care, the first point of call for majority of Nigerians that are ill or/and in need of medical intervention cannot provide the expected succour.

Consequently, most Nigerians ignore the primary health care facilities. While some people,especially at the grassroots, resort to consulting quacks, majority of Nigerians go directly to the secondary or tertiary institutions for their health challenges, hencemaking nonsense of the referral system.  The effect of this is that the secondary and tertiary institutions are burdened by conditions that can and should be treated by the PHCs.

It must also be said that a major reason we have the unacceptably high incidence of infant and maternal morbidity and mortality is because of the poor state of the PHC.  Most cases of infant/maternal health challenges get to these centres first and because of the inability of the PHC to provide immediate quality remedy and/or interventions, more complications sets in.

To improve the quality of care at the PHC, the federal government has established the National Primary Health Care Developing Agency (NPHCDA).  The agency, however, has not succeeded much because it is not constitutionally empowered to implement programmes or policies at the state and local government levels.  The NPHCDA requires the cooperation of state and local governments to achieve its mandate.  Thus, it is our view that resolving some constitutional logjam is necessary to unleash the NPHCDA to perform and improve service delivery at the PHC.

We also agree that the local governments in Nigeria right now lack the capacity to ensure that PHCs deliver quality health care services to Nigerians and in full support of the state government taking over.  However, the involvement of the state government must be to ensure that the PHCs have the necessary financial, technical and political capacity to effectively provide basic quality health care delivery expected from the level.  Also, while managing the PHC, the state government must equally find a way to involve the local government, which is a very important stakeholder that the community can easily relate with. This is because with community involvement, the PHC stands a better chance of meeting the needs of the people at the grassroots.

However, beyond just transferring the management of the PHC to the state government, all tiers of government must recognise the importance of these centres and accordingly ensure they have the capacity to provide quality health care services to Nigerians.